Diabetic Retinopathy: Symptoms, Risks & Prevention

According to a systematic review (2022), diabetic retinopathy is a common complication in newly diagnosed Type 2 diabetes mellitus patients, highlighting the need for early and routine screening. Implementing effective strategies for timely type 2 diabetes diagnosis, along with ophthalmic assessments, is crucial to reducing the risk of vision-threatening retinopathy.

Diabetic retinopathy, also called as diabetic eye disease, is a diabetes-related complication that affects the eyes caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). Retinopathy can start earlier in people with type 2 diabetes because the condition often goes undiagnosed for years. During this time, high blood sugar levels may already be damaging the small blood vessels in the retina. By the time diabetes is diagnosed, some individuals may have already developed complications like retinopathy due to prolonged, unmanaged hyperglycemia or high blood sugar. Let’s dive deep to know the risks, symptoms and prevention. Before that let us learn about the stages of diabetic retinopathy.

The Two Stages of Diabetic Retinopathy

1. Early Stage (Non-proliferative Diabetic Retinopathy or NPDR): This is the early stage, where tiny blood vessels in the retina leak, causing swelling. If the swelling reaches the macula (the centre of vision), it leads to blurry vision, called macular edema or oedema. Sometimes, blood flow to the macula is reduced, further harming vision.

2. Advanced Stage (Proliferative Diabetic Retinopathy or PDR): In this advanced stage, new, abnormal blood vessels grow in the retina, these can bleed into the eye. Proliferative diabetic retinopathy symptoms include floaters or vision loss. Scar tissue can also form, leading to more serious vision problems or retinal detachment.

What are the Risk Factors for Diabetic Retinopathy?

• Duration of diabetes - The longer you have diabetes, especially if it's not well-controlled, the higher the risk of developing diabetic retinopathy.
• Poor blood sugar control - Consistently high blood sugar levels increase the risk of damage to the retina’s blood vessels.
• Obesity - Being overweight can affect blood sugar levels and increase the risk of retinopathy.
• High blood pressure (hypertension) - Uncontrolled hypertension can exacerbate damage to retinal blood vessels. Intensive blood pressure control reduces the risk by 20%.
• High cholesterol - Elevated cholesterol levels can contribute to vascular damage in the retina.
• Smoking: Smoking contributes to blood vessel damage and increases the risk of retinopathy.
• Kidney disease - Kidney problems can indicate that blood vessels throughout the body, including in the eyes, are damaged.
• Pregnancy - Hormonal changes during pregnancy can worsen diabetic retinopathy in women with pre-existing diabetes.
• Other factors : People with type 2 diabetes on insulin have a high risk of macular oedema and diabetic retinopathy. Vitamin D deficiency increases the risk by three times.

What are Symptoms of Diabetic Retinopathy?

Retinopathy often has no early warning signs, regular eye check-ups are crucial for early detection. As the condition progresses, retinopathy symptoms may include

• Blurry vision - Gradual or sudden blurriness can indicate changes in the retina.
• Dark spots or floaters - You may notice small, floating dark shapes in your vision.
• Impaired colour vision - Colours may appear faded or less vibrant.
• Fluctuating vision - Vision may improve or worsen intermittently.
• Vision loss - In advanced stages, diabetic retinopathy can lead to partial or total vision loss.
• Dark or empty areas in vision - Peripheral or central vision may be affected.

Is Diabetes Eye Disease or Diabetic Retinopathy preventable?

While diabetic retinopathy can often be prevented or its progression delayed, people with diabetes—especially those with long-standing diabetes—remain at some risk. Strict control of blood sugar, regular health check-ups, and prompt treatment of any eye issues can significantly reduce the likelihood of vision loss from retinopathy.

Diabetic retinopathy is not entirely preventable in all cases but its risks can be greatly minimized through careful management of diabetes and associated health conditions.

10 Key Steps to Prevent & Reduce Risk of Diabetic Retinopathy or Diabetes Eye Disease

Prevention is largely centred on managing diabetes effectively and addressing associated risk factors

1. Manage blood sugar levels - Keeping blood glucose in target range reduces the risk of retinopathy.

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5. Control blood pressure and cholesterol - Maintain normal blood pressure and cholesterol levels through medication, diet, and exercise. To understand this better, read Diabetes and Heart Disease - A Critical Connection and Diabetes and hypertension: What you must know.

6. Get Regular eye exams: People with diabetes should have a comprehensive eye exam at least once a year to catch early signs of retinopathy.

7. Exercise regularly: Physical activity can help manage blood sugar levels and improve overall vascular health. Research shows that moderate physical activity reduces the risk of diabetic retinopathy by 31%.

8. Manage diabetes medications: Take prescribed medications, including insulin and other drugs, as directed by your doctor.

9. Quit smoking: Smoking can accelerate the progression of retinopathy.

10. Monitor for early signs: Be vigilant for any changes in vision, and report them to your doctor immediately.

The longer these factors are uncontrolled, the harder it is to stop or reverse diabetic retinopathy, regular check-up is a must for long-term well-being.