Review of Diabetic Retinopathy
Hi! I’m Randy Wong. I’m a retina specialist located in Fairfax, Virginia. Today we are going to talk about Diabetic Retinopathy. We are going to talk about:
- Who gets the disease?
- What the Disease can do
- How it’s diagnosed?
- Treatment Plans
I think it’s fair to say that almost every patient with diabetes will get some degree of diabetic retinopathy within their lifetime. So, the biggest risk factor is time; the number of years you’ve had diabetes.
A lot of people mistakenly believe that they won’t get the eye disease if their sugar is controlled and you ask any doctor and we’ve all seen patients with great sugar control who still have the eye disease. So, by and large, every patient with diabetes will get some degree of diabetic retinopathy. (1:01)
Symptoms of Diabetic Retinopthy
Symptoms of diabetic retinopathy include anything from:
- no symptoms
- 20/20 vision
- slight blurring
- profound vision loss including blindness, but that’s a rare case
It’s really important to stress that with timely regular eye exams, especially when your vision’s good, the chance of severe vision loss is well below 1%.
Diagnosis of Diabetic Retinopathy
The best way to diagnose diabetic retinopathy is to get your eyes dilated once a year. This will allow your eye doctor to directly examine your retina and there are characteristics findings that we look for which signify the develop of the disease.
Now sometimes we need additional testing like an OCT which will show leakage or a fluorescein angiogram which will show some other characteristic changes common in diabetic retinopathy.
When we examine patients with diabetic retinopathy, there are really only two things that we are looking for; we are looking for swelling, and swelling of the macula, which is the functional center of the retina.
Diabetic Macular Edema
Swelling in the macula, called diabetic macular edema, is the principle reason patients get a lot of blurring of vision.
A few patients get what we call proliferative retinopathy or proliferative diabetic retinopathy and that is signified by the presence of abnormal blood vessels growing on the retina or somewhere else in the eye. (2:24)
Patients who have diabetic macular edema are the largest group of patients I treat with diabetic retinopathy. It’s my goal to either get rid of the swelling, or the edema, so that the vision can improve, or, to prevent the macula from getting swollen if I’ve seen you in a timely fashion.
Treatment of Diabetic Macular Edema
There are lots of ways that we can treat macular edema. The gold standard used to be laser treatment. We essentially laser the areas in the retina which are leaking, and, the goal, again, is to keep the macula as normal looking as possible.
These days, there are also intravitreal injections. There are two things, there are two classes of drugs that we can inject. We can inject agents called “anti-VEGF,” that’s V-E-G-F, and that stands for vascular endothelial growth factor. (3:12)
These chemicals stop the retinal blood vessels from leaking and any existing fluid can be absorbed. There is a second class of drugs, such as steroids, which we can also inject and this also gets the same result although by a different mechanism.
So, the 3 treatments are laser, intravitreal injections of anti-VEGF or steroids.
The other finding that I’m looking for when I’m examining patients with diabetes is evidence of neovascularization. Neovascularization is defined as abnormal blood vessels that are growing somewhere on the retina or somewhere else in the eye. (3:52)
These abnormal blood vessels can cause two major problems, either a very painful type of glaucoma, or, a retinal detachment. This is how patients with diabetes go blind.
Again, remember, this is highly unlikely to happen if you get timely visits with your eye doctor.
Treatment of Proliferative Diabetic Retinopathy
Once I observe or once I diagnose proliferative diabetic retinopathy, what can I do? Well, the gold standard still is doing a certain type of laser called pan-retinal photocoagulation, Basically, I need to laser a portion of your retina.
Other treatments, which are not permanent fixes also include anti-VEGF medications which are the same that I mentioned a minute ago when treating macular edema.
anti-VEGF medications are known to cause the abnormal blood vessels to shrink up and go away, but no one really knows how long the blood vessels will be prevented from growing back. (4:48)
The best method, again, is laser Pan-Retinal Photocoagulation.
Summary of Diabetic Retinopathy
So, we’ve defined diabetic retinopathy as the eye disease caused by diabetes. It affects the retina. Almost every patient with diabetes is at risk for developing diabetic retinopathy, but it doesn’t mean you have to lose vision.
There are treatments available to prevent loss of vision or to improve your vision and to prevent blindness. These treatments include laser, anti-VEGF medications or steroids. (5:20)
It’s important to remember that every patient with diabetes needs to get examined at least once a year. You don’t have to have symptoms before you get diagnosed.
I hope you liked this video. Thank you very much for watching. Please leave a comment or ask a question at the end of this video or in the article in which this is embedded.
I’m Randy Wong. I’m a retina specialist in Fairfax, Virginia.
Thank you very much for watching.
2 replies on “What is Diabetic Retinopathy?”
Hi Dr Wong,
I really enjoy your articles and videos. I’m from the U.K and have been diabetic for 20 years. I’m 62 years old. I have my diabetic retina eye exam ever year 3 years ago they found minor changes in my right eye, then the following year everything was normal,last year they noticed minor changes in my left eye. They say no treatment is needed and don’t need to see me for another year, I do get blurry vision when my sugar levels rise. My optician said my general vision is excellent and I only need glasses for reading. Last year someone said everyone with diabetes eventually goes blind and their words have stuck with me and I often get tearful and panicky thinking about it. I wonder if you have any words of comfort that may help with this fear. Thankyou so much.
It is wonderful to hear that you’re keeping up with your eye examinations and following the guidance of your doctor.
The concept that everyone with diabetes eventually goes blind is COMPLETELY false. As long as you continue to manage your sugar levels and stay connected to your eye care team, you are positioned to enjoy a life of glorious vision.
Mike Rosco, MD