What Is Diabetic Retinopathy?
Diabetic Retinopathy (DR) is a serious eye condition caused by high blood sugar levels damaging the tiny blood vessels in the retina, the light-sensitive tissue at the back of the eye. It affects people with Type 1 and Type 2 diabetes, often without noticeable symptoms until vision is compromised.
It’s one of the leading causes of blindness globally, especially among adults in their most productive years. Early detection through regular eye exams is essential for preventing permanent vision loss.
Stages of Diabetic Retinopathy
DR progresses through two major forms and four defined stages:
Non-Proliferative Diabetic Retinopathy (NPDR) – Early Stage
- Mild NPDR: Microaneurysms (tiny balloon-like swellings in blood vessels) begin to form.
- Moderate NPDR: Vessels swell and distort, impairing blood flow.
- Severe NPDR: Widespread vessel blockage leads to areas of the retina being deprived of oxygen, triggering new vessel growth signals.
Proliferative Diabetic Retinopathy (PDR) – Advanced Stage
- PDR: Fragile, abnormal new blood vessels form (neovascularisation), often leaking into the vitreous. This can cause floaters, blurred vision, severe haemorrhaging, or even retinal detachment and vision loss.
In some cases, patients with PDR may only see shadows or light-dark contrast in affected eyes.
Signs and Symptoms
Early stages may be asymptomatic, but as DR progresses, symptoms include:
- Blurred or distorted vision
- Floaters (dark spots or strings in vision)
- Difficulty seeing at night
- Dark or empty areas in central vision
- Fluctuating vision
- Sudden vision loss (in cases of vitreous haemorrhage)
Causes and Risk Factors
The underlying cause is chronic high blood glucose damaging retinal blood vessels. As blood vessels leak, swell, or become blocked, retinal tissues become oxygen-deprived, causing irreversible damage.
Key risk factors include:
- Duration of diabetes: Risk increases after 10–20 years of the condition.
- Poor blood sugar control (high HbA1c levels)
- High blood pressure and cholesterol
- Pregnancy (especially gestational diabetes)
- Hispanic and African heritage
- Protein in urine (marker of kidney and retinal damage)
- Smoking
Even rapid glucose correction in long-term diabetics can trigger temporary worsening of DR.
Diagnosis and Monitoring
A comprehensive dilated eye exam is the gold standard for detecting DR. Retinal photography, OCT scanning, and fluorescein angiography may also be used to assess the retina’s condition.
Regular screenings are critical—especially if you’re diabetic, pregnant, or have been diagnosed with DR before.
Treatment Options
While there is no cure, treatment can slow progression and preserve vision.
Laser Therapy (Photocoagulation)
- Used in PDR to seal leaking vessels and prevent further abnormal growth.
- Panretinal photocoagulation (PRP) targets peripheral retina to preserve central vision.
Injections
- Anti-VEGF medications like Lucentis, Eylea, and Avastin reduce vessel growth and leakage.
- Steroid injections for persistent macular swelling (DME).
Vitrectomy Surgery
- Performed when there’s significant vitreous haemorrhage or retinal detachment.
- Involves removing the gel inside the eye and replacing it to restore or maintain vision.
Systemic Management
- Controlling blood sugar, blood pressure, and cholesterol significantly reduces the risk.
- HbA1c levels should be maintained at 6–7% as per international guidelines.
Patient education and lifestyle management play a critical role in treatment success.
Have diabetes? Don’t wait for symptoms.
Schedule your retinal screening with Davida van der Merwe Optometrist today to detect diabetic retinopathy early and protect your vision for years to come.
