Causes Of Diabetic Retinopathy
Diabetes is a chronic condition in which the glucose or sugar levels in the body gets high leading to various problems, including damage to small blood vessels.
Our eyes contain many microvessels or small vessels that help transport blood to its various parts. High glucose in blood vessels increases the blood pressure in these vessels leading to its narrowing, along with damage to its inner linings. [2]
As a result, the arteries respond by forming a plaque-like layer to fill the damage to the arteries, and leads to blockage in the tiny vessels that prevents the supply of blood to the eyes. Also, when the eyes try to grow new blood vessels, they do not grow properly leading to leakage problems. This results in diabetic retinopathy.
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Stages Of Diabetic Retinopathy
Diabetic retinopathy is classified into two main stages based on its progression:
1. Non-proliferative diabetic retinopathy (NPDR)
It is the early stage of diabetic retinopathy and occurs in most diabetics. The NPDR is developed when the blood vessels supplying your retina (and eyes) get obstructed. This results in microaneurysms (minute bulges), haemorrhages and hard exudates formed all over the blocked vessels as they fail to push out the blood. The swelling and blockage of blood supply in the eyes result in blurred or poor vision. [3]
2. Proliferative diabetic retinopathy (PDR)
It is the advanced stage of diabetic retinopathy. Once the disease has progressed considerably and a large number of arteries are occluded, new vessels start to develop from these obstructed ones. Only, they are abnormal blood vessels and fail to supply the blood to the eyes properly, and instead leak blood and fluid into the clear jelly of the eyeball (the vitreous humour). This leads to dark floaters and then vision loss. [4]
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Symptoms Of Diabetic Retinopathy
Diabetic retinopathy develops over time. At an early stage, the patient may be asymptomatic and show symptoms only when the disease has progressed considerably.
Some of the symptoms of diabetic retinopathy include: [1]
- Blurred vision
- Fluctuating field of vision
- Floaters - dark strings/spots that float past your field of vision due to haemorrhaged blood in the vitreous humour of the eye.
- Colour blindness
- Poor night vision
- Blindness
Risk Factors Of Diabetic Retinopathy
Diabetes retinopathy can affect individuals with both diagnosed and undiagnosed diabetes mellitus. Its development is directly proportional to the age, duration, diabetic control and fluctuation of blood pressure in the patient.
Some of the risk factors of diabetic retinopathy include:
1. Age of the patient
The risk of developing diabetic retinopathy is considerably higher in older patients due to their age than adults or children. [5]
2. Status of blood sugar
People who have poorly controlled blood sugar are at a greater risk of developing the complications associated with diabetes, including diabetic eye disease.
3. Duration of diabetes
If a person has had diabetes for many years, they are at increased risk of the condition, compared to those who have developed recently. Sometimes, the duration of diabetes may vary as the condition remains undiagnosed in many due to late detection.
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4. High Blood Pressure
The body's blood vessels are not equipped to handle blood rushing through them under high pressure for long durations of time. That's why those who suffer from hypertension may often develop arterial complications, including diabetic retinopathy. [6]
5. High Cholesterol
Cholesterol plaques can clog the arteries supplying blood to the heart. They can even clog the arteries in the peripheries of your body, including the eyes causing diabetic retinopathy. [7]
6. Pregnancy
Pregnancy is the time period in which the fluctuations of hormones are hormones, including insulin hormones. Therefore, along with gestational diabetes, it may also lead to the development of diabetic retinopathy. [8]
7. Nephropathy
Diabetic retinopathy is common in 90 per cent of nephropathy patients who are above 20 years of age and with type 1 diabetes, says a study. [9]
8. Other factors
- Puberty
- Inflammation
- Vitamin D
- Oxidative stress
- Genetic factors
Complications Of Diabetic Retinopathy
Untreated diabetic retinopathy can lead to problems like [11]
- Retinal detachment
- Glaucoma
- Vitreous haemorrhage
- blindness
Diagnosis Of Diabetic Retinopathy
In case the doctor suspects of severe retinopathy, they may order for fluorescein angiography to examine the retina and see any signs of damage., blockage, leakage or abnormal growth of blood vessels. Optical coherence tomography (OCT) is also suggested for examining the retina.
