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What is Diabetic Retinopothy (DRP)?

DRP deals with the long-term effects of diabetes mellitus on the retina. The cause of DRP lies in the disturbance of the cellular metabolism through chronically raised blood sugar levels. There are 2 different types of diabetes. Diabetes type 1, which appears in childhood and adolescence, results from the absence of insulin (the blood sugar reducing hormone) production in the pancreas. Type 2 diabetes mellitus, which appears at older ages, is caused by too little insulin production in the pancreas. Type 2 diabetes is the so-called prosperity illness and, in many people, it appears in connection with genetic predisposition, predominantly through overweight, unhealthy nutrition and lack of exercise. Because of an increasingly improving standard of living, it can be assumed that the number of diabetics, and therewith also the number of cases of DRP, will increase.

How does DRP develop?

The development of DRP is brought about by a narrowing and increasing closing of the retinal blood vessels, causing inadequate circulation in the retina and insufficient provision of nutrients to the retina. The longer the diabetes exists and the more the blood sugar fluctuates, as a rule, the earlier the onset of DRP. High blood pressure, smoking, and phases of hormonal changes (e.g. puberty or pregnancy) can be considered further risk factors. DRP is found in up to 90% of type 2 diabetics after about 20 years of having the illness, and signs of DRP appear after 10-15 years in type 1 diabetics.  DRP is the prime cause of blindness in adults in Europe and the USA.

How can DRP be diagnosed by the eye doctor?

Changes in the retina (with fat storage) after many years of diabetes
Changes in the retina (with fat storage) after many years of diabetes

In the first stage of DRP, changes in the blood vessels at the back of the eyes, small haemorrhages and focal fat storage on the retina are identifiable. With further progression, the sharpest point of vision (macula) is affected, in the form of fluid build-up. This so-called diabetic macular oedema (swelling) is later followed by the end stage: proliferative DRP. The poor provision of oxygen and nutrients to the retina, brought on by the closing of the vessels, can trigger the growth of new, abnormal vessels in the vitreous gel. In many cases of this serious form of DRP, there is haemorrhaging and retinal detachment. Additionally, the pathological creation of new vessels on the iris and in the anterior chamber can lead to an increase in intraocular (inner eye) pressure.

How is diabetic retinopathy recognisable?

DRP can remain undetected for a long time in diabetics. Over time however, spot-shaped losses in the field of vision appear, which patients perceive as small black shadows. The shadows become bigger and bigger with the advancement of DRP, and when the macula is affected there is a serious reduction of visual acuity.

If bleeding appears in the vitreous body, or if the retina detaches, the vision of the person affected will suddenly worsen.

What treatments are possible for diabetic retinopathy?

DRP after extensive argon laser coagulation
DRP after extensive argon laser coagulation

The most important thing for stopping DRP is optimising blood pressure and blood sugar levels, as strong fluctuation of these parameters can speed up the onset of DRP. Regular check-ups with your eye doctor are a further important pillar in preventive therapy for DRP. Your eye doctor should treat changes in retinal vessels and smaller haemorrhages  in due time, using argon laser coagulation, in order to reduce the production of new, abnormal vessels. In the case of macular edema, an injection of cortisone into the vitreous can support the reduction of fluid. With sudden loss of vision due to vitreous bleeding or a detached retina, the vitreous has to be removed surgically, in order to re-attach the retina with a laser procedure. A new form of treatment for DRP is the repeated injection of antibodies (e.g. Macugen®, Lucentis®, Avastin®) into the vitreous in order to hold back the formation of new vessels in proliferative DRP.