Frequently Asked Questions about Diabetic Retinopathy

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What is diabetic retinopathy?

It is damage to the vessels and tissues in the retina caused by changes that occur in people with diabetes.

Are there different types of diabetic retinopathy?

Yes. Depending on the severity, there are different stages of the disease and it can also develop into diabetic macular oedema.

What is macular oedema?

Macular oedema is the inflammation of the macula, which is the part of the eye that provides our detailed, central vision. It occurs when the blood vessels in the retina start to leak fluids.

What can I do to help prevent diabetic retinopathy?

The main preventive measures for avoiding or delaying the onset of diabetic retinopathy in patients with diabetes are to maintain strict control over their blood glucose level, blood pressure and cholesterol level, and to quit smoking. Pregnant women with diabetes must receive regular eye examinations during the pregnancy and for 1 year after giving birth.

What is my glycosylated haemoglobin level so important?

Measurement of your glycosylated haemoglobin level indicates your blood sugar level over the last few weeks and it is known that a high value has a direct influence on microvascular complications such as diabetic retinopathy. Generally, it should not exceed 7%, although the target value must be individualised and established by your doctor.

Could I develop diabetic retinopathy even though my diabetes is always well-controlled?

Yes. Many patients who have had type 1 diabetes for over 20 years can develop diabetic retinopathy despite maintaining good control over their blood sugar levels. Other factors associated with the disease, such as inflammation and direct changes to the blood vessels, are also believed to cause retinopathy.

Even though my diabetes is well-controlled, could I lose my eyesight because I have macular oedema?

Yes, because the diabetes-induced damage to the retina develops several years after the onset of the disease. Therefore, a severe complication such as macular oedema could coincide with a period when your diabetes is very well-controlled.

Could I have mild diabetic retinopathy and yet still lose my vision?

Yes. Classifying diabetic retinopathy as mild refers to the fact that it only affects small blood vessels. However, if these are located in the centre of the retina, the fluids they leak could cause diabetic macular oedema and vision loss.

Does macular oedema always lead to blindness?

No. It can produce irreversible vision loss if it goes untreated, if it is not treated correctly or if it is treated too late and becomes chronic.

If one eye is affected, will the other eye automatically suffer the same fate?

The signs and symptoms of diabetic retinopathy may initially develop in just one eye. However, in general, both eyes are usually compromised, although not necessarily to the same degree.

Why do some people have diabetic retinopathy from the onset of type 2 diabetes?

When people are diagnosed with type 2 diabetes, they have often been living with diabetic changes for years, but without realising it. Therefore, they may already have diabetic retinopathy because their eyes have been suffering the secondary effects of diabetes for years.

What are the potential warning symptoms for a patient with diabetes?

Most patients with diabetes do not experience any loss of visual acuity until the final stages of the condition. As such, good eyesight does not necessarily correspond to the absence of retinopathy. In advanced stages of diabetic retinopathy, any vision loss could be irreversible and therefore you should never wait until you reach this point before visiting a specialist.

Si tengo una pérdida de visión brusca en el ojo y tengo diabetes, ¿qué debo hacer?

Acudir al oftalmólogo de urgencias. El especialista le hará un fondo de ojo para valorar la causa de la pérdida de visión.

What should I do if I have diabetes and I experience sudden vision loss?

You should visit the emergency ophthalmologist. The specialist will examine your eye fundus to assess the cause of vision loss.

Why should people with diabetes undergo regular examinations of the eye fundus? How is it performed?

Regular tests will detect cases of diabetic retinopathy in its early stages before it produces symptoms and develops into a more severe form. The most effective means are the retinography screening programmes performed by primary care centres. Photographs revealing damage or suspected disease are referred to the ophthalmologist for a more in-depth examination.

When should I start receiving eye examinations and how often?

Rigorous ophthalmological monitoring is essential, check-ups are normally performed once a year, although the frequency may be greater in more severe cases. The first ophthalmological examination, normally by taking photographs of the eye fundus, should be conducted within 3–5 years of diagnosis in patients with type 1 diabetes, whereas people with type 2 diabetes will undergo the test as soon as their condition is diagnosed.

How have the new imaging tests changed the way diabetic retinopathy is studied?

New imaging tests based around optical coherence tomography now provide important information without any side effects or discomfort for the patient, which is why these techniques are used more and more every day. Tests like fluorescein angiography are now conducted less frequently and only when there are very specific reasons.

Can diabetic macular oedema be cured with just one intravitreal injection?

No. A course of several injections are required to treat oedema until the swelling is reduced and the macula stabilised.

Can the new treatments provide a definitive cure for diabetic retinopathy and diabetic macular oedema?

No, although the treatments developed in recent years have brought about a considerable improvement in the lifestyle of these patients because they can decelerate disease progression and reduce vision loss. Ongoing research provides hope that future treatments will be even more effective.

Are ocular injections of cortisone derivatives dangerous?

No, their safety has been studied and internationally approved for the drugs currently on the market. As with other medicines, they have their advantages and disadvantages which each retina specialist must evaluate with the patient. It is important to remember that they help treat the disease and require fewer injections.

What is the current state of research into diabetic retinopathy?

Several studies are being conducted to learn more about retinopathy and diabetic macular oedema. For example, through both laboratory-based studies and ones involving patients, the Hospital Clínic’s Ophthalmology Research Unit is learning about the causes of these diseases and how to treat them. These studies will provide better means of detecting and treating vision loss in people with diabetes.

Substantiated information by:

Anna Sala
Marc Figueras
Victoria Hernández

Published: 3 July 2018
Updated: 3 July 2018

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