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"  Diabetic retinopathy is an eye disease that&amp;#039;s associated with long-standing diabetes. It&amp;#039;s a major cause of poor vision in the UK.  Retinopathy can occur with all types of diabetes. If left untreated, diabetic retinopathy can lead to blindness. What causes diabetic retinopathy? The longer a person has diabetes, the higher their chances of developing diabetic retinopathy.  Prolonged periods of high blood sugar levels cause damage to the small blood vessels in the retina at the back of the eye. The retina is the film at the back of the eye, which receives light images and sends them to your brain. A healthy retina is essential for good vision.  These blood vessels are damaged by high blood sugar levels and initially become leaky, later they may become blocked off.  The leaky vessels can lead to haemorrhages (spots of bleeding), fluid and exudates (fats) to escape from the blood vessels on to the retina. This may also cause swelling, known as oedema of the retina.  The blocked vessels can starve the retina of oxygen, leading to the growth of new abnormal vessels from the retina, and damage to the retina due to lack of oxygen (ischaemia).  Good control of diabetes by controlling the blood sugar level helps to reduce the chances of developing retinopathy. Good control of blood pressure levels and cholesterol levels are also important for healthy eyes in diabetes. What are the different types of diabetic retinopathy? It can be classified in different ways, but there are three main types:  non-proliferative retinopathy maculopathy proliferative retinopathy.   These are not different diseases, but they are different stages of the same condition. This means the type you have may change as the disease progresses. It&amp;#039;s also possible to have more than one type at once. Non-proliferative retinopathy  There are tiny swellings in the blood vessel walls. These blebs (micro-aneurysms) appear as small red dots on the retina. There are tiny yellow patches of hard exudates (fats from the blood) on the retina. Dots and blots of haemorrhage (bleeding) appear on the retina.  This type of retinopathy is not sight-threatening, but needs to be monitored by a doctor who is trained in eye disease (ophthalmologist).  If non-proliferative retinopathy is not monitored it may progress to a more severe form of retinopathy \u2013 proliferative retinopathy \u2013 and this is sight-threatening.  Did you know? Non-proliferative retinopathy is also called background retinopathy. Maculopathy  The area of the retina we use most is called the macula. It is at the centre of the retina and provides our central vision, the macula is essential for clear, detailed vision.  In maculopathy, the haemorrhages, exudates and swellings of the non-proliferative stage occur in the macula.  This may interfere with vision, particularly for reading and seeing fine details.  If maculopathy is not monitored it may get worse and eventually cause loss of vision. Proliferative retinopathy In proliferative retinopathy, some of the tiny blood vessels in the retina become blocked. In response to this lack of blood in the retina, new abnormal blood vessels grow.  These blood vessels are fragile and may:  bleed into the eye (vitreous haemorrhage) stimulate the growth of abnormal fibrous tissues that can cause the retina to peel away from the back of the eye (detach).  Both these complications cause a reduction in vision. If these new, abnormal blood vessels were left untreated, it could eventually lead to blindness.  In addition, the abnormal blood vessels increase the likelihood of a type of glaucoma that is very difficult to treat.  Proliferative retinopathy causes no symptoms until it is very advanced. If a vitreous haemorrhage develops, it can cause sudden loss of vision in one eye. How is it diagnosed? Diagnosis is made by examining the back of the eye (retina), using special instruments.  Until diabetic retinopathy is at an advanced stage, vision is not usually affected. This means it&amp;#039;s usually detected by routine checks, making regular eye examinations a must for people with diabetes.  In the UK, all people with diabetes are screened for diabetic retinopathy on an annual basis.  If there&amp;#039;s any evidence of retinopathy picked up, you will be referred to an eye clinic. The frequency of follow-up then needed depends on the extent of the retinopathy, but early diagnosis will also help treatment. What are the risk factors?  There is an increased risk of retinopathy:  with poor blood sugar control, ie levels are too high for too much of the time if there&amp;#039;s protein in your urine if you have high blood pressure the longer you&amp;#039;ve had diabetes  if you have raised levels of fats (cholesterol and triglycerides) in the blood  the more blood vessel swellings you have (micro-aneurysms) with pregnancy (but not in diabetes caused by pregnancy).   This list has some things in common with that for diabetic kidney disease. What can I do to avoid diabetic retinopathy Diabetic retinopathy is not entirely preventable, but it&amp;#039;s clear that long-term good control of diabetes helps to reduce your risk.  You also need to pay attention to the risk factors for heart disease, because they also affect the likelihood of retinopathy. You can do this by:  stopping smoking  getting blood pressure and cholesterol checked regularly, and keeping them under control having regular eye check-ups \u2013 do not miss screening appointments if you have diabetes.  How is diabetic retinopathy treated?  Background retinopathy  This requires no treatment, although regular eye examinations are essential because it may progress. Maculopathy  Laser treatment Laser is a type of light that&amp;#039;s applied to the back of the eye causing burns.  These many tiny burns destroy small areas of the retina.  It&amp;#039;s carried out in hospital:  no anaesthetic is required some drops are put in the eye to numb it the number of burns ranges from 50 to 2000.  This treatment should be painless, although some sensation may be felt.  Usually there are no side-effects. Often, this doesn&amp;#039;t require treatment. Laser treatment is used when the leakage starts to threaten good vision.  While laser treatment may not improve vision, it often prevents deterioration. Intravitreal anti VEGF injections In the past few years a new type of treatment for maculopathy has been discovered. This is called intravitreal anti VEGF injections.  The treatment was invented for a disease called age related macular degeneration (ARMD), which is not related to diabetes.  Trials have found that it can improve vision in patients with diabetic maculopathy. The treatment is an injection into the eyeball of a drug, which stops the damaged blood vessels from leaking.  This reduces the amount of swelling at the back of the eye and can help to improve vision. Intravitreal anti VEGF injections are now routinely used, along with laser treatment, for the treatment of maculopathy. Most patients require a course of treatment, not a single injection.  The course of treatment is likely to go on for several months because the effect of the injection therapy can wear off quickly so repeat injections are needed. Usually injections are given every 1 to 2 months. Intravitreal steroid implant In recent years trials have found good results in the treatment of maculopathy using an injection of corticosteroid.  The medicine is in a slow-release tablet which is injected into the eye and dissolves slowly over a few months, gradually releasing the steroid.  Like anti-VEGF injections the effect of the drug may wear off and the patient may require further therapy in the future. The effect usually lasts several months and sometimes longer.  The corticosteroid implant may cause cataract and raised pressure in the eye (glaucoma) so patients need to be monitored for these conditions. Not all patients are suitable for the treatment if they are at risk of developing side effects. Proliferative retinopathy When abnormal blood vessels form, laser treatment is used to make the vessels &amp;#039;regress&amp;#039; or go away.  The laser isn&amp;#039;t used on the blood vessels directly, but it&amp;#039;s scattered over the whole retina (pan retinal photocoagulation).  This destroys the area of retina, which is starved of oxygen, eliminating the need for the abnormal vessels.  If a lot of laser is required to treat the abnormal blood vessels, peripheral (side) vision may be affected. This may lead to a problem with night vision or interfere with driving. Surgery  In rare cases eye surgery is necessary.  This may be done:  if there has been bleeding into the eye from the abnormal blood vessels (vitreous haemorrhage) if proliferative retinopathy has been identified at a late stage if laser treatment has been ineffective.   This type of surgery is called vitrectomy. It involves removing the vitreous (jelly) from the back of the eye. During the process bleeding is also removed.  Laser treatment may be applied at the time of the operation. In the long-term If diabetic retinopathy has been diagnosed, and provided it hasn&amp;#039;t reached an advanced stage, good control of blood sugar will prevent it from developing further.  So, keep your blood sugar level as near normal as possible, and have regular annual check-ups by a hospital diabetologist and ophthalmologist. It&amp;#039;s also important your blood pressure and cholesterol are well controlled.  Many high street opticians are now involved in shared-care arrangements for diabetes. Photographs of the retina can be taken with special cameras and allow detailed examination. Other people also read: Diabetes overview: find out how common diabetes is. Hypoglycaemia (low blood glucose) in diabetic patients: what causes hypoglycaemia? Eye tests: find out how to prepare for eye tests. Age related macular degeneration (ARMD): we look at the different types of macular degeneration.  Based on a text by Jan Erik Henriksen, Ole Hother Nielsen, Prof Henning Beck-Nielsen  Last updated 24.11.2014 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/conditions/diabetes/a833/diabetic-retinopathy-eye-disease/>