What is Diabetic Retinopathy

This blog has been contributed by Dr. Luisa Sastre, Consultant Ophthalmologist in Medical Retina and Cataract Surgery.

Diabetes is a significant public health issue across the Gulf region, including the UAE, Saudi Arabia and Kuwait. According to the international diabetes federation, approximately 20.7% of UAE adults are living with diabetes, equating to around 1.25 million adults, or 1 in 6 adults.

Diabetes is a chronic condition that affects how the body absorbs, stores, and utilises sugar from food. When this process is impaired, it leads to hyperglycemia, elevated blood sugar levels. Over time, consistently high blood sugar levels can damage blood vessels and nerves, leading to complications in multiple organs, including the eyes.

One of the most serious eye-related complications of diabetes is Diabetic Retinopathy. Despite its potential severity, it often develops gradually and without noticeable symptoms, making regular eye screenings essential for all individuals living with Diabetes.

In this blog, we explore the connection between Diabetes and vision, explaining the causes and progression of diabetic retinopathy, and provide insights into modern treatment options available.

What are the different types of diabetes?

There are two main types of Diabetes:

• Type 1 Diabetes is typically diagnosed in children or young adults. It is often referred to as “insulin-dependent” Diabetes and results from an autoimmune process where the pancreas produces little or no insulin.
• Type 2 Diabetes is the most common form and primarily affects adults over the age of 40, although it is increasingly seen in younger individuals. It is closely linked to obesity, sedentary lifestyles, and genetic predisposition.

What are the genetic factors of diabetes?

• If one parent has type 2 Diabetes, the child’s risk is approximately 40%.
• If both parents are affected, the risk increases to 70%.
• For type 1 Diabetes, the hereditary risk is significantly lower at around 5%.

What Is Diabetic Retinopathy?

Diabetic Retinopathy is a complication of diabetes that occurs when persistently high blood sugar levels damage the blood vessels of the retina which is the thin, light-sensitive tissue lining the back of the eye.

As the condition progresses, these vessels may swell, leak, or become blocked, resulting in reduced blood flow to the retina. In more advanced stages, abnormal new blood vessels may grow, potentially leading to bleeding, scar tissue formation, and further complications such as retinal detachment.

What leads to diabetic retinopathy?

There are various risk factors that contribute to the development of diabetic retinopathy, which include:

• Duration of diabetes (the longer a person has diabetes, the higher the risk)
• Poor blood sugar control
• High blood pressure
• Elevated cholesterol or lipid levels
• Kidney disease
• Pregnancy (in women with pre-existing diabetes)

What are the symptoms of diabetic retinopathy?

Diabetic Retinopathy often develops silently, without pain or obvious vision changes in the early stages. However, some individuals may experience:

• Blurred or fluctuating vision
• Impaired night vision
• Difficulty transitioning between light and dark
• Spots or dark strings (floaters) in their field of vision
• Partial or total vision loss in advanced cases

It is important to note that good vision does not rule out the presence of diabetic retinopathy. Regular diabetic eye examinations are important even in the absence of symptoms.

How is diabetic retinopathy diagnosed?

A retina specialist uses advanced diagnostic tools to detect and monitor diabetic retinopathy:

• Fundus Examination: A detailed evaluation of the retina using specialised lenses and lighting.
• Optical Coherence Tomography (OCT): A non-invasive imaging scan that captures cross-sectional views of the retina to detect swelling or structural changes.
• Fluorescein Angiography: A dye-based test used to assess blood vessel leakage and identify areas of poor circulation or abnormal growth.

These tests allow for accurate staging of the condition and guide the development of an individualised treatment plan.

What are the different stages of Diabetic Retinopathy?

1. Mild Non-Proliferative Retinopathy: Small bulges in blood vessels (microaneurysms) appear.
2. Moderate Non-Proliferative Retinopathy: Some blood vessels become blocked.
3. Severe Non-Proliferative Retinopathy: More vessels are blocked, cutting off blood supply.
4. Proliferative Diabetic Retinopathy (PDR): New, fragile blood vessels grow, which can bleed or cause scar tissue.

Another related condition, Diabetic Macular Oedema (DME), can occur at any stage and involves swelling in the central part of the retina (macula), resulting in blurred central vision.

Treatment Options for Diabetic Retinopathy

Treatment is tailored based on the severity and progression of the disease. Common options include:

1. Observation: For early or mild cases, regular monitoring may be sufficient, especially if there are no symptoms or changes in vision.
2. Intravitreal Injections: Medications such as anti-VEGF agents or steroids are injected directly into the eye to reduce retinal swelling, stop blood vessel leakage, and prevent new abnormal vessels from growing
3. Laser Therapy
   • Conventional Laser Photocoagulation: Targets leaking blood vessels or oxygen-deprived retinal areas in severe cases.
   • Subthreshold Micropulse Laser: A gentler, more targeted approach that minimises damage to surrounding tissue.
4. Subthreshold Micropulse Laser: A gentler, more targeted approach that minimises damage to surrounding tissue.
5. Vitrectomy Surgery: In advanced cases involving retinal detachment, dense bleeding (vitreous haemorrhage), or scar tissue, surgery may be necessary to restore vision and prevent further damage.

Importance of early diagnosis for Diabetic Retinopathy

Early diagnosis of diabetic retinopathy significantly improves treatment outcomes and helps prevent permanent vision loss. Annual dilated eye exams are strongly recommended for:

• All individuals with type 1 diabetes (starting within 5 years of diagnosis)
• All individuals with type 2 diabetes (starting at diagnosis)
• Pregnant women with diabetes (ideally before conception and during each trimester)

Consistent control of diabetes, combined with regular eye screening, is the cornerstone of prevention.

Living with Diabetes: Protecting your vision

Maintaining eye health with diabetes requires a comprehensive approach:

• Keep blood sugar, blood pressure, and cholesterol within recommended levels
• Adhere to prescribed medications and treatment plans
• Maintain a healthy diet and stay physically active
• Avoid smoking and limit alcohol consumption
• Prioritise annual eye exams—even if your vision seems fine

Your eye health is closely tied to your overall diabetic management plan. By staying proactive, you can preserve your sight and prevent complications.

Conclusion

Diabetic Retinopathy is one of the leading causes of preventable vision loss in the working-age population. The good news is that with regular monitoring and timely intervention, vision loss can often be slowed, stopped, or even reversed.

At Moorfields Eye Hospital Dubai, our retina specialists provide expert diabetic eye care utilising the latest diagnostic technologies and advanced treatments to ensure each patient receives a tailored management plan.

Frequently Asked Questions (FAQs) about Diabetic Retinopathy

1. Can diabetic retinopathy affect both eyes?                                                                                                                            Yes, diabetic retinopathy commonly affects both eyes. However, the degree of involvement may differ from one eye to the other. It’s not unusual for one eye to show more advanced damage while the other appears to be in an earlier stage. This asymmetry makes it essential for each eye to be evaluated separately during an examination. Since diabetic retinopathy can begin silently, even without noticeable symptoms, routine screenings by an ophthalmologist are critical for both eyes, regardless of how well a person may feel they are seeing.
2. How long does it take for diabetic retinopathy to develop?                                                                                              The timeline varies from person to person. In individuals with type 2 diabetes, which often goes undiagnosed for several years, diabetic retinopathy may already be present at the time of diagnosis. In contrast, those with type 1 diabetes typically begin to develop changes in the retina after about five years of living with the condition. However, the onset and severity depend on how well diabetes is controlled. Factors such as persistent high blood sugar, unmanaged blood pressure, and elevated cholesterol levels can accelerate the progression of retinopathy.
3. Can diabetic retinopathy be reversed?
   Unfortunately, the structural damage caused by advanced diabetic retinopathy such as scarring, retinal detachment, or blood vessel closure is often irreversible. However, if diagnosed in its early stages, diabetic retinopathy can be managed effectively. Treatments like laser therapy, intravitreal injections, and surgical procedures can help preserve the remaining vision and prevent the disease from progressing further. Early detection offers the best chance for stabilising the condition and maintaining quality of life.
4. Does vision always improve after treatment?
   Not always. The goal of treatment is to halt or slow down disease progression. While some patients do experience an improvement in vision, especially if they begin treatment early, others may not experience changes. For instance, if the macula (the central part of the retina responsible for sharp vision) has been affected, recovery may be limited. Nevertheless, stabilising the condition and avoiding further deterioration is a major success, particularly when intervention happens before irreversible damage has occurred.
5. Can I prevent diabetic retinopathy?
   While it is not always possible to completely prevent diabetic retinopathy, its development and progression can be significantly delayed through good diabetes management. Keeping blood glucose levels within the target range, controlling blood pressure and cholesterol, avoiding smoking, staying physically active, and attending regular medical and eye check-ups all contribute to lower risk. People who consistently monitor and manage their diabetes tend to have milder forms of retinopathy and better long-term vision outcomes
6. How often should I have my eyes checked if I have diabetes?                                                                                                        For individuals with diabetes, an annual comprehensive dilated eye exam is recommended. These exams allow ophthalmologists to detect changes in the retina before symptoms arise. If retinopathy is already present or if other risk factors exist such as pregnancy or poor diabetes control more frequent visits may be advised. Regular eye screenings are essential because diabetic retinopathy can develop and progress silently. Proactive monitoring helps ensure that any early signs are addressed before they escalate into vision-threatening complications