Nearly 4 million Canadians, or approximately 10% of Canada’s population, live with diagnosed diabetes. A staggering number that is only predicted to increase in the coming years.
Diabetes affects the entire body by damaging blood vessels and nerves, including those in your eyes. In fact, diabetic retinopathy is estimated to affect 25% of diabetics in Canada, and diabetic retinopathy can cause significant vision impairment and is the leading cause of blindness amongst working Canadians.
But what is diabetic retinopathy, how is it staged, what are its symptoms/early signs, and can it be managed or treated?
Key takeaways
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Diabetic retinopathy often starts with no symptoms.
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Annual dilated eye exams are the most effective way to detect changes early.
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Keeping blood sugar, blood pressure, and cholesterol in a healthy range lowers risk and slows progression.
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Sudden blurry vision, new floaters, flashes of light, dark shadows, or a curtain in your vision are all signs you should see an eye doctor right away.
What is Diabetic Retinopathy and Why Early Detection Matters
Diabetic retinopathy is one of the most common vision concerns for people with diabetes in Canada. This disease causes damage to the small blood vessels that feed the retina. When these vessels weaken, they can leak, close off, or grow in ways they shouldn’t. Over time, if blood sugar levels aren’t managed, this can lead to swelling, bleeding in the eye and retina, and areas of the retina may not get enough oxygen.
Diabetic retinopathy is associated with both type 1 and type 2 diabetes, and the longer you’ve had diabetes, the higher the risk of developing diabetic retinopathy. This risk is further exacerbated by poor blood sugar control, high blood pressure, high cholesterol, kidney disease, and pregnancy.
That’s not all.
Perhaps, the trickiest part of diabetic retinopathy is that the early stages are “silent”. This phase can last years, during which vision may seem perfectly normal - until suddenly it isn’t. Many don’t notice vision changes until swelling or bleeding reaches the macula, the area responsible for sharp central vision.
This is why clinicians always stress the importance of routine eye exams and diabetic eye screenings, as these can help identify early signs that would otherwise go undetected. Don’t ignore subtle early signs and only come in for a checkup when vision has already been impaired. At Insight Optometry, we routinely monitor patients for diabetic retinopathy.
Early Signs of Diabetic Retinopathy
More often than not, there are no real symptoms in the early stages of diabetic retinopathy.
Some people may notice subtle changes in their vision, such as trouble reading or seeing faraway objects. However, these changes come and go, as blood sugar levels change, and can often seem nothing out of the ordinary.
Early detection, then, is often only possible through annual dilated eye exams conducted by eye care professionals.
Thus, if you or a loved one lives with diabetes, you should make it a priority to schedule a comprehensive dilated eye exam at least once a year.
Later-Stage Signs & Symptoms
Signs of diabetic retinopathy can often appear out of nowhere and can be quite severe.
As the retinopathy progresses, blood vessels in the retina can start to bleed within the retina and into the vitreous (a jelly-like substance in the middle of your eye), which often results in:
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Floating spots or dark strings in your sight
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Blurry vision
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Dark spots or empty areas in your vision
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A curtain or a shadow across your vision
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Difficulty seeing at night
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Vision loss
If you or a loved one is experiencing any of these signs, you should consult with an eye doctor immediately. If left undiagnosed, diabetic retinopathy can lead to permanent vision loss and blindness.
Cause, Staging, and Severity: NPDR, PDR, and DME
Eye care professionals classify diabetic retinopathy into different stages.
1: NPDR: Nonproliferative Diabetic Retinopathy
This is the earliest stage and most common form of diabetic retinopathy. Many Nova Scotians diagnosed with diabetes can have this, but do not have symptoms and therefore may not be aware of it.
NPDR causes the walls of tiny blood vessels in the retina to swell or bulge, causing them to weaken and eventually leak fluid and blood into the retina. It can also restrict blood supply to regions in the retina - this is referred to as ischemia.
As more blood vessels become damaged, this condition progresses from mild to moderate to severe, and can cause your vision to go blurry or spotty.
2: PDR: Proliferative Diabetic Retinopathy
This is the advanced stage of diabetic retinopathy. The blood vessels become increasingly compromised, and the retina is forced to start growing new blood vessels. But there is a problem: the new blood vessels grow irregularly, causing further damage to the retina and leading to leakage and accumulation of fluid and blood in the retina and vitreous.
Depending on the extent of blood and fluid leakage, the impact on vision can vary. Changes may range from dark floaters or reduced clarity to, in extreme cases, complete vision loss.
Additionally, as proliferative diabetic retinopathy progresses, scar tissue can also form, which can lead to additional complications such as retinal detachments. Additional complications also include the formation of glaucoma.
3: DME: Diabetic Macular Edema
DME can occur in both NPDR and PDR. It occurs when fluid buildup from damaged blood vessels leaks into the macula. This causes the macula to swell, which makes your vision blurry and can even result in vision loss.
Screening And Diagnosis: Tests Used At Insight Optometry
At Insight Optometry, our highly trained optometrists conduct comprehensive eye exams utilizing modern technology to detect the earliest signs of eye disease.
Our eye exams usually include several tests that help us get a full picture of what’s going on inside your eye.
ICare Tonometry
The iCare Tonometer offers a more comfortable way to measure eye pressure. Elevated intraocular pressure (IOP) can often be a sign of glaucoma and other eye-related diseases.
Zeiss Cirrus OCT (Optical Coherence Tomography)
This state-of-the-art scanner conducts advanced analysis of your eye’s internal structure, detecting even the slightest changes. OCT scans help identify macular edema, which makes Zeiss Cirrus OCT an indispensable instrument for screening, diagnosing, and monitoring eye diseases.
Optos Optomap Digital Retinal Imaging
This technology enables us to capture a panoramic image of your retina (80% of it) in under a second. It allows our optometrists to quickly spot signs of early diabetic eye disease, which are often present in the far peripheral areas of the retina.
Treatment Pathways: What To Expect If Disease Is Found
Treatment of diabetic retinopathy often requires a collaborative effort between your eye doctors, primary care provider, and endocrinologist. They collectively guide you towards a treatment pathway that would be most beneficial, depending on the stage and severity of the disease.
In addition to optimization of diabetic medications and management of blood sugar levels, treatment of diabetic retinopathy may include:
Anti-VEGF injections
Anti-VEGF intravitreal injections are a common treatment method that helps reduce swelling in the macula and slow vision loss.
Laser Surgery
This treatment method utilizes lasers to manage the eye damage due to irregular blood vessel growth in the retina.
Vitrectomy
This surgical treatment method is used for advanced cases where significant amounts of blood and scar tissue are present in the vitreous gel. Vitrectomy helps remove blood and scar tissue.
Eye Care Checklist to Protect Vision
While diabetic retinopathy isn’t curable, treatments and eye care can certainly help slow progression, prevent further vision loss, and even restore some areas of lost vision.
Here is a checklist to help you manage your condition:
- Book a yearly dilated eye exam or come in more often if advised
- Track your blood sugar, blood pressure, and cholesterol
- Learn your stage: NPDR, PDR, or DME
- Watch for warning signs: floaters, flashes, dark shadows, sudden blur
- Keep your diabetes meds steady and stay hydrated
Book a Comprehensive Eye Exam Today!
Diabetic retinopathy develops stealthily, but early detection is possible through routine eye exams. Early detection and action can make all the difference in maintaining your vision.
Book your eye exam today to protect your vision for years to come.
FAQs
Q1) Is diabetic retinopathy common in Canada?
Yes. One in three Canadians with diabetes shows signs of diabetic retinopathy during their lifetime.
Q2) Can kids or teens with diabetes get diabetic retinopathy?
Yes, but it’s less common.
Q3) Does diabetic retinopathy always lead to blindness?
No. While it can lead to blindness in most cases, early detection and proper care can prevent that from happening.
