About Diabetic Retinopathy Exams, Diagnosis & Treatment

Diabetic eye disease and in particular diabetic retinopathy represents a major challenge for patients in our diabetic community. The eye doctors at Nevyas Eye Associates/Moore Eye Institute provide examination, diagnosis and treatment of diabetic eye problems including diabetic retinopathy. Diabetic Retinopathy is the most frequent cause of new cases of blindness among adults aged 20-74 years. However, with early diagnosis and treatment, progression of the disease and its associated vision loss can at a minimum be slowed, and in many cases vision loss from diabetic retinopathy can be prevented.

Stages of Diabetic Retinopathy
Diabetic Retinopathy tends to appear and progress in the following stages:

  • Mild Nonproliferative Retinopathy
    This is the earliest stage and is characterized by the presence of “dot” and “blot” hemorrhages and “microaneurysms” in the retina. These can be present without any change in your vision. Typically, mild nonproliferative retinopathy does not require treatment unless it progresses or is accompanied by Diabetic Macular Edema.
  • Moderate Nonproliferative Retinopathy
    This is the second and slightly more severe stage with more extensive changes whereby some of the small blood vessels in the retina become damaged enough that they close off. This interferes with delivery of nutrients and oxygen to certain areas of the retina, resulting in ischemia.
  • Severe Nonproliferative Retinopathy
    This next stage is characterized by an extensive amount of retinal blood vessel damage and ischemia with patients at a high risk of going to the next stage of retinopathy -- the proliferative stage.
  • Proliferative Retinopathy
    This is the most severe stage and has a significant risk of vision loss. To compensate for the lack of oxygen, areas of the retina send signals to stimulate the growth of new abnormal and fragile blood vessels in order to try to reestablish the supply of oxygen. These fragile abnormal new vessels are called neovascularization. These vessels tend to break and hemorrhage into the vitreous gel. They can scar and cause retinal detachment, with catastrophic vision loss. It is critical that this stage be treated as promptly as possible in order to stop the progression and preserve good vision.

Leakage from the retinal blood vessels may cause accumulation of fluid in the center of the retina, a condition called Diabetic Macular Edema (DME), which can occur in any stage of retinopathy. Diabetic Macular Edema is a very common cause of vision loss from diabetes. It is also possible to have Diabetic Macular Edema and not have vision loss.

Routine eye exams including dilated retinal exams and retinal photos should be scheduled for all patients with diabetes at least once a year. Depending on the health of your retina, exams may be needed more often. One of the most effective and accurate ways to observe and diagnose diabetic retinopathy, including Diabetic Macular Edema (DME), is to perform Optical Coherence Tomography (OCT).

Depending on the stage of retinopathy and the degree of vision loss, it is possible to treat, stabilize and often reverse the effects of diabetic retinopathy. Treatment of diabetic retinopathy can use retinal laser photocoagulation treatment as well as intravitreal medications that deter growth of new vessels. These medications are “Anti-VEGF”, or Vascular Endothelial Growth Factor Inhibitors. Optimal results require early detection and diagnosis for treatment. Intravitreal use of VEGF Inhibitor drugs is e often recommended as the primary treatment for management of vision threatening complications of diabetic retinopathy. However, successful management of diabetic eye problems requires early diagnosis and treatment.