Diabetic retinopathy

Retinopathy - diabetic; Photocoagulation - retina
Last reviewed: June 28, 2011.

Diabetic retinopathy is damage to the eye's retina that occurs with long-term diabetes. See also:

Causes, incidence, and risk factors
Diabetic retinopathy is caused by damage to blood vessels of the retina. The retina is the layer of tissue at the back of the inner eye. It changes light and images that enter the eye into nerve signals that are sent to the brain. There are two types, or stages of diabetic retinopathy: • • Nonproliferative develops first Proliferative is the more advanced and severe form of the disease

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Type 1 diabetes Type 2 diabetes

Diabetic retinopathy is the leading cause of blindness in working-age Americans. People with type 1 diabetes and type 2 diabetes are at risk for this condition. Having more severe diabetes for a longer period of time increases the chance of getting retinopathy. Retinopathy is also more likely to occur earlier and be more severe if your diabetes has been poorly controlled. Almost everyone who has had diabetes for more than 30 years will show signs of diabetic retinopathy.

Symptoms
Most often, diabetic retinopathy has no symptoms until the damage to your eyes is severe. Symptoms of diabetic retinopathy include: • Blurred vision and slow vision loss over time Floaters Shadows or missing areas of vision Trouble seeing at night


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Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.

Signs and tests
The health care provider can diagnose diabetic retinopathy by dilating your pupils with eye drops and then carefully examining the retina. A retinal photography or fluorescein angiography test may also be used. If you have nonproliferative diabetic retinopathy, your health care provider may see:

Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. and corticosteroids injected into the eyeball are being investigated as new treatments for diabetic retinopathy. However. treatment is usually needed. Scatter laser treatment or panretinal photocoagulation treats a large area of your retina. your health care provider may see: • • New blood vessels starting to grow in the eye that are fragile and can bleed Small scars developing on the retina and in other parts of the eye (the vitreous) Treatment To prevent diabetic retinopathy: • • Keep tight control of your blood sugar (glucose). Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema. • • Focal laser photocoagulation is used to treat macular edema. blood pressure. it can help keep the disease from getting worse.• • • Blood vessels in the eye that are larger in certain spots (called microaneurysms) Blood vessels that are blocked Small amounts of bleeding (retinal hemorrhages) and fluid leaking into the retina If you have proliferative retinopathy. However. A surgical procedure called vitrectomy is used when there is bleeding (hemorrhage) into the eye. Often two or more sessions are needed. Several procedures or surgeries are the main treatment for diabetic retinopathy. Treatment usually does not reverse damage that has already occurred. fragile vessels. It is used to keep vessels from leaking or to get rid of abnormal. It may also be used to repair retinal detachment. they should be closely followed by an eye doctor who is trained to treat diabetic retinopathy. This process is called photocoagulation. If you cannot see well: • • • Make sure your home is safe so you do not fall Organize your home so that you can easily find what you need Get help to make sure you are taking your medicines correctly See also: • Cataract removal . Drugs that prevent abnormal blood vessels from growing. and cholesterol levels Stop smoking People with the earlier form (nonproliferative) of diabetic retinopathy may not need treatment.

You have pain in one of your eyes. You cannot see things on the side of your field of vision.www. You have double vision (you see two things when there is only one).org • Retinal detachment repair Expectations (prognosis) You can improve your outcome by keeping good control of your blood sugar and blood pressure. blood pressure.www. your vision becomes more blurry Retinal detachment -.nih.preventblindness.scarring may cause part of the retina to pull away from the back of your eyeball • Calling your health care provider Call for an appointment with an eye doctor (ophthalmologist) if you have diabetes and you have not seen an ophthalmologist in the past year. and you may need more treatment. You see spots floating in your eyes. They do not cure diabetic retinopathy or reverse the changes that have already occurred. there is always a risk for bleeding.diabetes. and cholesterol is very important for preventing diabetic retinopathy. You are having headaches.gov Prevent Blindness America . You see shadows.niddk.Support Groups American Diabetes Association .if fluid leaks into the area of the retina that provides sharp vision straight in front of you.increased pressure in the eye that can lead to blindness Macular edema -. Call your doctor if any of the following symptoms are new or are becoming worse: • • • • • • • • • You cannot see well in dim light. Prevention Tight control of blood sugar. You have blind spots. Your vision is hazy or blurry and you cannot focus. Treatments can reduce vision loss.www. . Complications Other problems that may develop are: • • • Cataracts Glaucoma -.diabetes. You will need to be monitored regularly.org National Diabetes Information Clearinghouse . Once proliferative retinopathy occurs.

Medical Director. Dooley I. 2008. most patients should have a yearly eye exam.127:245-251.Do not smoke. Bressler NM. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. References 1.3 years. MD. Inc. Divisiopn of Endocrinology. The eye exam should include dilation to check for signs of retinal disease (retinopathy). Reviewed by: Ari S. Also reviewed by David Zieve. you may need follow-up exams only every 2 . [PubMed] 3. Interventions for diabetic macular oedema: a systematic review of the literature. Hickey-Dwyer M. If you are at low risk. Edwards AR. If you are beginning a new exercise program or are planning to get pregnant. Glassman AR.5 years or more Adults and adolescents with type 2 diabetes soon after diagnosis Adolescents and adults with type 1 diabetes within 5 years of diagnosis After the first exam. Begin having eye examinations as follows by an eye doctor skilled in the treatment of diabetic retinopathy: • • • • Children older than 10 years who have had diabetes for 3 . You will need to see an eye doctor who is trained to treat diabetic retinopathy. A.net).92:1581-1590.M. NJ. You may not know there is any damage to your eyes until the problem is very bad. Diabetes Care. O'Doherty M. Diabetic Retinopathy Clinical Research Network (DRCR. . Beck RW. 2011 Jan. American Diabetes Association. [PubMed] Review Date: 6/28/2011. MHA.. Diabetes and Metabolism. Ferris F. Review provided by VeriMed Healthcare Network. have your eyes examined. Your doctor can catch problems early if you get regular exams. 2009.34 Suppl 1:S11-61. Eckman. Standards of medical care in diabetes-2. [PubMed] 2011. et al. Elizabeth. Aiello LP. MD. which can strain already weakened blood vessels in the eyes. Avoid resistance or high-impact exercises. Chief.D. If you need help quitting. ask your doctor or nurse.A. Trinitas Regional Medical Center. Arch Ophthalmol. Br J Opthalmol.

Cómo utilizar la función de Escuchar. Home » Health Information » Diabetic Eye Disease » Facts About Diabetic Retinopathy .skip navigation Top of Form Search Search: Bottom of Form S M L Text size • • • • • • • • • • • • About NEI Health Information News and Events Research Funding Research at NEI Education Programs Jobs Training Resources A-Z Sitemap E-mail to a friend Order NEI Materials • Information in Spanish (Información en español) How to use theListen function.

abnormal new blood vessels grow on the surface of the retina. It is caused by changes in the blood vessels of the retina. Cataract—clouding of the eye's lens.Facts About Diabetic Retinopathy This information was developed by the National Eye Institute to help patients and their families search for general information about diabetic retinopathy. Diabetic eye disease may include:  Diabetic retinopathy—damage to the blood vessels in the retina.   What is diabetic retinopathy? Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. The retina is the light-sensitive tissue at the back of the eye. In other people. A healthy retina is necessary for good vision. at first you may not notice changes to your vision. All can cause severe vision loss or even blindness. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions. A person with diabetes is nearly twice as likely to get glaucoma as other adults. What are the stages of diabetic retinopathy? Diabetic retinopathy has four stages: . Table of Contents Diabetic Retinopathy Defined Causes and Risk Factors Symptoms and Detection Treatment Current Research More Information • • • • • • Diabetic Retinopathy Defined What is diabetic eye disease? Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. blood vessels may swell and leak fluid. Diabetic retinopathy usually affects both eyes. diabetic retinopathy can get worse and cause vision loss. Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. If you have diabetic retinopathy. In some people with diabetic retinopathy. Cataracts develop at an earlier age in people with diabetes. But over time.

although it is more likely to occur as the disease progresses. areas of the retina with their blood supply. straight-ahead vision occurs. microaneurysms occur. This condition is called proliferative retinopathy. Proliferative Retinopathy. As the disease progresses. vitreous gel that fills the inside of the eye. At this earliest stage. At this advanced stage. Fragile. these blood vessels do not cause symptoms or vision loss. It can occur at any stage of diabetic retinopathy. blurring vision. These areas of the retina send signals to the body to grow new blood vessels for nourishment. severe vision loss and even blindness can result. 2. The fluid makes the macula swell. Normal vision . By themselves. depriving several 4. Mild Nonproliferative Retinopathy. the part of the eye where sharp. Causes and Risk Factors How does diabetic retinopathy cause vision loss? Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways: 1.1. 3. blurring vision. Many more blood vessels are blocked. This is proliferative retinopathy and is the fourth and most advanced stage of the disease. 2. the signals sent by the retina for nourishment trigger the growth of new blood vessels. They are small areas of balloon-like swelling in the retina's tiny blood vessels. Normal Vision and the same scene viewed by a person with diabetic retinopathy. These new blood vessels are abnormal and fragile. Moderate Nonproliferative Retinopathy. they have thin. About half of the people with proliferative retinopathy also have macular edema. If they leak blood. abnormal blood vessels can develop and leak blood into the center of the eye. However. This condition is called macular edema. Severe Nonproliferative Retinopathy. Fluid can leak into the center of the macula. They grow along the retina and along the surface of the clear. some blood vessels that nourish the retina are blocked. fragile walls.

If you have diabetic retinopathy. The longer someone has diabetes. To protect vision. early detection and timely treatment can prevent vision loss.Same scene viewed by a person with diabetic retinopathy Who is at risk for diabetic retinopathy? All people with diabetes--both type 1 and type 2--are at risk. including some elderly patients. you are at high risk for vision loss. This level of blood sugar control may not be best for everyone. your doctor can recommend treatment to help prevent its progression. you are at high risk for vision loss. What can I do to protect my vision? If you have diabetes get a comprehensive dilated eye exam at least once a year and remember: Proliferative retinopathy can develop without symptoms. . Be sure to ask your doctor if such a control program is right for you. During pregnancy. diabetic retinopathy may be a problem for women with diabetes. Your doctor may recommend additional exams during your pregnancy. or people with heart disease.  Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible.  You can develop both proliferative retinopathy and macular edema and still see fine. Better control also reduces the need for sight-saving laser surgery. However. children under age 13.  Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.  The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy. At this advanced stage. you may need an eye exam more often. the more likely he or she will get diabetic retinopathy. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease.

If spots occur. Pale. Blurred vision may occur when the macula—the part of the retina that provides sharp central vision— swells from leaking fluid. a special dye is injected into your arm. you will see a few specks of blood. Visual acuity test. How are diabetic retinopathy and macular edema detected? Diabetic retinopathy and macular edema are detected during a comprehensive eye exam that includes: 1. the more likely treatment will be effective. often during sleep. and you will see better. If left untreated. nor is there any pain. the earlier you receive treatment. they can bleed into the eye and block vision. 3. the pupils. the spots clear. You need to be examined by your eye care professional at the first sign of blurred vision. see your eye care professional as soon as possible. fatty deposits on the retina--signs of leaking blood vessels. Damaged nerve tissue. However. You may need treatment before more serious bleeding occurs. without treatment. before more bleeding occurs. Sometimes. or spots. bleeding can reoccur and cause severely blurred vision. Tonometry. If new blood vessels grow on the surface of the retina. If your eye care professional believes you need treatment for macular edema. "floating" in your vision. Hemorrhages tend to happen more than once. Dilated eye exam. Retinal swelling (macular edema).Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Pictures are taken as . Symptoms and Detection Does diabetic retinopathy have any symptoms? Often there are no symptoms in the early stages of the disease. After the exam. your close-up vision may remain blurred for several hours. Drops are placed in your eyes to widen. Be sure to have a comprehensive dilated eye exam at least once a year. An instrument measures the pressure inside the eye. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. he or she may suggest a fluorescein angiogram. What are the symptoms of proliferative retinopathy if bleeding occurs? At first. including:      Leaking blood vessels. Numbing drops may be applied to your eye for this test. In this test. 2. Controlling these will help your overall health as well as help protect your vision. or dilate. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease. Any changes to the blood vessels.Don't wait for symptoms. Also. Your eye care professional checks your retina for early signs of the disease. proliferative retinopathy can cause severe vision loss and even blindness. This condition is called macular edema. This eye chart test measures how well you see at various distances.

scatter laser treatment can save the rest of your sight. In fact. usually several weeks apart. two or more sessions usually are required to complete treatment.the dye passes through the blood vessels in your retina. If the bleeding is severe. Even if bleeding has started. Further treatment may be needed. If you have macular edema in both eyes and require laser surgery. These flashes eventually may create a stinging sensation that can be uncomfortable. Proliferative retinopathy is treated with laser surgery. scatter laser treatment may still be possible. You will need someone to drive you home after surgery. This procedure is called focal laser treatment. . focal laser treatment reduces the risk of vision loss by 50 percent. no treatment is needed. That is why it is important to have regular. Because a high number of laser burns are necessary. The lights in the office will be dim. causing the abnormal blood vessels to shrink. unless you have macular edema.000 to 2. depending on the amount of bleeding. Before the surgery. you may see flashes of light. This procedure is called scatter laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. The area behind your eye also may be numbed to prevent discomfort. your doctor will dilate your pupil and apply drops to numb the eye. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment. you may need a surgical procedure called a vitrectomy. it can be improved. Treatment How is diabetic retinopathy treated? During the first three stages of diabetic retinopathy. new blood vessels have started to bleed. Your doctor places 1. Scatter laser treatment works better before the fragile.000 laser burns in the areas of the retina away from the macula. Contact your eye care professional if you have vision loss. generally only one eye will be treated at a time. What happens during laser treatment? Both focal and scatter laser treatment are performed in your doctor's office or eye clinic. if vision is lost. A patient may need focal laser surgery more than once to control the leaking fluid. Scatter laser treatment may slightly reduce your color vision and night vision. During a vitrectomy. During the procedure. Although you may notice some loss of your side vision. As you sit facing the laser machine. you should bring a pair of sunglasses. Because your pupil will remain dilated for a few hours. How is a macular edema treated? Macular edema is treated with laser surgery. comprehensive dilated eye exams. people with diabetes should control their levels of blood sugar. Focal laser treatment stabilizes vision. The surgery is usually completed in one session. blood is removed from the center of your eye. and blood cholesterol. In a small number of cases. blood pressure. your doctor will hold a special lens to your eye. Scatter laser treatment helps to shrink the abnormal blood vessels. To prevent progression of diabetic retinopathy.

treat. Because the vitreous gel is mostly water. Your doctor makes a tiny incision in your eye. You may need treatment more than once to protect your sight. This research is conducted through studies in the laboratory and with patients. . these drugs may help people control their diabetic retinopathy and reduce the need for laser surgery. they do not cure diabetic retinopathy. However. a small instrument is used to remove the vitreous gel that is clouded with blood. you will notice no change between the salt solution and the original vitreous gel. Some people stay in the hospital overnight. Both treatments are very effective in reducing vision loss. ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. you may need a vitrectomy to restore your sight. Your eye will be red and sensitive. your vision will probably be a little blurry. training. You will need to wear an eye patch for a few days or weeks to protect your eye. Although both treatments have high success rates. Once you have proliferative retinopathy.For the rest of the day. That is why finding diabetic retinopathy early is the best way to prevent vision loss. The vitreous gel is replaced with a salt solution. Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. and prevent vision loss in people with diabetes. A nearby school of medicine or optometry may provide low vision services. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. What is a vitrectomy? If you have a lot of blood in the center of the eye (vitreous gel). they are usually done several weeks apart. laser surgery often cannot restore vision that has already been lost. Many community organizations and agencies offer information about low vision counseling. and other special services for people with visual impairments. You also will need to use medicated eyedrops to protect against infection. A vitrectomy is performed under either local or general anesthesia. For example. Ask for a referral to a specialist in low vision. your doctor can suggest treatment. you always will be at risk for new bleeding. If you need vitrectomies in both eyes. Next. researchers are studying drugs that may stop the retina from sending signals to the body to grow new blood vessels. You will probably be able to return home after the vitrectomy. Someday. If your eye hurts. What can I do if I already have lost some vision from diabetic retinopathy? If you have lost some sight from diabetic retinopathy. Are scatter laser treatment and vitrectomy effective in treating proliferative retinopathy? Yes. Current Research What research is being done? The National Eye Institute (NEI) is conducting and supporting research that seeks better ways to detect.

04-3252) and Diabetic Retinopathy: What You Should Know (NIH Publication No. It was adapted from Don't Lose Sight of Diabetic Eye Disease (NIH Publication No.nei. [ NEI Home | Contact Us | A-Z Site Map | Information in Spanish (Información en español)] [ Web Site Policies and Important Links | Privacy Policy | FOIA | Information Quality Guidelines | FAQ ] We welcome your questions and comments.nih.gov For mapping or direction purposes use: 9000 Rockville Pike Bethesda. The National Eye Institute (NEI) is part of the National Institutes of Health (NIH) and is the Federal government's lead agency for vision research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness. Technical questions about this website can be addressed to the NEI Website Manager. MD 20892-2510 (301) 496-5248 www. This online resource guide provides information about diabetic eye disease. MD 20892 . Department of Health and Human Services National Institutes of Health National Eye Institute 31 Center Drive MSC 2510 Bethesda. U. 03-2171). and Education. It answers questions about causes and symptoms. S.More Information View Eye Health Organizations Tips on Talking to Your Doctor How to Find an Eye Care Professional Content last reviewed in October 2009. and discusses diagnosis and types of treatment. Public Liaison. Please send general questions and comments to the NEI Office of Science Communications.

. New vessels are growing toward the subretinal space.NEI Website Header Description: Confocal image of rat RPE layer two weeks after laser. A well-defined neovascular membrane labeled with Isolectin Ib4 (red) is detected below proliferating RPE cells (Phalloidin in green).