Your retina is a thin layer of tissue on the inside back wall of your eye. It contains millions of light-sensitive cells and other nerve cells that receive and organize visual information. Your retina sends this information to your brain through your optic nerve, enabling you to see.
Retinal diseases can affect any part of your retina and can cause total blindness. Disease affecting the edge of your retina can affect your side (peripheral) vision. Some diseases affect the part of your retina that serves your central vision (the macula and the fovea). Many retinal diseases share some common symptoms and treatments. The main goals of treatment are to stop or slow the disease and preserve, improve or restore your vision.
Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue in the back of the eye. A healthy retina is necessary for good vision.
If you have diabetic retinopathy, at first you may notice no changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
What are the stages of diabetic retinopathy?
Diabetic retinopathy has four stages:
- Mild Nonproliferative Retinopathy – At this earliest stage, micro aneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.
- Moderate Nonproliferative Retinopathy – As the disease progresses, some blood vessels that nourish the retina are blocked.
- Severe Nonproliferative Retinopathy – Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
- Proliferative retinopathy – At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.
Who is at risk for diabetic retinopathy?
All people with diabetes-both type 1 and type 2- are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor at Quigley Eye Specialists can recommend treatment to help prevent its progression.
During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, EVERY pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.
More about the stages of diabetic retinopathy?
Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:
- Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.
- Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half the people with proliferative retinopathy also have macular edema.
Does Diabetic Retinopathy have any symptoms?
Diabetic retinopathy often has no early warning signs. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.
What are the symptoms of Proliferative Retinopathy if bleeding occurs?
At first, you will see a few specks of blood or spots, “floating in your vision”. If spots occur, see your doctor at Quigley Eye Specialists as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.
Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your doctor at Quigley Eye Specialists at the first sign of blurred vision, before more bleeding occurs.
If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.
How are Macular Edema and Diabetic Retinopathy detected?
Macular edema and diabetic retinopathy are detected during a comprehensive eye exam that includes:
- Visual acuity test – This eye chart test measures how well you see at various distances.
- Dilated eye exam – Drops are placed in your eye to widen, or dilate, the pupils. Your Quigley Eye Specialists doctor uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
- Tonometry – An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.
Your doctor at Quigley Eye Specialists checks your retina for early signs of disease, including:
- Leaking blood vessels
- Retinal swelling (Macular Edema)
- Pale, fatty deposits on the retina – signs of leaking blood vessels
- Damaged nerve tissue
- Any change to the blood vessels
If your doctor at Quigley Eye Specialists believes you need treatment for Macular Edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The tests allow your doctor to identify any leaking blood vessels and recommend treatment.
How is macular edema treated?
Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor at Quigley Eye Specialists places up to several hundred small laser treatments in the areas of retinal leakage surrounding the macula. These treatments slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.
A patient may need focal laser surgery more than once to control a leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.
Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved.
How is diabetic retinopathy treated?
During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macula edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser treatments in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser treatments are necessary, two or more sessions are usually required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.
Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams at Quigley Eye Specialists. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.
What happens during laser treatment?
Both focal and scatter laser treatment are performed in our office at Quigley Eye Specialists. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.
The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eyes. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable.
You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses. For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.
What is a vitrectomy?
If you have a lot of blood in the center of the eye (the vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.
A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision to your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.
You will probably be able to return home after vitrectomy. Some people stay in a hospital overnight. Your eye will be red and sensitive. You will need to wear an eye patch for a few days or weeks to protect your eye. You also will need to use medicated eye drops to protect against infection.
Are scatter laser treatment and vitrectomy effective in treating proliferative retinopathy?
Yes. Both treatments are very effective in reducing vision loss. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have a high success rate, they do not cure diabetic retinopathy.
Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.
What can I do if I already have lost some vision from diabetic retinopathy?
If you have lost some sight from diabetic retinopathy, ask your doctor at Quigley Eye Specialists about low visions services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community’s organizations and agencies offer information about low vision counseling, training, and other special service for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.
What research is being done?
The National Eye Institute (NEI) is conducting and supporting research that seeks better ways to detect, treat, and prevent vision loss in people with diabetes. This research is conducted through studies in the laboratory and with patients.
For example, researchers are studying drugs that may stop the retina from sending signals to the body to grow new blood vessels. Someday, these drugs may help people control their diabetic retinopathy and reduce the need for laser surgery.
What can I do to protect my vision?
The NEI urges everyone with diabetes to have a comprehensive dilated eye exam at least once a year. If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.
A major study has shown that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight saving laser surgery.
This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.
Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.
Today, patients take an active role in their health care. Be an active patient about your eye care.
If you have diabetes, get a comprehensive dilated eye exam at least once a year.
Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.
For more information about low vision programs, you may wish to contact:
American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10001-2006
Council of Citizens with Low Visions International
111 East 59th Street
New York, NY 10022-1202
National Association for Visually Handicapped
22 West 21st Street, 6th Floor
New York, NY 10010-6493
What is macular degeneration?
Macular degeneration is the deterioration or breakdown of the macula. The macula is a small area in the retina at the back of the eye that allows you to see fine details clearly and perform activities such as reading and driving. When the macula does not function correctly, blurriness, dark areas or distortion can affect your central vision. Macular degeneration affects your ability to see near and far, and can make some activities like threading a needle, or reading, difficult or impossible.
Although macular degeneration reduces vision in the central part of the retina, it usually does not affect the eye’s side, or peripheral, vision. For example, you could see the outline of a clock but not be able to tell what time it is.
Macular degeneration alone does not result in total blindness. Even in more advanced cases, people continue to have some useful vision and are often able to take care of themselves. In many cases macular degeneration’s impact on your vision can be minimal.
What causes macular degeneration?
Many older people develop macular degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration (AMD). Exactly why it develops is not known, and no treatment has been uniformly effective. Macular degeneration is the leading cause of severe vision loss in Caucasians over 65.
The two most common types of AMD are “dry” (atrophic) and “wet” (exudative):
“Dry” Macular degeneration (atrophic) – Most people have the “dry” form of AMD. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual.
“Wet” Macular Degeneration (Exudative) – The “wet” form of macular degeneration accounts for about 10% of all AMD cases. It results when abnormal blood vessels form underneath the retina at the back of the eye. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.
Deposits under the retina called drusen are a common feature of macular degeneration. Drusen alone usually does not cause vision loss, but when they increase in size or number, this generally indicates an increased risk of developing advanced AMD. People at risk for developing advanced AMD have significant drusen, prominent dry AMD, or abnormal blood vessels under the macula in one eye (“wet” form).
What are the symptoms of macular degeneration?
Macular degeneration can cause different symptoms in different people. The condition may be hardly noticeable in its early stages. Sometimes, only one eye loses vision while the other eye continues to see well for many years. But when both eyes are affected, the loss of central vision may be noticed more quickly.
Following are the common ways vision loss is detected:
- Words on a page look blurred.
- A dark or empty area appears in the center of vision.
- Straight lines look distorted.
How is macular generation diagnosed?
Many people do not realize that they have a macular problem until blurred vision becomes obvious. Your doctor at Quigley Eye Specialists can detect early stages of AMD during a medical eye examination that includes the following:
- A simple vision test in which you look at a chart, called the Amsler grid, that resembles graph paper.
- Viewing the macula with a special instrument called an ophthalmoscope.
- Taking special photographs of the eye, called fluorescein angiography, to find abnormal blood vessels behind the retina.
How is macular degeneration treated?
Nutritional Supplements – Although the exact causes of macular degeneration are not fully understood, antioxidant vitamins and zinc may reduce the impact of AMD in some people.
A large scientific study found that people at risk for developing advanced stages of AMD lowered their risk by about 25% when treated with a high-dose combination of vitamin C, vitamin E, beta carotene and zinc. Among those who have either no AMD, or very early AMD, the supplements did not appear to provide an apparent benefit.
It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision that you may have already lost from the disease. However, specific amounts of these supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. You should speak with your doctor at Quigley Eye Specialists to determine if you are at risk for developing advanced AMD, and to learn if supplements are recommended for you.
Certain types of “wet” macular degeneration can be treated with laser surgery, a brief outpatient procedure that uses a focused beam of light to slow or stop leaking blood vessels that damage the macula. A treatment called photodynamic therapy (PDT) uses a combination of a special drug and laser treatment to slow or stop leaking blood vessels.
Another form of treatment targets a specific chemical in your body that is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor (VEGF). Anti-VEGF drugs block the trouble-causing VEGF, reducing the growth of abnormal blood vessels and slowing their leakage.
These procedures may preserve more sight overall, though they are not cures that restore vision to normal. Despite advanced medical treatment, many people with macular degeneration still experience some vision loss.
Adapting to low vision
To help you adapt to lower vision levels, your doctor at Quigley Eye Specialists can prescribe optical devices, or refer you to a low-vision specialist or center. A wide range of support services and rehabilitation programs are also available to help people with macular degeneration maintain a satisfying lifestyle. Because side vision is usually not affected, a person’s remaining sight is very useful. Often, people can continue with many of their favorite actives by using low-visions optical devices such as magnifying devices, closed circuit television, large-print reading materials, and talking or computer devices.
For more information on macular degeneration, please contact:
The American Academy of Ophthalmology
The American Macular Degeneration Foundation
Foundation Fighting Blindness