Retinopathy is the medical term for damage to the tiny blood vessels (capillaries) that nourish the retina, the tissue at the back of your eye that captures light and relays information to your brain. These blood vessels are often affected by the high blood sugar levels associated with diabetes.

Nearly half of people with known diabetes have some degree of diabetic retinopathy. The longer you have diabetes, the more likely it is you'll develop diabetic retinopathy. Initially, most people with diabetic retinopathy experience only mild vision problems. But the condition can worsen and threaten your vision. Diabetic retinopathy is a leading cause of legal blindness.

The threat of blindness is scary. But with early detection and treatment, the risk of severe vision loss from diabetic retinopathy is small. You can take steps to protect your sight if you have diabetes. These include a yearly eye examination and steps to keep your blood sugar, blood pressure and blood cholesterol under the best possible control.

Signs and symptoms

In the early, most treatable stages of diabetic retinopathy, you usually experience no visual symptoms or pain. The disease can even progress to an advanced stage without any noticeable change in your vision.

Symptoms of diabetic retinopathy may include:

• "Spiders," "cobwebs" or tiny specks floating in your vision

• Dark streaks or a red film that blocks vision

• Vision loss or blurred vision

• A dark or empty spot in the center of your vision

• Poor night vision

• Difficulty adjusting from bright light to dim light

Causes

If you have diabetes, your body doesn't use sugar (glucose) properly. Sugar in your blood is vital to your health because it's a main source of energy for your body's cells. But too much sugar in your blood can cause damage throughout your body, including your kidneys, nerves, heart and eyes. Damage to the capillaries in your eyes occurs in diabetic retinopathy.

Diabetic retinopathy occurs in two types, usually affecting both eyes similarly:

• Nonproliferative diabetic retinopathy (NPDR). This type, also called background diabetic retinopathy, is an early stage of the disease. It's the most common type of retinopathy, and symptoms are often mild or nonexistent.

• In NPDR the walls of blood vessels in the retina weaken. Tiny bulges called microaneurysms (mi-kro-AN-u-riz-umz) protrude from the vessel walls. Another term for these microaneurysms is outpouching. The microaneurysms may begin to leak, oozing fluid and blood into the retina. As NPDR progresses, other signs of damage appear. These include patches of swollen nerve fibers, which are called cotton-wool spots because they look like fluffy wisps of cotton.

• Mild NPDR may not affect your ability to see clearly. Vision problems from more severe NPDR are usually the result of swelling (edema) of the central part of the retina (macula) or the closing of capillaries, which reduces blood flow to the macula (macular ischemia). When the macula can't function properly, your central vision decreases.

• Proliferative diabetic retinopathy (PDR). This is the more advanced form of the disease. Retinopathy becomes proliferative when abnormal new blood vessels grow (proliferate) in the retina or the optic nerve. The blood vessels also can grow into the vitreous, the clear, jelly-like substance that fills the center of your eye.

• This abnormal growth follows the widespread closing of capillaries in the retina due to high blood sugar levels. The condition can cause vision loss affecting both your central and peripheral vision. The new blood vessels may leak blood into the vitreous, which clouds or even blocks your vision. Other complications include detachment of the retina due to scar tissue formation (traction retinal detachment) and a form of glaucoma associated with the growth of abnormal blood vessels on the iris, the pigmented portion of the eye surrounding the pupil (neovascular glaucoma).

Blurred vision in diabetes
Blurred vision can be brought on by rapid fluctuations in blood sugar. Prolonged periods of elevated blood sugar cause sugar and its breakdown products to accumulate in the lens. This accumulation sucks up water and makes the lens swell, resulting in nearsightedness — meaning distant objects appear blurry. The nearsightedness subsides once your blood sugar is brought under steady control.

Blurred vision can also be caused by macular swelling (edema), regardless of your blood sugar level. This is cause for greater concern because macular edema often develops in people with diabetic retinopathy. The swelling may fluctuate during the day, making your vision get better or worse. If blood vessels in your eye are hemorrhaging, you might notice spots floating in your field of vision. These small spots are often followed within a few days or weeks by larger spots or clouds, which are caused by more marked hemorrhaging.

Risk factors

Having diabetes puts you at risk of retinopathy, whether you have type 1 diabetes or type 2 diabetes. Your risk increases the longer you have the disease.

Other risk factors for diabetic retinopathy include:

• Poorly controlled blood sugar levels

• high blood pressure

• High blood cholesterol

• Pregnancy

• Obesity

• Kidney disease

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