Diabetic retinopathy is the leading cause of acquired blindness among Americans under the age of 65. The majority of cases of this type can be prevented with early detection and treatment. That’s why it is so important for diabetics to have a dilated eye exam at least once a year
All diabetics risk developing diabetic retinopathy; however, not all do. Diabetic retinopathy is linked to poorly controlled blood sugar. Damaged blood vessels can leak fluid or blood, causing deposits on the retina and swelling.

Background diabetic retinopathy (BDR) may occur at any point in time after the onset of diabetes. 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. In general, this is the first stage of diabetic retinopathy. This condition is often present without any visual symptoms.

In general, BDR patients are not treated with laser photocoagulation of the retina, that is using a laser to seal off the bleeding blood vessels. An exception exists for some patients with an advanced form of BDR known as pre-proliferative diabetic retinopathy. Swelling of the part of the retina responsible for central vision (the macula) can occur at this stage of diabetic retinopathy and may also be treated with laser if the swelling is found to be clinically significant.

Background DR with exudates and macular swelling

Proliferative diabetic retinopathy (PDR) is when new blood vessels grow on the surface of the retina and can lead to serious vision problems, including blindness. Patients with PDR should receive scatter laser photocoagulation (laser treatment of the blood vessels in the blocked area) as soon as possible following diagnosis of the condition. This treatment is also known as pan-retinal laser photocoagulation.

PDR with new vessel growth	SP laser treatment for PDR

These blood vessels may break and bleed into the clear, jelly-like substance that fills the center of the eye (the vitreous). The body will usually absorb blood from a vitreous hemorrhage, but that can take days, months or even years. If the vitreous hemorrhage does not clear within a reasonable time, or if a retinal detachment is detected, an operation called a vitrectomy can be performed. During a vitrectomy, the eye surgeon removes the hemorrhage and the abnormal blood vessels that caused the bleeding.

Vitreous hemorrhage

Vision loss from diabetic retinopathy can be reduced or avoided by following a common sense regimen—keeping blood sugar under good control; monitoring and controlling blood pressure; maintaining a healthy diet; regular exercise, and scrupulously following your eye doctor's instructions.

The bottom line: the American Academy of Ophthalmology estimates that 95% of those with significant diabetic retinopathy can avoid substantial vision loss if they are treated in time.

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