Hello,
this is Goyang Shinsegae Eye Clinic.
Diabetes is a chronic condition that requires ongoing blood sugar management.
However, just as important as controlling blood glucose levels is detecting complications at an early stage.
Among these complications, diabetic retinopathy is one of the most common microvascular complications that can occur in people with diabetes.
Even when vision still feels normal, damage to the small blood vessels in the retina may continue to progress.
In particular, if the appropriate timing for treatment is missed, the condition may lead to diabetic macular edema, vitreous hemorrhage, and significant vision loss.
Therefore, if you have been diagnosed with diabetes, it is important to undergo regular ophthalmologic examinations at the recommended intervals even when you do not have noticeable symptoms.
Based on the examination findings and the stage of the disease, an appropriate treatment plan can then be established.
1. What Is Diabetic Retinopathy?
Diabetic retinopathy is a condition in which prolonged high blood sugar levels damage the small blood vessels that supply the retina.
The retina is the tissue located at the back of the eye that receives incoming light and transmits visual information to the brain.
When these small blood vessels become damaged, blood or fluid may leak into the surrounding retinal tissue.
Blood flow through some vessels may also become impaired, leading to various retinal abnormalities.
One important concern is that diabetic retinopathy often causes no obvious symptoms in its early stages.
As the condition progresses, vision may become blurred, objects may appear distorted, or visual acuity may decrease.
If diabetic macular edema develops in the macula, which is responsible for central vision, patients may experience difficulty reading or seeing fine details clearly.
2. How Is Diabetic Retinopathy Diagnosed?
1) Fundus Photography
Fundus photography is used to capture images of the retina located at the back of the eye.
It can help identify retinal bleeding, exudates, and other abnormalities.
The images may also be compared with previous examinations to monitor changes over time.
2) Fluorescein Angiography
During fluorescein angiography, a fluorescent dye is injected into a vein and a series of photographs is taken as the dye circulates through the retinal blood vessels.
This examination can help identify areas of vascular leakage, blocked blood vessels, and abnormal new blood vessel formation that may be difficult to detect through a routine fundus examination alone.
3) Optical Coherence Tomography (OCT)
Optical coherence tomography, or OCT, provides high-resolution cross-sectional images of the retina.
It is particularly useful for determining whether swelling is present in the macula and evaluating the extent of macular edema.
OCT can also be used to compare changes in the macula before and after treatment.
3. When Should Eye Examinations Begin?
The time when symptoms first become noticeable does not necessarily correspond to the time when retinal damage actually begins.
For this reason, regular eye examinations are important even when no particular visual discomfort is present.
The recommended timing of examinations may vary depending on the type of diabetes.
Type 2 Diabetes
In people with type 2 diabetes, elevated blood sugar levels may have been present for some time before the condition is officially diagnosed.
As a result, retinal changes may already be present at the time diabetes is first detected.
Therefore, people with type 2 diabetes are generally advised to undergo an ophthalmologic examination from the time of diagnosis.
Type 1 Diabetes
For people with type 1 diabetes, the first comprehensive eye examination is generally recommended within five years after the onset of diabetes.
Afterward, the interval between examinations is determined according to factors such as the presence and severity of diabetic retinopathy and the level of blood sugar control.
If diabetic retinopathy or macular edema has already been identified, more frequent examinations may be necessary.
4. Why Are Regular Eye Examinations Necessary Even Without Symptoms?
Non-Proliferative Diabetic Retinopathy
In the early stages of diabetic retinopathy, retinal changes such as microaneurysms, small hemorrhages, and exudates may be observed.
Even when these abnormalities are already present, patients may still feel that their vision is normal.
Proliferative Diabetic Retinopathy
As the disease progresses, parts of the retina may receive an insufficient supply of oxygen.
In response, abnormal new blood vessels may begin to form.
These newly formed blood vessels are more fragile than normal vessels and may rupture easily, causing vitreous hemorrhage.
If significant bleeding occurs, vision may suddenly become blurred or decrease substantially.
In addition, scar tissue forming around the abnormal blood vessels may pull on the retina and lead to tractional retinal detachment.
5. Treatment Options
1) Intravitreal Anti-VEGF Injections
Anti-VEGF medications may help reduce swelling in the macula and suppress the growth of abnormal new blood vessels.
2) Focal Laser Treatment / Panretinal Photocoagulation
Focal laser treatment may be used in selected cases of macular edema to treat areas where vascular leakage is occurring.
Panretinal photocoagulation may also be used to reduce the retinal stimulus that promotes abnormal new blood vessel formation and help slow the progression of the disease.
3) Vitrectomy
Surgical treatment may be considered when vitreous hemorrhage persists for an extended period or when tractional retinal detachment develops.
During vitrectomy, the blood-filled or cloudy vitreous is removed.
Scar tissue or other tissues pulling on the retina may also be carefully removed to help stabilize the retina.