Diabetic Retinopathy

GENERAL INFORMATION:

What is diabetic retinopathy? Diabetic retinopathy (ret-i-nop-ah-the), also called DR, is an eye disease usually affecting both eyes that is caused by diabetes. Diabetes is a condition when your body makes little or no insulin, causing high blood sugar levels. The increased blood sugar levels affect the blood vessels of the retina. The retina is the part of the eye that captures light and sends information to your brain. With DR, the damaged retina causes vision problems that may cause you to lose your vision.

What causes diabetic retinopathy? Having long standing uncontrolled type 1 or type 2 diabetes is the main cause of DR. With DR, the walls of the blood vessels in the retina may weaken and leak blood. This causes edema (swelling) and vision problems. Over time, new blood vessels may grow, leak blood, and cover the center of the retina. This may cause your eyesight to be completely blocked and cause blindness.

What puts me at risk of having diabetic retinopathy? The longer you have diabetes, the more likely you will have DR. The following may increase your chances of having DR or of DR becoming worse:

• Having diabetes during puberty (ages 11 to 15) or a pregnancy.
  
  
• Having other eye problems or eye surgery.
  
  
• Having other family members with DR.
  
  
• High blood pressure.
  
  
• High blood cholesterol (fat).
  
  
• Other health problems, such as anemia or kidney problems.

What are the signs and symptoms of diabetic retinopathy? You may have any of the following signs or symptoms:

• Blurred vision.
  
  
• Fast and painless worsening of vision.
  
  
• Seeing red or black wavy lines that have a curtain-like or spider web effect.
  
  
• Seeing light flashes or red, black, or grey floating spots.

How is diabetic retinopathy diagnosed? Diabetic retinopathy may be diagnosed during a complete eye exam. You may also have the following:

• Dilated indirect ophthalmoscopy: This test uses a magnifying lens to see your retina and other parts of your eye. Eyedrops are placed into your eyes to dilate (widen) the pupils. The pupil is the dark circle in the middle of the eye.
  
  
• Fluorescein angiography: This test uses a dye called Fluorescein that is put in your eye and then a special camera will take a picture.
  
  
• Stereo fundus: This test is also called fundus photography. You may have this test to diagnose DR or check your DR to see if it is getting worse.

How is diabetic retinopathy treated? You may not need treatment right away if you have mild DR. For severe DR, surgery may be needed to slow or stop the disease from becoming worse. Laser treatment may slow DR and prevent blindness. This treatment shrinks the new blood vessels and seals the areas that have leaks. Surgery called a vitrectomy may be done if there is bleeding in the vitreous that does not clear. The vitreous is the gel-like material that fills the inside of the eye.

What can I do to prevent diabetic retinopathy? You may decrease your risk of having DR with the following:

• Blood sugar control: Keep your blood sugar levels as close to normal as possible. Your blood sugar levels should be between 90 and 130 mg/dl (milligrams per deciliter) before meals. After meals, your blood sugar level should be less than 180 mg/dL. Your hemoglobin A1c (HbA1c) level should be less than 7 percent. The hemoglobin A1c gives your average blood sugar levels over the past 2 to 3 months. Controlling your blood sugar can be done by taking insulin, diabetes medicine, eating correctly, and exercising.
  
  
• Blood pressure control: Your blood pressure should not be higher than 140/80 mmHg (millimeters of mercury). You may need to make lifestyle changes and take medicines to control your blood pressure.
  
  
• Blood cholesterol control: This test measures the amount of cholesterol (fat) in your blood. Talk to your caregiver about your total blood cholesterol. You may need to make lifestyle changes or take medicines to control your cholesterol.
  
  
• Regular eye checks: You should have regular eye exams.
  
  
  • Have your eyes checked 3 to 5 years after being diagnosed with type 1 diabetes or during puberty (11 to 15 years). Your eyes should be checked soon after you learn you have type 2 diabetes.
    
    
  • Have your eyes checked every year.
    
    
  • If you are planning to get pregnant, have your eyes checked before pregnancy.
    
    
  • If you are pregnant, have your eyes checked during the first 13 weeks of your pregnancy. You should also have your eyes checked six weeks after the birth of your baby.

Where can I find support and more information? Having DR may be life-changing for you and your family. Accepting that you have diabetic retinopathy may be hard. You may want to join a support group which is a group of people who also have diabetes. Contact the following for more information:

• American Diabetes Association
  1701 North Beauregard Street
  Alexandria, VA 22311
  Phone: 1-800-342-2383
  Web Address: http://www.diabetes.org
  

• National Diabetes Information Clearinghouse
  1 Information Way
  Bethesda, MD 20892-3560
  Phone: 1-800-860-8747
  Web Address: www.diabetes.niddk.nih.gov/
  

• National Eye Institute, National Institutes of Health
  202 Vision Pl.
  Bethesda, MD 20892-3655
  Phone: 1-301-496-5248
  Web Address: www.nei.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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