Advanced diabetic retinopathy is a serious eye complication of diabetes. It signifies a progression from earlier forms, where uncontrolled blood sugar levels have extensively damaged the delicate blood vessels within the retina. This advanced stage can lead to significant vision impairment.
How Diabetic Retinopathy Progresses
Diabetic retinopathy begins when high blood sugar levels weaken the small blood vessels in the retina, the light-sensitive tissue at the back of the eye. In initial stages, known as non-proliferative diabetic retinopathy (NPDR), these vessels may develop tiny bulges or microaneurysms, and some can leak fluid or close off. As NPDR progresses, more blood vessels become blocked, reducing blood flow and oxygen supply to parts of the retina.
The eye attempts to compensate for this lack of oxygen by growing new, abnormal blood vessels on the retina’s surface, a process called neovascularization. This marks the transition to the advanced stage, proliferative diabetic retinopathy (PDR). These new vessels are fragile, often growing into the vitreous, the jelly-like substance filling the eye. They are prone to bleeding and can lead to scar tissue formation, which can pull on the retina.
Signs and Visual Changes
Individuals with advanced diabetic retinopathy may experience various symptoms. Floaters are a common symptom, appearing as dark spots or “cobwebs” that drift across the field of vision. These floaters often result from vitreous hemorrhage, where fragile new blood vessels bleed into the vitreous gel. Extensive bleeding can significantly obscure vision, sometimes causing sudden, painless vision loss or a red tint to vision.
Another serious complication is retinal detachment, occurring when scar tissue from abnormal blood vessel growth pulls the retina away from the back of the eye. Symptoms of retinal detachment can include flashes of light, a sudden increase in floaters, or a “curtain” or shadow appearing over a portion of the visual field. Blurred or distorted vision, difficulty seeing at night, or blank areas in vision are also common as the condition advances.
Confirming the Diagnosis
Diagnosing advanced diabetic retinopathy involves a comprehensive eye examination by an ophthalmologist. A dilated eye exam uses special eye drops to widen pupils, allowing a clear view of the retina. This enables the detection of abnormal blood vessels, bleeding, or swelling.
Optical Coherence Tomography (OCT) uses light waves to create detailed cross-sectional images of the retina. OCT can detect subtle changes like retinal swelling, fluid accumulation, and scar tissue, providing precise measurements of retinal thickness. Fluorescein angiography involves injecting a special dye into the bloodstream and taking photographs as the dye travels through retinal blood vessels. This test highlights leaking blood vessels, areas of poor circulation, and the growth of new, abnormal vessels characteristic of advanced retinopathy.
Current Treatment Options
Treatment for advanced diabetic retinopathy aims to preserve vision and prevent further damage. Anti-VEGF injections are a common treatment, involving injecting medications like ranibizumab, bevacizumab, or aflibercept into the eye. These drugs block vascular endothelial growth factor (VEGF), a substance promoting abnormal blood vessel growth and leakage. Anti-VEGF injections can reduce new vessel growth and decrease swelling in the macula, the central part of the retina responsible for sharp vision.
Laser photocoagulation, specifically panretinal photocoagulation (PRP), involves creating laser burns across the peripheral retina. This process destroys areas of the retina to reduce oxygen demand, shrinking abnormal blood vessels and preventing new ones. While PRP can help stabilize the condition and reduce the risk of severe vision loss, it may sometimes affect peripheral or night vision.
Vitrectomy surgery is performed for more severe complications, such as non-clearing vitreous hemorrhage or tractional retinal detachment. During this procedure, the surgeon removes the vitreous gel from the eye, along with any blood or scar tissue pulling on the retina. This allows the retina to reattach to the back of the eye, helping to restore or preserve vision. The choice of treatment depends on the specific complications and severity of the condition.
Living with Advanced Diabetic Retinopathy
Managing advanced diabetic retinopathy requires ongoing comprehensive health management beyond eye treatments. Strict blood sugar control is crucial, as high glucose levels directly damage retinal blood vessels. Regular monitoring of blood pressure and cholesterol is also important, as these factors can accelerate disease progression.
Adherence to prescribed medications and treatment plans, including regular eye injections or laser sessions, is crucial for stabilizing vision and preventing decline. Regular comprehensive eye exams, annually or more frequently as recommended, are necessary to monitor the condition and adjust treatment. For significant vision changes, low vision aids like magnifiers, specialized lighting, and adaptive technologies can maximize remaining vision and maintain independence. Support groups and educational resources can also provide assistance for adapting to life with vision impairment.