Diabetes mellitus (DM) is a major medical problem throughout the world. As a systemic disease it can cause a variety of long-term complications; all of which have considerable impact on both the patient and the society because it typically affects individuals in their most productive years. There are many ophthalmic complications of diabetes, but the most common and potentially blinding of these complications is diabetic retinopathy (DR).
High blood sugar levels from diabetes can damage small blood vessels of the retina, the light sensitive portion of the eye. This damage is called diabetic retinopathy. 1, 2 Diabetic retinopathy is a leading cause of blindness in the United States, often affecting working-aged adults. It is characterized by signs of retinal ischemia (microaneurysms, hemorrhages, cotton-wool spots, intraretinal microvascular abnormalities, venous caliber abnormalities, and neovascularization) and/or signs of increased retinal vascular permeability. Vision loss can result from several mechanisms, including neovascularization leading to vitreous hemorrhage and/or retinal detachment, macular edema, and retinal capillary non-perfusion. 3
In general, the longer someone has diabetes, the greater the risk of developing diabetic retinopathy. Almost everyone with juvenile-onset diabetes will eventually develop some signs of diabetic retinopathy. Those who obtain diabetes later in life are also at risk of diabetic retinopathy, but are less likely to develop advanced diabetic retinopathy.4
Diabetic retinopathy has four stages which are fitted under the category of early or advanced.
- Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.
- Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
- Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
- Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result. 5
It’s important to be aware of diabetic retinopathy because early diagnosis and treatment can prevent vision loss!!!