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Diabetic retinopathy is a complication of diabetes. High blood sugar levels damage the capillaries, or tiny blood vessels, that supply blood to the retina. The disease is usually diagnosed as early nonproliferative diabetic retinopathy or the more advanced proliferative diabetic retinopathy.
The eyeball is very similar to a camera. The colored part of the eye is the iris. At the center of the iris is the pupil, which is an opening that enlarges in the dark and shrinks in the light. This process works just like the diaphragm of a camera to control the amount of light that gets into the eye. The lens of the eyeball camera sits behind the iris. The back of the eye is lined by a thin tissue called the retina. Like film in a camera, the retina captures the light to create an image which is then sent to the brain through the optic nerve. The eyeball globe is filled with a jelly-like substance called the vitreous. This gel is firm when we are young and more watery as we age.
To function properly, the cells of the retina require fresh oxygen and other nutrients. These are delivered by capillaries, or tiny blood vessels, that connect the arteries to the veins.
The most common form of diabetic retinopathy is called background or non-proliferative disease.
In this form of the disease, high blood sugar levels create weak spots in the walls of the retinal capillaries. The weak spots can cause the walls of the capillaries to break and create tiny hemorrhages. These damaged capillaries leak fluid causing swelling in the surrounding retinal cells. The higher your blood pressure, the faster the fluid is forced out of the leaky vessels. The damaged capillaries also become clogged and are unable to deliver sufficient nutrients to the retinal cells. When capillary damage occurs in the center of your retina (the macula), your vision blurs. Visual blurring caused by non-proliferative retinopathy can't be corrected with glasses and long-term swelling can permanently reduce your central vision.
Proliferative retinopathy can occur in any diabetic but is most common in diabetics who develop the disease as children (known as type 1 or juvenile onset diabetics). It can occur alone or at the same time as non-proliferative disease.
In this advanced stage of the disease, the retinal cells do not receive enough oxygen which triggers the growth of abnormal blood vessels that grow into the vitreous gel in the center of the eye. These abnormal blood vessels may break, filling the vitreous gel with blood. A hemorrhage of this type can rapidly reduce vision and may take weeks or months to clear.
Over time, these blood vessels contract forming fibrous bands that can tear the retina and detach it from the back wall of the eye. A retinal detachment of this type can severely affect your vision.
Diabetic retinopathy is caused by elevated blood sugar levels. Too much sugar in your blood damages the tiny blood vessels (capillaries) that supply the retina. Other factors that may increase your risk of developing diabetic retinopathy include high blood pressure, pregnancy, a family history of retinopathy, kidney disease, high cholesterol, and a history of smoking.
Most of the time, there are no symptoms until the disease starts to change your vision. When this happens, diabetic retinopathy is usually already severe. Changes in vision can be a sign of severe damage to your eye. Changes can include:
We diagnose diabetic retinopathy by reviewing your medical and family history and performing a comprehensive eye exam that may include a photograph of your eye.
You can help prevent or slow the progression of diabetic retinopathy. Even if you have vision loss, it is important for you to be an active participant in your daily diabetes care. The following steps can help you retain good vision:
Treatment strategies include:
The best treatment for diabetic eye disease is the maintenance of excellent blood sugar and blood pressure control. If you already have diabetic retinopathy, establishing good blood sugar control will help to stabilize your vision loss and in some cases improve your vision. However, it may take some months of good control before vision is stabilized.
Your blood sugar levels fluctuate over the course of the day. Some very sensitive diabetics experience fluctuations in the sharpness of their vision during these changes even with the best pair of glasses. Here are some guidelines to help you receive the best possible pair of glasses:
It is important to find ways to adapt so that you can use your remaining eyesight to its greatest potential and identify the kinds of vision aids that are most helpful for you. Here are some recommendations.
If you have diabetes, your personal physician will automatically make an appointment for you to come in every 2 years to be screened for diabetic retinopathy. This screening will be included in the list of preventive services that we recommend for you.
After you come in for your screening, we will review the results. If there is evidence of retinopathy on the screening test, we will schedule an appointment for you to come in and see me or one of my colleagues in the Ophthalmology department.
I will examine one or both of your eyes to assess the severity of your retinopathy. I will administer eyedrops to dilate your pupil so that I can clearly see the structures in your eyes, including the retina. Your pupils will remain dilated for several hours, so you may wish to bring someone who can drive you home after your exam.
We will discuss potential lifestyle changes and therapies, and together we will create a treatment plan that is right for you.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.