We provide an overview of this all-too-common complication of type 1 diabetes. Take a breath and read about it when you’re ready, because it’s important to know what it is.
—Danielle Gianferante St. Pierre
We know this isn’t a pleasant subject, so we’re going to skip the pleasant intro and go right to the facts.
What Is Diabetic Retinopathy?
Retinopathy refers to any damage to the retina of the eye, which is the layer of cells at the back of the eye. The retina is responsible for sending information to the brain for processing, resulting in vision. Diabetic retinopathy is a subtype of this disease, and is considered to be a microvascular complication of chronic high blood glucose. In diabetic retinopathy, damage to the blood vessels in the retina results in clogging and increased fragility and may lead to bleeding, which damages the retina and can result in decreased vision (Kempen et al., 2004).
Diabetic macular edema (DME) is a complication of diabetic retinopathy which may lead to swelling of the surrounding tissue, including the macula.
The Link between Retinopathy and High Blood Glucose
Damaged blood vessels in the retina are the result of high blood glucose levels, which is why this disease is so common in people with both type 1 and type 2 diabetes. About 56% of people with type 1 diabetes will get some form of diabetic retinopathy, compared to 31% in people with type 2 diabetes (Thomas et al., 2015).
Risk factors include:
- higher A1c levels
- high blood pressure
- impaired kidney function
- increased body mass (Klein et al., 2008)
Using diabetes devices such as CGM and/or insulin pump can help reduce swings in blood glucose, which may also help lower the risk for retinopathy. In fact, treatments aimed at reducing A1c by increasing the frequency of insulin injections (via pump use, for example), showed significant reductions in occurrence of retinopathy (Nathan, 2014).
Symptoms, Screening, and Treatment Options
Symptoms of vision loss due to diabetic retinopathy include:
- blurred vision
- having a dark spot in the center of the visual field
- difficulty seeing at night
It’s essential to detect retinopathy early; in fact, it is best if any retinopathy is detected before these symptoms even appear.
Eye doctors can detect some early signs through dilated eye exams. That’s why people with type 1 diabetes should have regular screenings. The American Academy of Ophthalmology (AAO) recommends annual comprehensive eye exams for all people with type 1 diabetes.
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Here are some tips to reduce your risk of retinopathy:
Try and reach recommended targets: Optimizing glycemic control, lowering blood pressure and cholesterol (lipids) can help reduce the risk or slow progression of retinopathy. To improve glycemic control, you might consider using a pump and/or CGM to help (if you aren’t already) as A1c is lower with the use of insulin pumps and/or CGM (Miller et al).
Get screened! Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within five years after the onset of diabetes. If you show evidence of retinopathy, make sure you have annual eye exams (at least) or more frequently if your doctor recommends it. If you don’t show evidence of retinopathy and your blood sugar is well-controlled, eye exams every two years may be considered.
It’s worth nothing that while retinal photography may serve as a screening tool for retinopathy, it should not be a substitute for a comprehensive eye exam.
Trying to get pregnant or are you pregnant with type 1 diabetes? Rapid progression of diabetic retinopathy can occur during pregnancy. It’s best to have blood sugar well-controlled before getting pregnant. If you are pregnant or planning to get pregnant, get counseled on the risk of developing diabetic retinopathy; or the progression of it (if you show evidence of it). Get an eye exam before pregnancy or in the first trimester, and then you should be monitored each trimester and for one year postpartum, or as recommended.
Get Specialized. Choose an ophthalmologist or optometrist who is experienced in diagnosing diabetic retinopathy. If you show evidence of diabetic retinopathy, you should be referred to an ophthalmologist.
If retinopathy is progressing or sight-threatening, then examinations will be required more frequently.
Ask Questions, Be Informed. Take action before retinopathy develops. Make sure you get regular eye exams, don’t be afraid to ask questions so that you understand your risk for retinopathy and what you may do to lower that risk, and if you show evidence of retinopathy, be sure you see an experienced specialist. It’s important to do what it takes to protect your vision.
If You Develop Diabetic Retinopathy
If you show evidence of retinopathy, you should be referred to an ophthalmologist experienced in treating diabetic retinopathy.
Available treatments are mostly aimed at preventing further damage, and therefore the sooner treatments start the less likely it is that vision loss will occur. Some retinal damage can even be reversed.
Treatments (from AAO.org) include:
- Good monitoring and control
- Your doctor will want you to keep your blood glucose levels well-controlled, lower high blood pressure, and receive frequent retinal monitoring in mild cases.
- Anti-inflammatory medications can be given. These usually consist of steroid shots into the eye, and several may be needed over a specific period of time
- Laser surgery
- Laser surgery is used to help seal off blood vessels that may be leaking, which reduces swelling in the eye. Lasers can also be used to help shrink blood vessels.=
Learn about Polyphotonix, a company that offers a non-invasive treatment for retinopathy in the UK
Kempen, J. H., O’Colmain, B. J., Leske, M. C., Haffner, S. M., Klein, R., Moss, S. E., … & Hamman, R. F. (2004). The prevalence of diabetic retinopathy among adults in the United States. Archives of ophthalmology (Chicago, Ill.: 1960), 122(4), 552-563.
Klein, R., Knudtson, M. D., Lee, K. E., Gangnon, R., & Klein, B. E. (2008). The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXII: the twenty-five-year progression of retinopathy in persons with type 1 diabetes. Ophthalmology, 115(11), 1859-1868.
Miller KM, Foster NC, Beck RW, Bergenstal RM, DuBose SN, DiMeglio LA, Maahs DM, Tamborlane WV. Current state of type 1 diabetes treatment in the US: Updated data from the T1D Exchange Clinic Registry. Diabetes Care. 2015;38(6):968-70.
Nathan, D. M., & DCCT/Edic Research Group. (2014). The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes care, 37(1), 9-16.
Thomas, R. L., Dunstan, F. D., Luzio, S. D., Chowdhury, S. R., North, R. V., Hale, S. L., … & Owens, D. R. (2015). Prevalence of diabetic retinopathy within a national diabetic retinopathy screening service. British Journal of Ophthalmology, 99(1), 64-68.