What Is Retinopathy? Symptoms, Treatment, And More

Retinopathy is the leading cause of preventable blindness in the world. It develops primarily in people with diabetes, earning the title “diabetic retinopathy.” Nearly one in three people with diabetes over age 40 will develop this condition. Read more about the symptoms, risk factors, and treatment options for retinopathy.

What Is Retinopathy?

Retinopathy is characterized by blood vessel damage to the sensitive area at the back of the eye, the retina. When these vessels are damaged, your retinas have a harder time sending signals to the brain along the optic nerve. This can lead to blindness. If you have diabetes, it is essential to have a yearly dilated eye exam because retinopathy doesn’t usually cause symptoms in its early stages.

If you have diabetes, you should be under a doctor’s care. They know the risks of diabetic retinopathy and will screen you for it regularly. This will decrease the risk of the condition becoming serious.

What Causes Retinopathy?

The main cause of retinopathy is high blood sugar from diabetes. Diabetes damages all blood vessels. Many people with severe diabetes get amputations because of extreme loss of circulation to their limbs.

Blood vessels at the back of the eye, near the retinas, can also become damaged in the same way. Tiny breaks (hemorrhages) and bulges (aneurysms) can develop in the vessels at the back of the eye, restricting blood flow. This decreases the ability of the retina to send signals to the brain via the optic nerve, which can lead to blindness.

Can you develop retinopathy without having diabetes? The simple answer is yes, but this condition usually develops in middle-aged and older people with preexisting conditions Like:

Lupus: A chronic autoimmune disease that causes inflammation and pain throughout the body.
Sickle cell disease: A condition that changes the shape of red blood cells and slows down blood flow to the body.

Risk Factors

Some people are at higher risk of developing diabetic retinopathy. It is important to be aware of these risk factors and identify any that make you more likely to have this condition. Risk factors include:

Length of time you’ve had diabetes: the longer you’ve had diabetes, the higher your risk.
High blood pressure: hypertension can cause retinopathy on its own. When combined with diabetes, retinopathy likelihood increases greatly.
Tobacco use: smokers are more at risk.
High blood sugar: if your blood sugar is consistently high or you are not regularly taking your prescribed insulin, you are more at risk.
Cholesterol: if you have a history of high cholesterol, you are at a higher risk.

Stages of Retinopathy

Retinopathy is a progressive disease, meaning it gets worse with time. There are three distinct stages:

Stage I–Background Retinopathy

In this stage, small bulges appear in the blood vessels at the back of your eye, which can leak blood. This does not damage your vision and is extremely common in people with diabetes. Treatment is not required at this stage, but you should work with your doctor to keep your blood sugar levels down to prevent progression.

Stage II–Pre-Proliferative Retinopathy

In this stage, more changes happen near your retina, including bleeding. Your vision will most likely be affected in this stage. Your doctor will recommend increased screening frequency to check for further progression of the condition.

Stage III–Proliferative Retinopathy

In this stage, new blood vessels appear near the retina. These can rupture or hemorrhage, causing increasingly severe loss of vision, pain, and even retina detachment. Your doctor may treat the blood vessel damage so it doesn’t lead to blindness. Unfortunately, treatment cannot reverse the damage already done.

When people with diabetes have retinopathy that damages blood vessels in the center of the retina (macula), it’s called diabetic maculopathy. The macula is responsible for fine vision, such as reading and other close-up work. Damage to this sensitive region of the eye is serious.

Symptoms of Retinopathy

Because retinopathy takes years to develop, most people do not experience any symptoms for quite a long time. When symptoms do develop, they tend to appear gradually and progress slowly. Symptoms include:

Gradually worsening vision
Floaters in your vision
Eye redness
Pain in the eyes
Worsening night vision
Sudden loss of vision in one or both eyes

Over time, especially if you do not consult your doctor about these concerning vision changes, retinopathy will progress, eventually leading to complete blindness. Regular checkups with your primary care physician are crucial, as well as yearly visits to an ophthalmologist (eye doctor) to check for signs of blood vessel damage in the retinal area.

Prevention

What can you do to lower your risk of developing retinopathy?

Meticulous attention to your diabetes is the most effective way to prevent retinopathy. Regulation of blood sugar is important for managing all aspects of diabetes, not just your vision.
Yearly comprehensive dilated eye exams can help your doctors identify signs of early retinopathy and attempt to stop or slow the progression of the disease.
Limit your alcohol, sugar, fat, and salt intake, as these can increase blood sugar and cholesterol.
Monitor and manage your blood pressure. Normal blood pressure levels are typically 120/80 or below.

How Is Retinopathy Treated?

Unfortunately, there is no cure for retinopathy. However, some treatments can ward off further damage. Treatment is only recommended for advanced cases in which your vision is severely affected. There are three common treatments for diabetic retinopathy:

Eye injections: this treatment can stop or slow the progression of the disease, potentially saving your vision. The medication in these injections is called anti-VEGF, which slows down the growth of new blood vessels.
Laser treatment: ophthalmologists can use laser treatment to shrink the blood vessels near the retina and reduce swelling in the eye.
Surgery: if there is significant scarring or bleeding in the retina, your ophthalmologist may recommend a surgery called vitrectomy. In this surgery, most of your vitreous humor (the gel-like fluid that fills your eye) is removed and replaced by a clearer gel to improve vision. They may also inject a bubble of air or gas to fill the void the vitreous left behind. This holds your retina in place.
Medication: Limited evidence suggests that a cholesterol medication called fenofibrate can slow the progression of retinopathy. However, there are still studies on this treatment, and it’s not available for general use.

Next Steps

If you have retinopathy or are at risk for it, resources are available. VisionAware is a website containing information, tips, and symptom management methods for those losing their vision due to retinopathy. You can also check out this guide to living with diabetes and vision loss.

And, remember, it’s important to regularly see your primary care doctor and your ophthalmologist to check for signs of retinopathy or disease progression.

Resource Links:

“What is Retinopathy?” via American Diabetes Association.
“Diabetic Retinopathy” via National Eye Institute
“Diabetic Retinopathy” via CDC
“Ocular and Systemic Causes of Retinopathy in Patients Without Diabetes Mellitus” via NIH
“Retinopathy” via MedBroadcast
“Diabetic Retinopathy Risk Factors” via News Medical
“Overview Diabetic Retinopathy” via NHS
“Diabetic Retinopathy” via Mayo Clinic
“Top 10 Tips for Diabetic Retinopathy Prevention” via IrisVision
“Stages of Diabetic Retinopathy” via NHS
“Proliferative Diabetic Retinopathy” via Columbia University
“Diabetic Maculopathy and Treatment Options: A Guide For Patients” via NHS
“Vitrectomy” via NIH
“Diabetes 101” via The Health Feed