Diabetic Retinopathy

	Deposits in the retina formed by background diabetic retinopathy

What is Diabetic Retinopathy?

High blood-sugar levels caused by diabetes can damage blood vessels throughout the body. When blood vessels in the retina—the nerve layer membrane at the back inside of the eye that senses light and helps transmit images to your brain—are damaged, it is called diabetic retinopathy.

There are two types of diabetic retinopathy:

Nonproliferative diabetic retinopathy (NPDR), commonly called background retinopathy, is the early stage of diabetic retinopathy. Leaking blood or other fluid from damaged blood vessels causes the retina to swell or form deposits called exudates. Many people with diabetes have mild NPDR, which usually does not affect their vision.

Proliferative diabetic retinopathy (PDR) is when abnormal new vessels grow on the surface of the retina or the optic nerve. PDR may cause more severe vision loss than NPDR because it can affect both central and peripheral vision.

Signs to Look For

Because changes in your blood-sugar levels can temporarily affect vision, it’s often hard to tell when diabetic retinopathy is causing changes to your vision. That’s one reason that strict control of your blood sugar is so important. If you notice a vision change that lasts more than a day or two, or vision changes that don’t seem related to changes in your blood-sugar levels, contact your ophthalmologist immediately.

Risk Factors

The primary cause of diabetic retinopathy is uncontrolled blood-sugar levels. Additional risk factors include: 

• High blood pressure 
• High cholesterol 
• Smoking

Preventative Measures

In order to prevent diabetic retinopathy, strict control of your glucose, blood pressure and lipid levels is essential. This will reduce the long-term risk of vision loss.

Early detection of diabetic retinopathy can help prevent vision loss. You should see your ophthalmologist at least once a year or as often as recommended by your ophthalmologist.

Treatment Options

Laser surgery is often recommended for people with PDR and more advanced forms of NPDR. Multiple laser treatments over time are sometimes necessary. Laser surgery does not cure diabetic retinopathy, but it may help stabilize your vision and prevent any further vision loss.

In cases of advanced PDR with bleeding within the vitreous of your eye your ophthalmologist may recommend a surgical procedure called a vitrectomy to remove the blood and replace your blood filled vitreous,  the gel-like substance that fills the center of the eye, with a clear solution. Removing the blood-filled vitreous helps to improve your vision.

Eye Disease in Veterans with Diabetes

Diabetes is the number one cause of blindness in adults each year, according to the American Diabetes Association. In people with diabetes, loss of vision can result from eye disease complications, such as cataracts, glaucoma and diabetic retinopathy.

The good news is that the combination of regular eye exams, appropriate referral, diagnosis and timely treatment leads to the best visual outcomes. This is why it is so important for veterans with eye disease or veterans with diabetes to get an annual eye examination from an ophthalmologist. In fact, VA guidelines call for an annual eye exam or a biennial follow-up exam in patients who have diabetes.

The VA health care system was established so that veterans could receive the best treatment possible. However, veteran participation is the one variable that the VA does not control. The American Academy of Ophthalmology encourages all veterans to utilize the VA system and get an eye exam.

Did You Know?

• Eye procedures performed in veterans with diabetes accounted for about one-quarter of all eye surgeries performed in the VA system.
• Nearly 85 percent of veterans with diabetes got an eye exam in one calendar year.
• Most veterans with diabetes and with a lower-limb amputation also had an eye exam in the same year. This is important because having a lower-extremity amputation for diabetes-related reasons increases risk for diabetic retinopathy.
• Nearly 5 percent of all veterans are blind. These 11,500 veterans require rehabilitation and care in the VA healthcare system.