Diabetic retinopathy - stages, prevention, treatment
High blood sugar levels caused by diabetes can damage the retina, a sensitive area at the back of your eye. This is called diabetic retinopathy, and is a common issue for people with diabetes.
The retina detects light, and converts it into electrical signals which are sent to your brain. Your brain processes these electrical signals as images, giving you sight. The retina plays a key role in sight, so severe damage can lead to blindness, if not treated.
Over 3.2 million people in the UK have diabetes, and everyone with diabetes is at risk of retinopathy. Annual eye screenings are important to diagnose retinopathy as quickly as possible, as the easy stages may not be noticeable in your day to day life.
Four stages of diabetic retinopathy
1. Background retinopathy
In the earliest stages, blood vessels become weak and may leak tiny amounts of blood. At this stage, it is unlikely to affect your vision. Regular eye tests and screens are essential to diagnose this stage, and treat it before it progresses.
2. Pre-proliferative retinopathy
During this stage, the bleeding from the blood vessels becomes more severe, and the amount of oxygen in the eye may be reduced. This has the potential to affect your vision, but may not always be noticed.
3. Proliferative retinopathy
As the amount of oxygen in the eye reduces, new blood vessels form on the retina while older ones scar. The scar tissue and new blood vessels cause more severe vision loss. Permanent vision damage is probable from this stage.
4. Advanced diabetic retinopathy
In the most severe case, it may bleed into the eye. As the scars shrink, they may pull the retina away from the eye, causing retinal detachment and blindness.
Diabetic retinopathy symptoms
In the early stages, retinopathy can easily go unnoticed, making regular eye screenings essential. During the later stages, vision loss becomes more severe and the risks of permanent vision loss increase. In the most severe circumstances, it can lead to blindness. During any of the four stages, a condition called diabetic maculopathy may develop. The macula is responsible for central vision, and the leaking blood vessels may damage it and affect your vision.
How to minimise the risk of diabetic retinopathy
Diabetic eye screenings are essential, and everyone with diabetes over the age of 12 should attend one annually. This is essential for diagnosing retinopathy as early as possible in order to treat it.
You can minimise the risk through a healthy lifestyle. Controlling your blood pressure, blood sugar levels and cholesterol can reduce the likelihood of developing retinopathy. The Diabetes Control and Complications Trial (DCCT) reported that intensively controlling your blood sugar level can reduce the risk of retinopathy by 78%.
To minimise the risk, consider taking the following steps:
- Maintain a healthy, balanced diet
- Regularly exercise
- Stop smoking
- Checking and controlling your cholesterol and blood pressure levels regularly
- Notify your GP or Optician as soon as you notice changes in your vision
- Attend your annual diabetic eye screening
In the early stages (background and pre-proliferative), treatment may not be required. However, taking steps to prevent it from developing is strongly recommended.
As it progresses, it may be treated in one of three ways:
- Laser surgery may be used to treat proliferative retinopathy. The purpose of this is to prevent new blood cells growing on the retina, preventing further vision loss.
- Intravitreal injections into the eye may be used if you also have diabetic maculopathy
- Vitreoretinal surgery may be required if it has become too advanced for laser surgery to be used