Diabetic Retinopathy: A potentially serious eye disease

Diabetes is often referred to as a silent disease. That’s because it can remain asymptomatic for years, and its complications can sneak up on you without warning—complications like diabetic retinopathy (DR). Left untreated, DR can lead to irreversible blindness, says Dr. Abdallah Mahrous, an Assistant Professor in Ophthalmology and an Attending Physician at Weill Cornell Medicine. “It’s the leading cause of blindness in middle-aged Americans,” he says.

To get a handle on DR from diagnosis to symptoms, treatments and prevention, see the following Q&A with Dr. Mahrous.

What causes DR?

Fluctuations in blood sugar levels along with prolonged blood sugar elevation can cause damage to small blood vessels, he explains. “A healthy retina relies heavily on small blood vessels to function properly. But diabetes-related damage leads to areas of poor blood flow in the retina. These areas of poor blood perfusion, or ischemia, can lead to the formation of abnormal blood vessels—the body’s attempt to compensate for the loss of normal blood flow.” However, these abnormal blood vessels hurt more than help, causing bleeding, swelling and vision loss.  

Please describe the two stages of DR.

The first stage

The disease usually starts as non-proliferative diabetic retinopathy (NPDR). NPDR itself is split into mild, moderate and severe. “If you have NPDR, your retinal blood vessels are damaged and may leak. You might experience swelling in the retina if the leaks are significant, leading to impairment of vision,” Dr. Mahrous says.

The second stage

Proliferative diabetic retinopathy (PDR) is the more severe stage, involving the presence of abnormal blood vessels (proliferation). These blood vessels are at high risk of bleeding, and bleeding may cause vision loss. Repetitive bleeding without treatment can lead to the formation of tractional blood vessels and membranes, resulting from scar tissue on the retina’s surface and causing the retina to pull away from the back of the eye. That can lead to irreversibly blinding detachment of the retina.

How can I tell if I have it?

“It’s best to get a dilated eye exam, preferably with an ophthalmologist, to check for DR,” he says. Symptoms may include floaters and loss of vision. However, it’s also possible to be completely asymptomatic, even with severe disease. Therefore, “a dilated eye exam is recommended on an annual basis for any patient with diabetes,” Dr. Mahrous advises.

How will my ophthalmologist diagnose the disease?

Your ophthalmologist will place dilating drops into your eyes. This will allow the doctor to look into the retina and see if DR is present. Additional testing, including retinal imaging, may be indicated to determine the stage of the disease and the best treatment plan, if needed.

What are the available treatment options?

The three main treatment options for DR are:

• Injections
• Lasers
• Surgery

Intravitreal injections are by far the most commonly performed treatment, as they are the quickest, and they’re administered in the doctor’s office. The medication is used to fight the swelling and growth of abnormal blood vessels. Injections usually have a promising and quick response, but they only last for several weeks. Patients with severe DR may need to come in for monthly injections.

Laser treatment is a great option for some patients. Although it takes much longer to administer, its effects are permanent. It is also noninvasive, meaning it carries a lower risk of complications compared to injections or surgery.

Finally, says Dr. Mahrous, “if recurrent bleeds happen and the blood vessels form tractional retinal detachments, then the only solution would be surgery to remove the blood and relieve the traction of the abnormal vessels and membranes.”

What measures can I take to prevent vision loss from DR?

Work with your primary care doctor to keep your blood sugar levels at the target rate.

Maintain normal blood pressure. High blood pressure has been shown to worsen the effects of diabetes on the eyes.

Most importantly, get your eyes checked regularly. As mentioned above, DR can be completely asymptomatic. Therefore, if you have diabetes, an annual dilated eye exam with an ophthalmologist is strongly recommended.

To schedule an appointment with an ophthalmologist at Weill Cornell Medicine, please call us at: (646) 962–2020 or visit here.