How does it develop?
Some people develop a condition called macular edema. This occurs when the damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which may cause decreased vision.

As the disease progresses, it enters its advanced, or proliferative, stage. New, abnormal blood vessels grow along the retina and in the clear, gel-like vitreous that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina.

What are the symptoms?
Diabetic retinopathy often has no early warning signs. As the disease develops, a person will experience blurred vision, making it hard to do things like read and drive. In some cases, vision will get better or worse during the day.

As new blood vessels form at the back of the eye, they can bleed (hemorrhage) and blur vision. The first time this happens it may not be severe. In most cases, it will leave just a few specks of blood, or spots, floating in your vision. They often go away after a few hours.

These spots are often followed within a few days or weeks by a much greater leakage of blood. In extreme cases, a person will only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from the inside of the eye. In some cases, the blood will not clear. Be aware that large hemorrhages tend to happen more than once.

It is important for all people with diabetes to have a dilated eye exam every year. Your eye doctor will look for: (1) leaking blood vessels, (2) retinal swelling, such as macular edema, (3) pale, fatty deposits on the retina - signs of leaking blood vessels, (4) damaged nerve tissue, and (5) any growth of abnormal blood vessels.

Who is at risk for this disease?
All people with diabetes are at risk - those with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset).

During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.

How is diabetic retinopathy treated?
There are two treatments for diabetic retinopathy: laser surgery and vitrectomy.
1) Doctors will perform laser surgery to treat severe macular edema and proliferative retinopathy.

Macular Edema: Timely laser surgery can reduce vision loss from macular edema by half. But you may need to have laser surgery more than once to control the leaking fluid. During the surgery, your doctor will aim a high-energy beam of light directly onto the damaged blood vessels. This is called focal laser treatment. This seals the vessels and stops them from leaking. Generally, laser surgery is used to stabilize vision, not necessarily to improve it.

Proliferative Retinopathy: In treating advanced diabetic retinopathy, doctors use the laser to destroy the parts of the retina that are causing the abnormal blood vessels to grow. Although these treatments are very successful, they do not cure diabetic retinopathy.

2) An eye operation called a vitrectomy is performed if there is a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a salt solution. Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous.

How can you protect your vision?
All people with diabetes should have an eye examination through dilated pupils at least once a year. If you have more serious retinopathy, you may need to have a dilated eye examination more often.

A recent study, the Diabetes Control and Complications Trial (DCCT), showed that better control of blood sugar levels slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy. Other facts you should know
At first, you may notice no changes in your vision. But it could get worse over the years and threaten your good vision. With timely treatment, 90 percent of those with advanced diabetic retinopathy can be saved from going blind.

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Women's Eye Health	Diabetic Retinopathy

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