What Is Diabetic Retinopathy? Symptoms, Causes, Diagnosis, Treatment, and Prevention

糖尿病retinopathy is a form of eye disease caused by chronically high or variable blood sugar that is associated with diabetes.

“当视网膜的小血管因数年的高血糖而损害时，发生糖尿病性视网膜病。”Farah Khan, MD，UW Medicine的糖尿病研究所的医生以及西雅图华盛顿大学医学院的新陈代谢，内分泌学和营养的医学助理教授。“视网膜病是涵盖对眼睛视网膜的任何形式的损害，这是眼睛最深的组织之一。”

If left untreated, diabetic retinopathy can lead to vision loss and blindness, so it’s important to get a comprehensive eye exam at least once a year if you have diabetes, according to the National Eye Institute. Getting treatment as early as possible, as well as taking steps to manage diabetes, can help prevent or delay vision problems.(1)

DR progresses through four stages, each of which is associated with different symptoms.

In the early stages, DR often does not have noticeable symptoms, so the disease often goes undetected until it affects vision. (1)

Bleeding from damaged blood vessels in the retina can cause you to see “floaters,” or spots that appear across your field of vision.飞蚊症有时会独自清楚。

But if you experience floaters or any other type of blurred vision or vision loss and have one of the underlying conditions that can cause retinopathy, check with your doctor.

糖尿病性视网膜病的阶段是：

Mild nonproliferative diabetic retinopathy (NPDR)In this stage, small areas of balloon-like swelling — called microaneurysms — form in the retinal blood vessels and may leak fluid into the retina.

中度NPDRAs the disease progresses, blood vessels that provide important nourishment to the retina may swell and lose their ability to transport blood.

During this stage, the appearance of the retina may change as a result of these symptoms. But these changes would only be visible to your eye doctor during a全面的眼科检查.

未经治疗的中度NPDR可能导致糖尿病黄斑edema, or swelling in the macular region of the retina, which can cause serious vision loss.

轻度和中等的NPDR有时将其分组为“早期” DR。

Severe NPDRIn this stage, the blood supply to the retina is disrupted, leading to more damage in the blood vessels.

Proliferative diabetic retinopathy (PDR)At this advanced stage of DR, the retina secretes growth factors (substances that stimulate cell growth) to generate new blood vessels.

These new blood vessels grow along the inside surface of the retina as well as in the vitreous gel, the jelly-like fluid that fills the center of the eye.

Because they’re fragile, these new blood vessels are more likely to leak and bleed, producing scar tissue that can shrink and lead toretinal detachment- 从基础组织中拉出视网膜。(2,3)

Anyone with any type of diabetes, including type 2, type 1, or gestational, can develop diabetic retinopathy. (1)

“The longer a person has diabetes and the worse their blood sugar control is, the greater their risk of getting diabetic retinopathy,” Dr. Khan says.

The following factors may also raise your risk of developing retinopathy: (3)

• Havinghigh cholesterollevels
• 高血压
• Becoming pregnant
• Smoking
• Being African-American, Hispanic, or Native American

You’ll need to undergo a comprehensive eye exam to receive a diagnosis of diabetic retinopathy.

Your pupils will be dilated with eye drops during the exam, to allow your doctor to better view the inside of your eyes.

The drops used to dilate your pupils may cause you to experienceblurry visionuntil they wear off, which may be several hours later.

Your eye doctor will use several different instruments to examine your eyes and identify potential: (3)

• Damaged blood vessels
• Blood or fatty deposits in the retina
• New blood vessels along the inside lining of the retina
• Scar tissue in the retina
• Bleeding in the vitreous fluid
• 视网膜脱离
• Optic nerve abnormalities

为了为视网膜拍照，您的医生可能会使用荧光素血管造影，该荧光素血管造影使用被注入手臂的特殊染料。

Your doctor can use these photos of your retinas to identify damaged blood vessels.

Your doctor may also use optical coherence tomography to obtain cross-sectional images of your retinas.

These images can show your doctor the thickness of the retina, which can help determine whether fluid has leaked into retinal tissue. (3)

In addition, your eye doctor may: (3)

• Test your vision
• Test you forglaucoma
• Check for the presence ofcataracts(a common age-related eye disease that causes vision loss)

There is no cure for diabetic retinopathy, but there is some hope for relief. “Mild levels of [diabetic retinopathy] can be treated with careful diabetes management,” saysRishi Singh, MD，俄亥俄州克利夫兰诊所科尔眼科研究所的视网膜专家。这包括适当的饮食，运动和可能的药物，包括可注射胰岛素。“仅医疗管理就会导致一些回归，但只有最早的阶段。”但是，即使治疗了糖尿病性视网膜病变，由于糖尿病是终生疾病，也可能会发生视网膜损害和视力丧失。（3）

If you have an earlier stage of diabetic retinopathy, treatment may not be needed right away and your doctor will monitor your eyes closely. Managing blood sugar appropriately can help slow or stop the progression of this eye disease. (1)

糖尿病性视网膜病的较长未经治疗，永久视力丧失的风险就越大。

If you have early or mild- to moderate NPDR, you may not need treatment immediately. Still, your eye doctor will probably want to monitor your condition closely with regular eye exams. (3)

严重的NPDR或PDR的诊断很可能需要立即进行手术。

Because diabetes is a lifelong condition, additional retinal damage and vision loss are possible even after surgery. You should continue to get常规眼科检查to monitor your condition.

另外，向您的内分泌学家询问改善糖尿病管理计划的方法。有效的血糖控制通常会减慢轻度至中度糖尿病性视网膜病的进展。

Surgery Options

Surgical options for advanced diabetic retinopathy include:

注射眼睛Medications called vascular endothelial growth factor (VEGF) inhibitors can be used to help stop the growth of new blood vessels and improve vision. Most people who receive these injections will need to get them for at least three months. Over time, some people may need to get them less often or may no longer need them at all, but others will need to continue in order to protect their vision. (1)

Focal laser surgeryThis surgery attempts to stop or reduce the leaking of blood or fluid into the eye by burning — and sealing — the damaged blood vessels.

Also calledphotocoagulation, this is usually done in your doctor’s office as an outpatient procedure during a single session.

The procedure may or may not restore your vision to normal, but it should prevent your condition from worsening.

Scatter laser surgeryThis surgery uses lasers to burn the damaged blood vessels so that they shrink.

This procedure may require more than one application, and your vision may be blurry for a day or more after each session.

You may also experience loss of peripheral vision or night vision after the procedure.

VitrectomyThis surgery involves making a tiny incision in the eye to remove blood from the vitreous fluid, as well as any scar tissue that may cause retinal detachment.

Vitrectomy requires the use of general anesthesia. (3)

Prevention of Diabetic Retinopathy

预防糖尿病视网膜病变的主要方式to follow your prescribed diabetes treatment plan. Keeping your blood sugar within the goal range should help reduce your risk for not only diabetic retinopathy but also all types of diabetes-related complications.

“Because diabetic retinopathy is essentially irreversible, it is very important to take care of your health to prevent it from happening in the first place,” Khan says. “Good blood sugar control is crucial to preventing long-term complications such as diabetic retinopathy.”

The Centers for Disease Control and Prevention (CDC) recommends the following steps to keep your eyes healthy: (4)

• A healthy diet and regular physical activity can help control weight, blood sugar, blood pressure, and cholesterol, which can all reduce the risk of diabetic retinopathy.
• Schedule an annual comprehensive dilated-eye exam if you have diabetes. This will help ensure any problems with your vision are caught early.
• Quit smoking或者，如果您不抽烟，就永远不会开始。吸烟吸烟会增加糖尿病并发症的风险，包括糖尿病性视网膜病。
• Contact an eye doctor immediately if you notice any changes in your vision.

Complications of diabetic retinopathy can lead to serious vision problems, including:

Vitreous hemorrhageThis complication occurs when new blood vessels bleed into the vitreous fluid.

Minor vitreous hemorrhage can cause you to see floaters. With severe vitreous hemorrhage, blood can fill the vitreous cavity and completely block your vision.

这种视力丧失是暂时的，通常在几周或几个月内清除，除非您的视网膜损坏。

视网膜脱离This condition develops when damaged blood vessels form scar tissue, which pulls your retina away from the back of your eye.

视网膜脱离can cause you to see floaters or flashes of light. If left untreated, it may lead to severe, permanent vision loss.

Glaucoma会导致博士在弗伦联盟新血管的生长t of your eye, interfering with the normal flow of fluid out of the eye and leading to a buildup of pressure.

This condition can lead to damage in the optic nerve, the bundle of nerve fibers that transmits visual information from your eye to your brain.

If left untreated,glaucomamay cause permanent blindness. (3)

According to the National Eye Institute, more than 2 in 5 Americans living with diabetes have some form of diabetic retinopathy. (1)

What’s more, the CDC estimates that from 2010 to 2050, the number of people in the United States living with DR is expected to nearly double from 7.7 million to 14.6 million.

糖尿病retinopathy is the most common cause of vision loss and blindness among working-age Americans, the CDC says. (4)

Certain minority groups are disproportionately affected by diabetic retinopathy. According to a 2017 review published inInternational Journal of Clinical Endocrinology and Metabolism, African American and Hispanic populations are 2 to 3 times more likely to develop visually significant complications from diabetes than non-Hispanic whites.(5)

An estimated 800,000 African Americans have diabetic retinopathy, and that number is projected to rise to 1.2 million by 2030, the National Eye Institute reports.(6)

One reason African Americans are at greater risk for diabetic retinopathy is thatthey are at an increased risk for developing diabetes, Dr. Singh says.

“Furthermore, African Americans have been found to have higher levels of risk factors for retinopathy, including but not limited to duration of diabetes,HbA1Clevels, obesity, and systolic blood pressure,” he says. “All of these risk factors along with the potential socioeconomic barriers to entry for treatment amongst this population is why African Americans are at greater risk for diabetic retinopathy.”

Singh emphasizes the importance of a healthy lifestyle and keeping blood sugar levels in a healthy range to prevent vision loss and other complications.

他说：“对于糖尿病的人来说，重要的是要进行年度眼睛检查，以监测[糖尿病性视网膜病变]的迹象，直到为时已晚，视力丧失开始开始。”“通过保持健康的饮食并控制血糖和血压，可以延迟或防止糖尿病患者[糖尿病性视网膜病]发作。”

Favorite Orgs for Essential Info on Diabetic Retinopathy

American Foundation for the Blind

This nonprofit offers a comprehensive guide to living with diabetes and vision loss in both English and Spanish. For those who have vision troubles, free audio lectures are available on the website where you can learn about diabetes basics, as well as healthy eating and self-care tips from a certified diabetes educator.

美国糖尿病协会（ADA）专注于糖尿病

The ADA is considered the leading nonprofit for type 1 and type 2 diabetes education. We love how the organization’s subsite focuses on ways you can take control of your eye care, including its resource to find an eye care professional to schedule your routine eye exam.

美国眼科学会（AAO）

The AAO is the world’s largest association of eye physicians and surgeons, and is a major advocacy organization for people with vision problems. On the site, you can watch quick, informational animations on how diabetic retinopathy affects the eye, sign up for the free newsletter for ophthalmologist-reviewed tips on preserving eye health, and plug in your ZIP code to find an eye specialist near you.

Favorite Online Support Network for Diabetic Retinopathy

VisionAware

On this blog from the American Foundation for the Blind, people from all walks of life share their stories about vision loss, how it has affected their lifestyle and relationships, and how they are managing to cope. We love having the chance to connect with others through these personal reflections, and there’s an opportunity to contribute your own story, too. You can also find alist of local in-person support groups.

Favorite Resource for Diet Advice

track糖尿病

Sticking to healthy eating habits is necessary to maintain control over your diabetes and prevent complications like vision loss, but it can often be difficult. That’s where OnTrack Diabetes comes in. The site offers hundreds of diabetes-friendly recipes created by award-winning cookbook authors Frances Towner Giedt and Bonnie Sanders Polin, PhD, that are sure to satisfy your taste buds while keeping your blood sugar in check.

Favorite Site for Diabetes Products

糖尿病

This website offers roundups of the latest tech products for diabetes management, including glucose monitors, insulin pens,glucagonkits, and more.

Favorite App

RetinaRisk

This app offers a clinically validated risk calculator that allows people with diabetes to assess in real time their individualized risk for developing diabetic retinopathy. This is done by collecting health measurements from the user like diabetes type, A1C, duration of diabetes, blood pressure, and gender. The data is then crunched through an algorithm to tell the patient their risk. RetinaRisk, which is free and compatible with both Android and iOS operating systems, also includes detailed guidelines and有关糖尿病的信息, diabetic retinopathy, and tips for improved self-care.

Additional reporting byBrian P. Dunleavy.