Diabetic Retinopathy Princeton, Monroe Township, & Somerset, NJ

If you have diabetes mellitus, your body does not use and store sugar properly. High blood-sugar levels can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as diabetic retinopathy.

Types of Diabetic Retinopathy

There are two types of diabetic retinopathy: nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).

Nonproliferative Diabetic Retinopathy (NPDR)

NPDR is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates. Many people with diabetes have mild NPDR, which may not affect their vision. When vision is affected, it is the result of macular edema and/or macular ischemia.

Macular Edema

Macular edema is swelling, or thickening, of the macula—a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from the retinal blood vessels. It is the most common cause of visual loss in diabetes. Vision loss may be mild to severe, but even in the worst cases, peripheral vision continues to function.

Macular Ischemia

Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly.

Proliferative Diabetic Retinopathy (PDR)

PDR is present when abnormal new vessels (neovascularization) begin growing on the surface of the retina or optic nerve. The main cause of PDR is widespread closure of retinal blood vessels, preventing adequate blood flow. The retina responds by growing new blood vessels in an attempt to supply blood to the area where the original vessels closed. Unfortunately, the new, abnormal blood vessels do not resupply the retina with normal blood flow. The new vessels are often accompanied by scar tissue that may cause wrinkling or detachment of the retina. PDR may cause more severe vision loss than NPDR because it can affect both central and peripheral vision. Proliferative diabetic retinopathy causes visual loss in the following ways:

Vitreous Hemorrhage: The fragile new vessels may bleed into the vitreous, a clear, jelly-like substance that fills the center of the eye. If the vitreous hemorrhage is small, a person might see only a few new dark floaters. A very large hemorrhage might block out all vision. It may take days, months,, or even years to resorb the blood, depending on the amount present. If the eye does not clear the vitreous blood adequately within a reasonable amount of time, vitrectomy surgery may be recommended. Vitreous hemorrhage alone does not cause permanent vision loss. When the blood clears, visual acuity may return to its former level unless the macula is damaged.
Traction Retinal Detachment: When PDR is present, scar tissue associated with neovascularization can shrink, wrinkling and pulling the retina from its normal position. Macular wrinkling can cause visual distortion. More severe vision loss can occur if the macula or large areas of the retina are detached.
Neovascular Glaucoma: Occasionally, extensive retinal vessel closure will cause new, abnormal blood vessels to grow on the iris (colored part of the eye) and block the normal flow of fluid out of the eye. Pressure in the eye builds up, resulting in neovascular glaucoma, a severe eye disease that causes damage to the optic nerve.

How Is Diabetic Retinopathy Diagnosed?

A medical eye examination is the only way to find changes inside your eye. An ophthalmologist can often diagnose and treat serious retinopathy before you are aware of any vision problems.

If your ophthalmologist finds diabetic retinopathy, he or she may order color photographs of the retina, OCT imaging, or a special test called fluorescein angiography to find out if you need treatment. In this test, a dye is injected into your arm, and photographs of your eye are taken to detect where fluid is leaking.

Preventing and Treating Diabetic Retinopathy

The best diabetic retinopathy treatment in Princeton, Monroe Township, & Somerset, NJ, prevents the development of retinopathy as much as possible. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy. If high blood pressure and kidney problems are present, they need to be treated.

Treatment Options

Laser Surgery

Laser surgery is often recommended for people with macular edema, PDR, and neovascular glaucoma. Each condition is treated with a different type of laser surgery. For macular edema, the laser is focused on the damaged retina near the macula to decrease fluid leakage. The main goal of treatment is to prevent further loss of vision. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement. A few people may see laser spots near the center of their vision following treatment. The spots usually fade with time, but may not disappear. For PDR, the laser is focused on all parts of the retina except the macula. This panretinal photocoagulation treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. Multiple laser treatments over time are sometimes necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.

Vitrectomy

In advanced PDR, the ophthalmologist may recommend a vitrectomy. During this microsurgical procedure, performed in the operating room, the blood-filled vitreous is removed and replaced with a clear solution. The ophthalmologist may wait several months or up to a year to see if the blood clears on its own before performing a vitrectomy.

Vitrectomy often prevents further bleeding by removing the abnormal vessels that cause bleeding. If the retina is detached, it can be repaired during the vitrectomy surgery. Surgery may be done earlier if there is macular distortion or a traction retinal detachment. The longer the macula is distorted or out of place, the more serious the vision loss can be.

Intravitreal Injections

Medications have been approved by the FDA to directly stabilize the leaking blood vessels damaged in diabetic retinopathy. These are known as vascular endothelial growth factor (VEGF) inhibitors. Large-scale national studies have confirmed the efficacy of these medications. The medicines are introduced directly into the eye through a sterile procedure called an intravitreal injection. There is usually no pain or discomfort associated with the procedure, and the medicines can work for four weeks or longer before re-treatment may be needed. Vision can often be stabilized, and in many cases improved, with regular treatment. The need for and frequency of treatment are determined by a number of factors, including the patient's visual acuity, clinical appearance of the retina, and results of retinal testing. Intravitreal injections have rapidly become the standard of care for many cases of diabetic retinal edema and macular edema.

Vision Loss Is Largely Preventable

If you have diabetes, it is important to know that with today’s improved methods of diagnosis and treatment, only a small percentage of people who develop retinopathy have serious vision problems.

Early detection of diabetic retinopathy is the best protection against loss of vision. You can significantly lower your risk of vision loss by maintaining strict control of your blood sugar and visiting your ophthalmologist regularly.

Schedule a Consultation

When to Schedule an Examination

People with diabetes should schedule eye examinations at least once a year. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy.

Special Scheduling Considerations

Pregnant Women With Diabetes

Pregnant women with diabetes should schedule an appointment in the first trimester because retinopathy can progress quickly during pregnancy.

Blood Sugar Control and Glasses Prescriptions

If you need to be examined for glasses, it is important that your blood sugar be under consistent control for several days before seeing your ophthalmologist. Glasses that work well when blood sugar is out of control will not work well when it is stable. Rapid changes in blood sugar can cause fluctuating vision in both eyes, even if retinopathy is not present.

When to Seek Prompt Attention

You should have your eyes checked promptly if you experience visual changes that:

Affect only one eye
Last more than a few days
Are not associated with a change in blood sugar

Recommended Timing After a Diabetes Diagnosis

When you are first diagnosed with diabetes, you should have your eyes checked:

Within five years of diagnosis, if you are 30 years old or younger
Within a few months of diagnosis, if you are older than 30

Did You Know?

The retina is the only place in the body where a doctor can directly view blood vessels affected by diabetes or hypertension. Protecting these delicate vessels requires specialized diabetic retinopathy treatment in Princeton, Monroe Township, & Somerset, NJ.