Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated. However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight.

If you have diabetes, your risk of diabetic retinopathy increases based on how well you control your general health. If you can manage your blood sugars well and keep them well controlled, and manage your A1C levels, if you can keep your blood pressure low and controlled, and if you can manage your serum cholesterol levels, then your risk of developing diabetic retinopathy will be significantly reduced. And that's an important piece for patients with diabetes to discuss with their family physicians.

Now, assuming that you're doing the best you can with your systemic control, then you still need to have your eyes examined, and that process would require going to see an ophthalmologist, having dilating drops put in your eyes so the retina can be examined in properly. You would then sit at a high powered microscope, have your retinas examined, often with a headlamp microscope as well, and depending on what was seen, supplementary testing might be necessary. Now many times this testing can be performed the same day. It would include such a test as a fluorescein angiogram dye that is injected into your arm where photos are taken of your eye. There's a laser photograph tests that can be done to look at the thickness of the retina if we're worried about leakage of fluid into your central vision area. And really those are the main tests that we would do to look at your eye in conjunction with the eye exam to diagnose diabetic retinopathy. Your pupils will be dilated during the process, so bringing a pair of sunglasses with you or having someone drive you to pick you up and take you home is probably a good idea.

Once you're seen by your ophthalmologist, if testing is required, depending on the facilities available to that individual, there may be an opportunity for performing your tests the same day and even possibly treatment the same day so that your treatment if you need it can be initiated as quickly as possible for your diabetic retinopathy.

If you have questions or further queries about diabetes and diabetic retinopathy, please talk to your family physician or your local ophthalmologist Presenter: Dr. David Maberley, Ophthalmologist, Ottawa, ON

Local Practitioners: Ophthalmologist

Diabetic retinopathy, we start treating from a holistic approach. We have to deal with the diabetes as it affects a patient’s body. So our first step in treating diabetic retinopathy is making sure a patient’s blood sugar is optimized, that whatever treatments they’re receiving for their diabetes in the systemic level are optimally managed, that the blood sugar is controlled with the context of good blood pressure control, cholesterol control, kidney function is assessed, and all those potential risk factors for all the complications of diabetes, but including diabetic retinopathy, are optimized.

At that point, we tend to be in a situation where we are monitoring people for the development of diabetic retinopathy. And this can typically be done with a yearly eye assessment, dilating drops and then evaluation. And in doing that, we would tend to pick up people who have developed early diabetic retinopathy. The follow-up interval then changes. If you have changes that are worrisome, you might be coming back at the three or four monthly interval. If everything looks good, you may even be sent away for up to two years. But in general, it’s ideal to try to stick that that one-year interval as much as possible.

The treatment of diabetic retinopathy is really based on what type of retinopathy you have in your eyes. If you have swelling in the central part of your vision or near the central part of your vision, which is called diabetic macular edema, then we tend to start with one of two treatment options.

If the leakage is not very close to your center vision, we can do a little bit of laser treatment, which is a bright flashing light in the eye, and it is pretty painless and it doesn’t really set you back in terms of recovery.

You’re pretty much good to go the same day. Up to injection treatments. And we do the injection treatments when the swelling or the leakage is more in the center vision, where it’s not safe to do laser.

And there in that setting, you may undergo a series of injections with a class of drugs called anti-VEGF drugs, and those drugs – there’s a few different ones – they tend to reduce the fluid and the leakage from the blood vessels and help restore vision if it’s becoming deteriorated or if you’re having distortion or vision loss.

The other type of diabetic retinopathy, where blood vessels grow in the back of your eye and often lead to bleeding, that’s initially treated with more of an extensive laser, of the peripheral retina, and that tends to stop the blood vessels from growing and can cause them to regress and go away. That laser can be a bit more uncomfortable and often takes a lot longer to administer.

So that would be something to discuss with your ophthalmologist, the process around that in more detail if you were scheduled for a more extensive laser called pan retinal photo coagulation.

There’s also a role for the anti-VEGEF drugs in treating the type of diabetic retinopathy where blood vessels are growing, and that’s still being clarified in the literature. But there does tend to appear to be some significant benefit to using these injectable drugs when you have blood vessels that are growing in the back of your eye.

Now in the advanced stages of the blood vessel growth part of diabetic retinopathy, there can be bleeding in the eye, and there can be scar tissue that starts to pull your retina off. When those things occur, you’ll ultimately probably need a vitrectomy or surgical intervention to remove the scar tissue and blood from your eye. Local Ophthalmologist

And again, that’s a more involved procedure, and you would definitely want to discuss any issues around that with your ophthalmologist, your vitreoretinal surgeon at that point in time. Presenter: Dr. David Maberley, Ophthalmologist, Vancouver, BC

Local Practitioners: Ophthalmologist