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Diabetic Retinopathy: How to Reduce the Risk


Diabetic retinopathy (DR) – also known as diabetic eye disease – is the one complication people with diabetes fear the most. In 2010 there were about 7.7 million people in the US with diabetic retinopathy. In 2015 there were 415 million people globally with DR and the number of people is expected to increase to 642 million by 2040. In 2010 the rates for diabetic retinopathy were 51% female and 49% male.

Retinopathy is caused by chronic high blood sugar over a long period of time and genetics. In early stages, most people do not have any symptoms. Chronic high blood sugar causes changes in the person’s eye. This results in the formation of areas of swelling (like little air bubbles) in small blood vessels called microaneurysms, weakness and/or damage in the small vessel walls, and loss of cells that line the small blood vessels (extramural pericytes).

Stages of retinopathy

There are different stages of retinopathy.

Non-proliferative diabetic retinopathy (NPDR) is the first stage and occurs when microaneurysms develop in the retina’s tiny blood vessels. As the NPDR progresses, more blood vessels become affected and lead to a loss of blood flow to the retina. In response, the retina starts to secrete chemicals for new vessels to grow.

This secretion of chemicals is characteristic of the more advanced stage of retinopathy known as proliferative diabetic retinopathy (PDR). These new blood vessels are fragile, which makes them more likely to leak and bleed. This may cause scar tissue to contract and cause retinal detachment — the pulling away of the retina from underlying tissue, like wallpaper peeling away from a wall. Retinal detachment can lead to permanent vision loss.

About one in 15 people with diabetes who have retinopathy will develop diabetic macular edema (DME). DME is the buildup of fluid in the area at the back of the eye near the center of the retina called the macula. This fluid causes the macula to swell and become thicker, causing blurry vision. This can happen at any stage of retinopathy and doesn’t have symptoms until the DME is very progressed.

Prevention of complications

People can develop diabetic retinopathy and macular edema without symptoms, but both can rapidly damage the eye, progress, and lead to blindness. Therefore, having a comprehensive eye exam is very important. With early treatment, progression can be reduced, preventing blindness.

Although we know that genetics play a part in the development of diabetic eye diseases, we also know that chronically high blood glucose and how long a person has had diabetes also play an important role.

However, we also now know that managing your diabetes and keeping your blood sugars as close to normal as possible can prevent and/or delay the progression of complications, improve symptoms, and increase lifespan. Keeping your blood sugar between 70 to 180 mg/dL can reduce the risk of progression of retinopathy by 75% and macular edema by 58%.

Tips for prevention:

  • Keep your blood sugar in your target range as much as possible.
  • Live a healthy lifestyle – eating healthy (modifications in your daily protein and/or salt as recommended by your doctor); getting regular physical activity; getting enough sleep; managing stress; stopping smoking and drinking alcohol; etc.
  • Lose weight if you are overweight.
  • Manage your blood pressure and cholesterol.
  • Manage kidney disease.
  • If you do have diabetic eye disease, follow your health care provider’s recommendations on exercise modifications.
  • Get a regular dilated eye exam according to the schedule. The American Diabetes Association and the American Academy of Ophthalmology recommend a comprehensive dilated eye exam for:
    • T1D – within five years of diagnosis and then once per year thereafter.
    • T2D – at diagnosis and then yearly dilated eye examinations.
    • Pregnant patients – prior to conception, each trimester, and within three months after delivery.

Conclusion

Learning that you have a complication from diabetes or that it has progressed can be devastating. It can affect your quality of life as well as many other aspects including your feelings and thoughts (anger, worry, guilt, etc.), work life, family life, social interaction, and financial strain, among other things.

If you have diabetes complications, you may want to get some extra support to help you cope. Talk to your diabetes health care provider about how you are feeling and your worries so they can recommend tips for adjusting to your new normal as well as provide you a mental health provider that has experience in diabetes.

Key takeaways

In 2010 there were about 7.7 million people in the US with diabetic retinopathy, also known as diabetic eye disease.

There are different stages to the disease.

Chronically high blood glucose and how long a person has had diabetes also play an important role in the progression of diabetic retinopathy.

Having a comprehensive eye exam is very important, because with early treatment, progression can be reduced, preventing blindness.

Resources:

Prem Senthil, M., Khadka, J., Gilhotra, J.S., Simon, S., Peludos, K. (2017). Exploring the quality of life issues in people with retinal diseases: a qualitative study. J Patient Rep Outcomes.

Fenwick, E., Rees, G., Pesudovs, K., Dirani, M., Kawasaki, R., Wong, T.Y. and Lamoureux, E. (2012). Social and emotional impact of diabetic retinopathy: a review. Clinical and Experimental Ophthalmology.

National Eye Institute. Learn About Eye Health.

Leasher, J.L., et. al. (2016). Global Estimates on the Number of People Blind or Visually Impaired by Diabetic Retinopathy: A Meta-Analysis from 1990 to 2010. Diabetes Care.

Romero-Aroca, P. (2011). Managing diabetic macular edema: The leading cause of diabetes blindness. World J Diabetes.

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