Diabetic Retinopathy

Diabetic retinopathy happens when the blood vessels in the retina are damaged. There are two types of diabetic retinopathy – proliferative and non-proliferative.

Non proliferative diabetic retinopathy occurs as high levels of sugar in the blood vessels, causes them to leak and bleed.  Typically this occurs without any change to people's vision, unless the leakage occurs in the macular, or in the area responsible for your central vision.

Proliferative retinopathy happens when the blood doesn't get to the peripheral retina, so new blood vessels start to grow in the eye.  These blood vessels are fragile and can break, causing a bleed into the vitreous (back of the eye), which will cause the vision to become blurry. 

Scar tissue can also form on the retina, which can lead to retinal detachment

Diabetic oedema

Diabetic macular oedema can happen in both proliferative and non proliferative diabetic retinaopathy. 

Macular oedema is swelling of the macula (the area responsible for your central vision) which occurs due to the leaky blood vessels.  You will notice that your vision will become blurred or distorted when your macula is swollen. 

Healthy Vision Diabetic Retinopathy

Healthy vision versus diabetes-affected vision.

How is it diabetic eye disease diagnosed?

Regular eye exams are especially important if you’ve been diagnosed with diabetes. As well as diabetic eye disease, people with diabetes are more susceptible to conditions like cataracts and glaucoma.

Dialated Eye Exam

Diabetic eye disease is usually diagnosed in a comprehensive dilated eye exam. The doctor places drops in your eye which cause the iris to relax, opening the pupil. This lets the doctor gain a clear view of the inside of your eye. They will look for things like bleeding, swelling, scar tissue, or new blood vessels.

OCT Scan

An optical coherence tomography (OCT) is used to measure the retina’s thickness and ascertain whether there is any macular oedema or swelling. 

After the tests are performed, your eye doctor will use the results to determine the best course of treatment.

The goal of treatment is to prevent further damage to your vision by managing your diabetes and preventing further leakage from the blood vessels.

Coastal Eye Surgeons will recommend an approach that is tailored to you and the type of diabetic eye disease you have.  A co-ordinated approach will be adopted with your GP / specialist, to ensure your blood sugar, cholesterol and blood pressure are all adequately controlled and treated.  

Your treatment may involve some or all of the following approaches:

Macular Oedema Treatment: Injections

Coastal Eye Surgeons can put medication into your eye which will help stop the creation of new blood vessels and to stop leakage from them that cause macular oedema / swelling. 

These injections are called Anti VEGF injections (or intra vitreal Anti vascular endothelial growth factor injections).

Treatment is usually given monthly until three months and then the treatment frequency will be tailored to how your eye has reacted to the injections.

These injections can be performed at Coastal Eye Surgeons rooms. 

Vitrectomy

This is a surgery, preformed in a day surgery theatre.

This is appropriate for people who have proliferative diabetic retinopathy and who have a vitreous haemorrhage / or bleeding into the back of the eye due to breakage of new fragile blood vessels.  It is also performed for those with a retinal detachment. 

The surgery is performed under sedation, similar to "twilight sedation" you may have had for a colonoscopy. 

It involves removing the blood and the natural vitreous or gel like substance, from the back of the eye.  It is common that laser to the retina is performed as well as the instillation of an Anti VEGF injection. 

Laser photocoagulation

Laser is used to either shrinks tiny blood vessels, that are causing leakage, or applied to areas of the retina in order to stop them sending signals to cause new fragile blood vessels to grow.

This is used less commonly now with the advent of Anti VEGF injections, however, it is still appropriate for certain people.

Your eye doctor will often also work with your GP and/or endocrinologist to help manage your diabetes and blood sugar levels. This can help prevent further damage to your eyes.

Additional Information

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