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Diabetic retinopathy
Definition:
Progressive damage to the eye's retina caused by long-term diabetes. It can result in loss of vision.
Causes, incidence, and risk factors:

Diabetic retinopathy is the leading cause of blindness in working age Americans. People with both non-insulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus are at risk for developing diabetic retinopathy. The incidence and severity of the retinopathy increases with the duration of diabetes and is likely to be worse if control of the diabetes is poor. Almost all people who have had diabetes for more than 30 years will show signs of diabetic retinopathy. The disease is caused by damage to blood vessels of the retina. In the earlier and less severe type (non-proliferative diabetic retinopathy) the existing blood vessels become porous and leak fluid into the retina, causing blurred vision. In the more advanced and severe type (proliferative retinopathy) new growth of blood vessels occurs within the eye. These new vessels are fragile and can hemorrhage causing loss of vision.
Symptoms:
  • Decreased visual acuity
  • Floating spots in the vision (floaters)
  • Many people have no preliminary symptoms before a major hemorrhage in the eye
Signs and tests:


Treatment:

Control of diabetes and associated high blood pressure is the aim of treatment. Such treatment usually does not reverse existing damage but will slow the progression of the disease. Laser surgery may be indicated to seal leaking vessels or eradicate abnormal fragile vessels. Surgical treatment (vitrectomy) is used in cases of hemorrhage into the eye.  It may also be used to repair retinal detachment caused by hemorrhage and subsequent scarring.

A dilated examination of the retina by an ophthalmologist once per year is indicated for people with diabetes.
Expectations (prognosis):

The outcome may be improved by good control of diabetes and high blood pressure. Some degree of diabetic retinopathy usually becomes evident after 10 years and is nearly universal in people who have diabetes mellitus for more than 30 years. Diabetic retinopathy can lead to blindness without treatment. Treatment can prevent blindness in most cases.
Complications:


Calling your health care provider:
Call for an appointment with your health care provider if you have diabetes mellitus and you have not seen an ophthalmologist in the past year.
Prevention:
Adequate control of diabetes and control of high blood pressure, if present, will slow the progression of retinopathy.
Review Date: 4/12/2001
Reviewed By: Edward B. Feinberg, M.D., M.P.H., Department of Ophthalmology, Boston University School of Medicine, Boston, MA. Review provided by VeriMed Healthcare Network.

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