What is diabetic retinopathy?

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated. However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight.

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Dr. David Maberley, MD, MSc. (Epid), FRCSC, Ophthalmologist, discusses diabetic retinopathy and how it is prevented and treated.

Quiz: Do You Understand Diabetic Retinopathy?

Test your knowledge by answering the following questions:

Questions
True
False
1

There are two types of diabetic retinopathy.

Explanation:
There are two types of diabetic retinopathy: early diabetic retinopathy and advanced diabetic retinopathy.
2

Diabetic retinopathy usually affects one eye.

Explanation:
Diabetic retinopathy usually affects both eyes, and anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy.
3

Diabetic retinopathy can be caused by poor blood control management.

Explanation:
Diabetic retinopathy can be caused by poor blood control management. Excess sugar in your blood can lead to a blockage of the blood vessels leading to the retina, cutting off the blood supply.
4

Effectively managing your serum cholesterol levels can help prevent diabetic retinopathy.

Explanation:
If you can manage your blood sugars and A1C levels, keep your blood pressure low and controlled and manage your serum cholesterol levels, your risk of developing diabetic retinopathy will be significantly reduced
5

Steroid injections are not a treatment for diabetic retinopathy.

Explanation:
Diabetic retinopathy treatment includes anti-VEGF medication, steroid injections, vitrectomy to remove vitreous gel and blood from leaking vessels or laser surgery to seal off leaking blood vessels.
(Answer all questions to activate)

Dr. Amit Gupta, MD, FACS, Ophthalmologist, talks about the risks to vision if diabetic retinopathy is not treated and well controlled.

Diabetic Retinopathy Treatment Options

Diabetic retinopathy, we start treating from a holistic approach. We have to deal with the diabetes as it affects a patient’s body.

So our first step in treating diabetic retinopathy is making sure a patient’s blood sugar is optimized, that whatever treatments they’re receiving for their diabetes in the systemic level are optimally managed, that the blood sugar is controlled with the context of good blood pressure control, cholesterol control, kidney function is assessed, and all those potential risk factors for all the complications of diabetes, but including diabetic retinopathy, are optimized.

At that point, we tend to be in a situation where we are monitoring people for the development of diabetic retinopathy. And this can typically be done with a yearly eye assessment, dilating drops and then evaluation.

And in doing that, we would tend to pick up people who have developed early diabetic retinopathy. The follow-up interval then changes. If you have changes that are worrisome, you might be coming back at the three or four monthly interval. If everything looks good, you may even be sent away for up to two years. But in general, it’s ideal to try to stick that that one-year interval as much as possible.

The treatment of diabetic retinopathy is really based on what type of retinopathy you have in your eyes. If you have swelling in the central part of your vision or near the central part of your vision, which is called diabetic macular edema, then we tend to start with one of two treatment options.

If the leakage is not very close to your center vision, we can do a little bit of laser treatment, which is a bright flashing light in the eye, and it is pretty painless and it doesn’t really set you back in terms of recovery.

You’re pretty much good to go the same day. Up to injection treatments. And we do the injection treatments when the swelling or the leakage is more in the center vision, where it’s not safe to do laser.

And there in that setting, you may undergo a series of injections with a class of drugs called anti-VEGF drugs, and those drugs – there’s a few different ones – they tend to reduce the fluid and the leakage from the blood vessels and help restore vision if it’s becoming deteriorated or if you’re having distortion or vision loss.

The other type of diabetic retinopathy, where blood vessels grow in the back of your eye and often lead to bleeding, that’s initially treated with more of an extensive laser, of the peripheral retina, and that tends to stop the blood vessels from growing and can cause them to regress and go away. That laser can be a bit more uncomfortable and often takes a lot longer to administer.

So that would be something to discuss with your ophthalmologist, the process around that in more detail if you were scheduled for a more extensive laser called pan retinal photo coagulation.

There’s also a role for the anti-VEGEF drugs in treating the type of diabetic retinopathy where blood vessels are growing, and that’s still being clarified in the literature. But there does tend to appear to be some significant benefit to using these injectable drugs when you have blood vessels that are growing in the back of your eye.

Now in the advanced stages of the blood vessel growth part of diabetic retinopathy, there can be bleeding in the eye, and there can be scar tissue that starts to pull your retina off. When those things occur, you’ll ultimately probably need a vitrectomy or surgical intervention to remove the scar tissue and blood from your eye.

And again, that’s a more involved procedure, and you would definitely want to discuss any issues around that with your ophthalmologist, your vitreoretinal surgeon at that point in time.

Presenter: Dr. David Maberley, Ophthalmologist, Vancouver, BC

Local Practitioners: Ophthalmologist

 Optometrist  Local Optometrist

Dr. Amit Gupta, MD, FACS, Ophthalmologist, talks about the cause of diabetic retinopathy and also who typically gets it.

The Risks of Not Treating Diabetic Retinopathy

Dr. Amit Gupta, MD, FACS, Ophthalmologist

The risks of not treating your eyes and not controlling the diabetic retinopathy are many. You can have blurring of vision, you can have loss of vision—some of which is recoverable once you start treatment.

But you can also have permanent loss of side vision or centre vision in a way that can’t be recovered. If ignored long enough the doctor can help you but maybe not enough.

You can also have bleeding inside the eye that will completely blot out your vision. It can be extremely sudden, so that you wake up one morning and you say “I can’t see out of my eye.” It can also cause tearing above the retina with growth blood vessels that maybe can be fixed by surgery and may be not even fixable despite good surgery.

For more information on the risks of untreated diabetic retinopathy, talk to your eye doctor.

Presenter: Dr. Amit Gupta, Ophthalmologist, Scarborough, ON

Local Practitioners: Ophthalmologist

 Optometrist  Local Optometrist

FAQ - Audio Presenter

Dr. Amit Gupta

Dr. Amit Gupta

MD, FACS
Ophthalmologist
Scarborough, ON
What do you mean there is bleeding in my eye?
Diabetic Retinopathy - Can it cause blindness?
Can Diabetic Retinopathy damage your eyes?





Dr. Amit Gupta, MD, FACS, Ophthalmologist, talks about the cause of diabetic retinopathy and also who typically gets it.

What Causes Diabetic Retinopathy and Who Can Get It

Dr. Amit Gupta, MD, FACS, Ophthalmologist

Diabetes is a lot of sugar in your blood, and that is about the limit of what most people—patients—understand about diabetes. But what is the implication of that is the real problem. Sugar is high, your doctor tells you to control your sugars, you look at the numbers, you get frustrated, but at the end of the day you feel fine.

And that is the problem. The diabetes, the sugar in the blood, it’s a sticky substance, just like water—sugar and water makes the water sticky. Sugar in the blood makes the blood sticky; it clogs the blood vessels, damages blood vessels head to toe. And the result is, it damages your organs like corrosion, slowly over time.

And years later, you find out that all those years you thought you were okay—with a little bit of high sugar, or eating a little bit of sugar—it catches up with you. And that’s when you end up with things like diabetic eye disease, kidney disease or other problems due to diabetes.

Diabetes affects the eye in so many different ways. It is the number one cause of blindness in the working-age group worldwide. Certainly in Canada and America despite our great health systems, it is still a very big cause of blindness. It affects the blood vessels. The blood vessels are in the back of the eye in the retina, and they slowly leak, they bleed and they get blocked.

The blocked blood vessels actually cause a lot of areas of the retina that don’t have blood flow, and that causes the retina to try to grow new blood vessels. In the end, these new blood vessels can also bleed, break, filling the eye with blood, or literally tear the retina up, causing total permanent blindness.

It needs to be managed before it gets to these stages. And even worse than that, the worst-case scenario would be a totally blind eye that is, in addition, very painful. We want to avoid that, and diabetes needs to be treated, as does the diabetic eye disease, or diabetic retinopathy.

In terms of age, diabetes can affect juvenile diabetics, usually not till they’re in their teens, if they’ve got diabetes at an earlier age. It also affects people with adult onset diabetes, or type 2 diabetes. People think that if they’re type 2 they’re less susceptible to these diseases. While that may be true, they can equally go blind as a younger person can with type 1 diabetes.

So, diabetes can affect all age groups. It really depends on your sugar levels, not just what age you are. And usually, these are people that are in the working age group or young people.

If you have diabetes, your optometrist will usually monitor this, and if they see any serious problems, if they see things getting worse, we’ll tend to refer you to an ophthalmologist, who can then either manage or further escalate to a retina specialist depending on the treatment needs.

Presenter: Dr. Amit Gupta, Ophthalmologist, Scarborough, ON

Local Practitioners: Ophthalmologist

 Optometrist  Local Optometrist

Local Optometrist

Mr. Steven Sorkin

Mr. Steven Sorkin

OD, FSLS
Optometrist
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Alexa Fox

Alexa Fox

OD
Optometrist
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Information – Diabetic Retinopathy

Diabetic retinopathy (also called diabetic eye disease) is a diabetes-related complication. It damages the blood vessels of the tissue at the back of the retina. There are two types of diabetic retinopathy: early diabetic retinopathy and advanced diabetic retinopathy.

Diabetic Retinopathy Diagnosis & Symptoms

Diabetic retinopathy usually affects both eyes, and anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy. The longer you have diabetes, the higher your risk of developing diabetic retinopathy. Diabetic retinopathy can be difficult to diagnose, as it may cause no symptoms or very mild vision problems. It’s important to see your ophthalmologist for an eye examination. Supplementary testing might be necessary, which can include a fluorescein angiogram, where dye is injected into your arm and photos are taken of the eye. There is a laser photograph test that can be done to look at the thickness of the retina if your opthalmologist is worried about leakage of fluid into your central vision area.

Diabetic retinopathy symptoms include:

• Blurry vision
• Vision loss
• Floaters
• Difficulty seeing colours
• Dark spots in your vision

Diabetic retinopathy can be caused by poor blood control management. Excess sugar in your blood can lead to a blockage of the blood vessels leading to the retina, cutting off the blood supply. While the eye tries to compensate by growing new blood vessels, they don’t properly develop and may begin to leak.

Diabetic Retinopathy Treatment

If you can manage your blood sugars and A1C levels, keep your blood pressure low and controlled and manage your serum cholesterol levels, your risk of developing diabetic retinopathy will be significantly reduced. The treatment of diabetic retinopathy is based on what type of retinopathy you have. Diabetic retinopathy treatment includes anti-VEGF medication, steroid injections, vitrectomy to remove vitreous gel and blood from leaking vessels or laser surgery to seal off leaking blood vessels. Patients will also see an ophthalmologist for follow-up monitoring.

Talk to your doctor if you’d like more information on diabetic retinopathy. 

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Print this Action Plan and check off items that you want to discuss with your healthcare provider

  • There are two types of diabetic retinopathy: early diabetic retinopathy and advanced diabetic retinopathy.
  • Diabetic retinopathy usually affects both eyes, and anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy.
  • Diabetic retinopathy can be caused by poor blood control management.
  • If you can manage your blood sugars and A1C levels, keep your blood pressure low and controlled and manage your serum cholesterol levels, your risk of developing diabetic retinopathy will be significantly reduced
  • Diabetic retinopathy treatment includes anti-VEGF medication, steroid injections, vitrectomy to remove vitreous gel and blood from leaking vessels or laser surgery to seal off leaking blood vessels.

Diabetic Retinopathy

Diabetic Retinopathy