Diabetic Retinopathy (DR)

Based on the manifestation of the disease, diabetic retinopathy is classified:

• Non-proliferative diabetic retinopathy (NPDR)
• Proliferative diabetic retinopathy (PDR)

Diabetic retinopathy is a common manifestation of diabetes, affecting over 34% of diabetics worldwide. It occurs in both types 1 and 2 diabetes mellitus, however, the onset of DR occurs later in the course of disease for type 1 than type 2 DM. 

Risk factors of DR:

• Longer duration of diabetes
• Poor glycemic control
• Arterial hypertension
• Increased creatinine levels 
• Increased levels of LDL

What are the signs and symptoms of diabetic retinopathy?

On fundoscopic examination, diabetic retinopathy may manifest as many changes in the retina. The symptoms of NDPR represent the early stages of disease and can include:

• Increased permeability of the retinal vessels
• Micro-aneurysms
• Deposition of exudates 
• Hemorrhage. 

NDPR is classified based on the severity of disease as mild, moderate, severe, and very severe.

Proliferative retinopathy is the latter stage of the disease characterized by the formation of new, abnormal vessels, from the retinal vessels or the disc, in response to an increased level of vasoproliferative factors.

DR will be noticed by patients with the development of visual changes that may include:

• Blurry vision that often clears up on its own
• Cotton wool spots
• Streaks in the field of vision

The complications of DR can be severe, and may result in the loss of vision:

• Neovascularization
• Diabetic Macular Edema (DME)
• Retinal detachment

Management of Diabetic Retinopathy

The development and worsening of diabetic retinopathy can be prevented by managing risk factors such as glycemic control, hypertension, and cholesterol. In addition, other lifestyle modifications have been found to be protective against the development of diabetic retinopathy. Increased physical activity leads to the reduction in development of disease from 29 to 58%. 

Treatment of DR is used to improve visual changes, preserve existing vision, and reduce the rate of progression of DR and its complications. Treatment options include:

• Intravitreal injections of anti-VEGF agents
• Focal laser photocoagulation
• Intravitreal glucocorticoids
• Vitrectomy