Understanding Diabetic Retinopathy: Stages and Treatment Options

 It is essential for people with diabetes not only to keep their blood sugar levels safe but also to get regular eye exams by an ophthalmologist. Early detection makes it possible to treat the disease without any significant vision loss. Read this article for an overview of diabetic retinopathy and common treatment options.

Stages of Diabetic Retinopathy
Getting an eye exam is the only time a doctor can observe physical changes in your eye noninvasively. Diabetic retinopathy can worsen over time, leading to vision changes, like blurred or fluctuating sight, before the ultimate loss of vision. Catching the disease with regular screenings in an early stage allows for more effective treatment options.

Stage 1. Mild nonproliferative diabetic retinopathy (NPDR) – Balloon-like swelling begins in the retina’s tiny blood vessels, causing them to weaken. These microaneurysms rarely affect vision or require treatment, but they are a critical sign of diabetes damage. 

Stage 2. Moderate NPDR – As the disease progresses, high blood sugar levels can damage the walls of tiny blood vessels nourishing the retina. This further weakens and narrows the vessels, resulting in blood and fluid leaking into the retina tissue. This fluid can lead to vision loss. 

Stage 3. Severe NPDR – Without proper disease management, more blood vessels become damaged and blocked in the eye. With larger volumes of blood and fluid leaking into the retina, the impact on vision is more significant. Venous beading, or retinal veins that appear abnormally large and begin to look like a string of sausages, is a sign of severe NPDR. 

Stage 4. Proliferative diabetic retinopathy (PDR) – Extensive damage in the eye’s blood vessels and worsening circulation within the eye causes the retina to grow new blood vessels. Unfortunately, these “proliferative” and abnormally formed vessels are fragile. Their thin, delicate walls can leak blood, causing critical damage such as vision loss or blindness.

The abnormal blood vessels characterized by more advanced stages of this disease can lead to complications, which, in turn, cause serious vision issues:

·         Vitreous hemorrhage – The center of your eye is filled with the vitreous body, a jelly-like substance. When the blood vessels in your eye weaken, they can leak blood and fluid into this area. If the bleeding is minimal, you might only see some small dark spots, also known as floaters. In significant cases, blood can fill this cavity and completely block your vision. Fortunately, this isn’t permanent. The blood can clear from your eyes in weeks or months and restore your vision to its prior clarity as long as there is no damage to your retina.

·         Retinal detachment – Scar tissue growth is stimulated by the abnormal blood vessels. They can cause the retina to pull away from the back of the eye, leading to floaters, flashes of light or serious vision loss. 

·         Glaucoma – New blood vessels can also grow in the front part of your eye, known as the iris, and interfere with the normal flow of fluid, causing your intraocular pressure to build. This pressure can damage your optic nerve, the part of the eye that carries visual information to the brain. As a result, small blind spots can begin to develop, usually on the side or in your peripheral vision.

·         Blindness – If extremely damaged, this disease can lead to acute vision changes and eventually blindness.  

Treating Diabetic Retinopathy
Treatment depends on which stage of retinopathy you’re in and how advanced it is, according to insights from the Mayo Clinic. 

Early Diabetic Retinopathy

For those experiencing the early stages of this disease, meaning mild or moderate nonproliferative retinopathy, you might not require treatment immediately. However, it is essential you work with your ophthalmologist to track the status of the disease and any progression, as well as your primary care provider or endocrinologist to improve your diabetes management. In mild or moderate cases, good blood sugar control can slow its progression. From there, you will need to closely monitor your diabetes and eye health for the rest of your life. 

Advanced Diabetic Retinopathy
Proliferative blood vessels mark the more severe stage of this disease, leading to complications examined earlier, such as vitreous hemorrhaging, retinal detachment, glaucoma or even blindness. Depending on the issues you’re experiencing, your doctor might recommend different treatments, such as:

·         Injecting eye medications – Performed under topical anesthesia, your doctor might inject medications into the vitreous of your eye to help stop the growth of new blood vessels and decrease fluid buildup. These injections can cause mild discomfort and side effects, including eye pressure and infection.

·         Photocoagulation – This laser treatment seals or destroys abnormal blood vessels in the retina. There is a focal approach, which targets a very small area of the retina, and a scatter (pan-retinal) version, which slows the growth of vessels over a wider retina area. During treatment, there might be a slight stinging sensation or brief flashes of light.

·         Vitrectomy – This surgery entails a doctor making a small incision in your eye to remove blood from the vitreous, as well as scar tissue that may impact your retina. This procedure can be done under local or general anesthesia. 

In 2021, it was estimated that 9.6 million people in the United States were living with diabetic retinopathy, according to insights published by the Centers for Disease Control and Prevention (CDC). Of that number, 1.84 million had their vision threatened with more advanced stages of the disease. Avoid becoming part of that sobering statistic by properly managing your blood sugar to prevent or control your diabetes and getting regular eye exams. The Healthy Vision Association (HVA) members prioritize their eye health; explore our member benefits, including vision insurance, at healthyvisionassociation.com/benefits.  

Articles in this newsletter are supposed to be informative, enlightening and helpful to you. While all information contained herein is meant to be completely factual, it is always subject to change. Articles are not intended to provide medical advice, diagnosis or treatment. Consult your doctor before starting any new health routine. 

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