There Are Four Stages of Diabetic Retinopathy: Experts Reveal What Professional Measures Can be Taken to Stunt That Progression
Diabetic Disease Awareness Month aims to increase awareness of diabetes and diabetic eye disease.
Diabetes is the leading cause of blindness in adults, therefore it is important to seek treatment for vision impairment that are related to diabetes.
As the number of people living with diabetes grows, so does the number of people with impaired vision.
High blood sugar levels damage the blood vessels of the retina and can cause permanent vision loss. Vision impairment caused by Diabetic Retinopathy (DR) may be prevented by regulating blood sugar and blood pressure levels as well as regular eye examinations at the local Smart Vision Optometry.
Jacquie Gattengo, a Smart Vision Optometrist at Eyes InDesign Bondi, explains the four stages of DR and what preventable measures can be taken to reduce the disease from advancing and causing permanent vision loss.
There are two types of DR; Non-proliferative retinopathy – which refers to the bleeding of the retina or leakage of blood – and proliferative retinopathy whereby abnormal blood vessels grow on the retina. The blood may bleed in the centre of the eye, causing vision problems.
Micro aneurysms (MA) occurs in patients with non-proliferative diabetic retinopathy (NPDR) when the capillary walls leak fluid due to the haemorrhage of blood vessels.
Stage one: Mild NPDR
The first stage consists of mild non-proliferative retinopathy, which is an early stage of DR. In this stage, “small areas of swelling or bulges occur in the blood vessels of the retina,” says Jacquie.
Vision may not be affected yet during this stage.
Mild NPDR has at least one MA. Such findings are elusive, therefore close monitoring and inspection are crucial. Patients should have an extensive eye examination once a year.
It is also essential that “patients diagnosed with diabetes monitor the blood sugar level and diet,” says Jacquie.
Stage 2: Moderate NPDR
As the disease progresses, it results in moderate non-proliferative diabetic retinopathy, where some of “the blood vessels that nourish the retina become blocked and damage the retina,” says Jacquie.
Blood and other fluids build up in the small central part of the retina causing diabetic macular edema. Vision may be affected in this stage.
Patients with moderate NPDR should have an eye examination at least twice a year.
Stage 3: Severe NPDR
The third stage consists of an additional blockage of the blood vessels, “this disrupts the blood supply to the retina,” says Jacquie. The damaged retina signals the body to produce new blood vessels. The development of new blood vessels grows in the retina and fills the interior of the eye. “The obstructed blood vessels may lead to blurred vision with dark spots visible,” says Jacquie.
Multiple haemorrhages occur in the retinal quadrants. During this stage, retinal detachment may occur.
“Patients with severe NPDR should have a dilated fungus examination three or four times a year,” advises Jacquie. These patients are at high risk of disease progression and permanent vision loss
Stage 4: Proliferative Diabetic Retinopathy (PDR)
During this stage, “the new blood vessels are abnormal and rupture causing a flow of blood to the retina,” says Jacquie.
The growth of abnormal and fragile new blood vessels advance during this stage. “These blood vessels have fragile walls and can leak blood in the retina, causing severe vision loss and blindness,” says Jacquie.
Patients exhibit either neovascularisation of the eye or pre-retinal haemorrhage. Until the disease stabilises, it is required that the visit a retinal speciality once a month.
There are usually no warning signs of Diabetic retinopathy (DR), however early signs of DR can be detected through regular eye examinations. The procedure of such examination includes near and distant eye tests, a dilated eye exam (which allows the examiner to see through the pupil to the retina), and a tonometry test to measure the fluid pressure in the eye.
Patients with type 1 or type 2 diabetes, are at risk of developing neurovascular complications that can lead to Diabetic Retinopathy (DR). It is advised that “patients with diagnosed type 1 and type 2 diabetes should have a comprehensive dilated eye examination,” says Jacquie.
Smart Vision Optometry clinics are located in Sydney. Book a Smart Vision Comprehensive Vision Skills Assessment or Advanced Eye Health Test for any child or adult by calling the Bondi clinic (02) 9365 5047 or the Mosman clinic (02) 9969 1600, alternatively book an appointment online.
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