A Diabetes Australia initiative, National Diabetes Week runs from Sunday, 14th to Sunday, 21st July with this year’s campaign shining a light on the impact of diabetes technology and what needs to be done to improve access.
In Australia, around 1.3 million people have diabetes and, of those with the disease, between 25% and 30% report some form of diabetic retinopathy.
Diabetic retinopathy is a common complication of diabetes that affects the eyes, which can potentially lead to blindness if left untreated in severe cases.
However, early detection and prompt treatment can prevent 98% of visual impairment.
What is diabetic retinopathy?
“Diabetic retinopathy affects the blood vessels in the retina, the light-sensitive tissue at the back of the eye, due to prolonged high blood sugar levels associated with diabetes. This condition damages the small blood vessels in the retina, causing them to leak fluid or bleed. As diabetic retinopathy progresses, which often occurs when left untreated, abnormal new blood vessels may develop on the retina, potentially leading to complications,” said Dom Willson, optometrist and National Professional Services Advisor at Optometry Australia.
The stages of diabetic retinopathy include non-proliferative diabetic retinopathy (NPDR), characterised by leaking blood vessels in the early stages, and proliferative diabetic retinopathy (PDR), where new blood vessels grow abnormally on the retina or into the vitreous gel, risking severe vision impairment or loss.
Risk factors
Several factors contribute to an increased risk of developing diabetic retinopathy. These include the duration of diabetes, with longer durations generally correlating to higher risks.
“Poor control of blood sugar levels, which is distinguished by fluctuating or consistently high glucose levels, also often heightens susceptibility. Additionally, individuals with high blood pressure and cholesterol levels face exacerbated retinal damage risks.”
For women with diabetes, pregnancy can accelerate the onset or progression of diabetic retinopathy, underscoring the importance of careful management during this period.
Symptoms
Symptoms of diabetic retinopathy can vary based on its stage.
In mild to moderate NPDR, which are the earlier stages of disease, diabetic retinopathy may present with no noticeable symptoms. As the condition progresses, individuals may experience occasional blurriness or fluctuations in vision.
In its more advanced stages, symptoms of diabetic retinopathy can include blurred vision due to macular oedema (cyst like sacs in the macula), floaters (dark spots or strings in vision), impaired colour vision, dark or empty areas in vision indicating bleeding or retinal damage.
Sudden vision loss from extensive eye bleeding or retinal detachment can also occasionally occur in advanced cases. These generally require urgent eye health attention.
“It's important to emphasise that diabetic retinopathy may be asymptomatic in its initial phases, underscoring the necessity for regular eye exams for patients living with diabetes, even in the absence of apparent vision issues. Early detection and treatment are crucial in preventing vision loss or minimising its severity.”
Technological advancements in optometry
In terms of early detection and diagnosis, telemedicine and remote screening have emerged as potentially transformative tools for patients with diabetic retinopathy.
“This may particularly be beneficial in underserved or rural areas where access to optometrists may be limited. Additionally, AI-powered image analysis, while not currently in broad use, promises earlier detection and diagnosis of diabetic retinopathy in remote and under-served areas.”
By using automated analysis of retinal images, affected patients are given the opportunity for earlier preventative managements and treatments.
Handheld retinal cameras have also revolutionised screening practices by allowing primary care physicians to capture retina images even in secondary or visiting practice locations.
These images can be swiftly transmitted to optometrists for interpretation, facilitating quicker diagnosis and intervention. Limitations of the current generation of handheld cameras, compared to conventional desktop cameras, are image quality and ease of use.
Preventing and managing diabetic retinopathy
Key preventive measures include maintaining stable blood sugar levels through diet, exercise, and medication, as well as managing blood pressure and cholesterol to protect retinal blood vessels.
“Adopting a healthy lifestyle with nutritious eating habits and regular physical activity supports overall diabetes management and eye health. Comprehensive eye exams, at least every two years or more frequently for those at higher risk, are crucial for early detection of diabetic retinopathy, enabling prompt intervention to prevent irreversible damage.”
In terms of management, treatments such as laser therapy, anti-VEGF injections and vitrectomy (a type of eye surgery to treat various problems with the retina and vitreous) may be recommended depending on the disease's progression.
However, the treatments are not always perfect, and so with diabetic retinopathy, as with many other diseases and ailments, prevention is always better than the cure.
Regular monitoring of the retina through imaging techniques helps assess treatment efficacy and track diabetic retinopathy's advancement.
Ultimately, a holistic approach that emphasises diabetes control and vigilant eye care is pivotal in reducing the risk of vision loss and enhancing the quality of life for individuals with diabetic retinopathy.
To book in your next eye examination, use our Find an Optometrist search tool to locate your nearest optometrist today.
