Diabetic Retinopathy, Eye Disease You May Not See

diabetic retinopathy

Diabetic retinopathy is an eye disease that can sneak up on you without warning. You can literally be blindsided by this complication of diabetes—significant or complete loss of vision can result--yet a little knowledge and action can help prevent you from falling victim to the condition.

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Diabetic retinopathy is sneaky
Diabetic retinopathy is a vision-threatening complication of diabetes that causes progressive damage to the blood vessels that nourish the retina. As these vessels leak blood and other fluids, the retinal tissue swells and affects your vision.

The longer you have diabetes, the greater your risk of developing this eye disease. Some diabetics manage to avoid this eye condition, however, although experts have not yet determined why this is true.

Diabetic retinopathy can be sneaky, as early stages of the disease often can occur without symptoms. When symptoms do present themselves, they can include blurry vision, difficulty seeing at night, seeing spots in your vision, and having an empty spot in the center of your vision.

Diabetic retinopathy is common
Diabetic eye disease is all too common among people who have type 1 or type 2 diabetes. In fact, a new study published in JAMA Ophthalmology reported that slightly more than 20 percent of patients screened via telemedicine were found to have the eye disease.

The participants included mainly ethnic and racial minority populations and uninsured individuals with diabetes. Among these individuals, only about one third to one half received annual eye care.

The study’s authors stressed that if these populations can be reached using an inexpensive screening technique such as telemedicine, it would be possible to identify diabetic retinopathy early so it could be managed. Cynthia Owsley, PhD, professor in the University of Alabama, Birmingham Department of Ophthalmology and the lead author of the study, noted that telemedicine is “cost-effective and expands the reach of screenings by accessing regions that may be experiencing a shortage of ophthalmologists and optometrists.”

An older study (2010), also appearing in JAMA, reported on the prevalence of diabetic retinopathy among US adults aged 40 and older. That study found the prevalence to be 28.5 percent overall, with the disease being more common among men than women (31.6% vs 25.7% average). Blacks had a higher prevalence than non-Hispanic whites (38.8% vs 26.4%, respectively).

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Meeting diabetic retinopathy head on
To help prevent and manage diabetic retinopathy, the most important things you can do are:

  • Keep your glucose levels under control with diet and exercise (and drugs as needed)
  • Monitor your blood glucose levels regularly
  • Undergo a comprehensive dilated eye exam once a year
  • Keep your blood pressure in check
  • Don’t smoke
  • Consider natural remedies such as pycnogenol, bilberry, magnesium, and green tea

These steps could prevent the eye disease or effectively hinder progression.

If, however, you already have diabetic retinopathy and you need more aggressive care, there are some treatments available in addition to the abovementioned factors. For example, your doctor may suggest photocoagulation (laser treatment) to seal the blood vessels that are leaking blood and fluid.

When too much blood had gotten into the vitreous fluid (which is found between the lens and the retina), laser photocoagulation may not be possible. That’s when your doctor may recommend a vitrectomy, which removes the bloody vitreous fluid and replaces it with clear fluid.

Thus far, no medications for diabetic retinopathy have been approved by the Food and Drug Administration. However, Genentech has filed (August 2014) and received Priority Review of Lucentis (ranibizumab) for treatment of diabetic retinopathy. If approved, it will be the first eye medication available in the United States for diabetic retinopathy. Lucentis has already been approved for age-related macular degeneration, another serious eye disease.

Some doctors use another medication similar to Lucentis, called Avastin, to treat macular degeneration, although such use is off-label. A few studies also have indicated that Avastin, along with Lucentis, may be appropriate for diabetic retinopathy, although this use is still under investigation.

To cope with the vision loss associated with diabetic retinopathy, you might use special low vision devices such as magnifiers, video magnification machines, and microscopic and telescopic lens glasses.

Don’t let diabetic retinopathy sneak up on you. Get a yearly eye exam and keep your blood glucose and blood pressure levels in check, especially if you are at higher risk of developing this complication of diabetes.

SOURCES
Owsley C et al. Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine. JAMA Ophthalmology 2014 Nov 13
Pharmacy Times
Zhang X et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA 2010; 304(6): 649-656

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