Living with Diabetic Retinopathy

It is possible to have diabetic retinopathy for a long time without noticing symptoms until substantial damage has occurred. Symptoms of diabetic retinopathy may occur in one or both eyes and include:1

  • Blurred or double vision 
  • Difficulty reading 
  • The appearance of spots — commonly called “floaters” — in your vision 
  • A shadow across the field of vision 
  • Eye pain or pressure 
  • Difficulty with color perception

The primary cause of diabetic retinopathy is diabetes — a condition in which the levels of glucose (sugar) in the blood are too high. Elevated sugar levels from diabetes can damage the small blood vessels that nourish the retina and may, in some cases, block them completely. When damaged blood vessels leak fluid into the retina it results in a condition known as diabetic macular edema which causes swelling in the center part of the eye that provides the sharp vision needed for reading and recognizing faces. Prolonged damage to the small blood vessels in the retina results in poor circulation to the retina and macula prompting the development of growth factors that cause new abnormal blood vessels and scar tissue to grow on the surface of the retina. New vessels may bleed
into the middle of the eye, cause scar tissue formation, pull on the retina, cause retinal detachment, or may cause high pressure and
pain if the blood vessels grow on the iris, clogging the drainage system of the eye — all of this can cause vision loss.1

A comprehensive eye exam should be performed at least initially and at intervals thereafter as recommended by an eye care professional and outlined in the following Table. An ophthalmologist or optometrist who is knowledgeable and experienced in diagnosing diabetic retinopathy should perform the examinations. Results of eye examinations should be documented and transmitted to the referring healthcare professional.2

Table: Suggested Referral and Follow-up Timeframes for Patients with Diabetic Eye Disease.2

CIDME = central involved diabetic macular edema; DME = diabetic macular edema; HRCs = high-risk characteristics;
NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; PRP = panretinal photocoagulation;
VEGF = vascular endothelial growth factor.

Optometrists are the primary eye care providers for a majority of Americans with, and at risk for, diabetes. The goal of optometrists
is to prevent patients with diabetic eye disease from progressing to the level of sight-threatening retinopathy. Optometrists assist in
the early identification of diabetes by evaluating for ophthalmic signs and symptoms like refractive fluctuation, ocular surface disease, recurrent staphylococcal lid disease, dermatologic changes like acanthosis nigricans, and unexplained retinopathy, and by using simple, validated in-office screening tools for undiagnosed diabetes.3

To detect sight-threatening retinopathy, optometrists must start with a thorough clinical examination through dilated pupils. The index of suspicion should be elevated when patients have a higher risk profile (high hemoglobin A1c [HbA1c], long diabetes duration, type 1 diabetes, uncontrolled hypertension, untreated sleep apnea, clinical depression, and presence of other diabetes complications).3

If diabetic retinopathy is present, prompt referral to an ophthalmologist is recommended. Comprehensive evaluation by an ophthalmologist will include dilated slit-lamp examination including biomicroscopy with a hand-held lens, indirect ophthalmoscopy, and testing as appropriate that may include optical coherence tomography (OCT) and fluorescein angiography. High-quality fundus photographs can detect most clinically significant diabetic retinopathy. Interpretation of the images should be performed by a trained eye care provider. In-person exams are still necessary when the retinal photos are unacceptable and for follow-up if abnormalities are detected.2,3

References

  1. American Society of Retina Specialists (ASRS). Diabetic retinopathy. https://www.asrs.org/patients/retinal-diseases/3/diabetic-retinopathy. Accessed November 26, 2019.
  2. Solomon SD, Chew E, Duh EJ, et al [2017 ADA Position Statement]. Diabetic retinopathy: A position statement by the American Diabetes Association. Diabetes Care. 2017;40(3):412–418.
  3. Chous AP. Take charge of diabetic care. https://www.reviewofoptometry.com/article/take-charge-of-diabetic-care.
    Accessed November 26, 2019.
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Patient & Caregiver Educational Resources

The RELIEF Patient Toolkit is a resource center for patients who have been diagnosed with or who are interested in learning about diabetic retinopathy (DR). Choose from the options below to learn more.

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/CCM.
This activity is supported by an educational grant from Regeneron Pharmaceuticals, Inc.

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Scientific Council

Neil M. Bressler, MD

James P. Gills Professor of Ophthalmology
Professor of Ophthalmology, Johns Hopkins University School of Medicine
Wilmer Eye Institute, Johns Hopkins Medicine
Baltimore, MD

A. Paul Chous, MA, OD, FAAO

Specializing in Diabetes Eye Care & Education, Chous Eye Care Associates
Adjunct Professor of Optometry, Western University of Health Sciences
AOA Representative, National Diabetes Education Program
Tacoma, WA

Steven Ferrucci, OD, FAAO

Chief of Optometry, Sepulveda VA Medical Center
Professor, Southern California College of Optometry at Marshall B. Ketchum University
Sepulveda, CA

Julia A. Haller, MD

Ophthalmologist-in-Chief
Wills Eye Hospital
Philadelphia, PA

Allen C. Ho, MD, FACS

Director, Retina Research
Wills Eye Hospital
Professor and Chair of the Department of Ophthalmology
Thomas Jefferson University Hospitals
Philadelphia, PA

Charles C. Wykoff, MD, PhD

Director of Research, Retina Consultants of Houston
Associate Professor of Clinical Ophthalmology
Blanton Eye Institute & Houston Methodist Hospital
Houston, TX