Diabetic Retinopathy
Symptoms
You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, you might develop:
- Spots or dark strings floating in your vision (floaters)
- Blurred vision
- Fluctuating vision
- Dark or empty areas in your vision
- Vision loss
When to see an eye doctor
Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision seems fine.
Developing diabetes when pregnant (gestational diabetes) or having diabetes before becoming pregnant can increase your risk of diabetic retinopathy. If you’re pregnant, your eye doctor might recommend additional eye exams throughout your pregnancy.
Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy.
Causes
Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don’t develop properly and can leak easily.
There are two types of diabetic retinopathy:
- Early diabetic retinopathy. In this more common form — called nonproliferative diabetic retinopathy (NPDR) — new blood vessels aren’t growing (proliferating).
When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter as well. NPDR can progress from mild to severe as more blood vessels become blocked.
Sometimes retinal blood vessel damage leads to a buildup of fluid (edema) in the center portion (macula) of the retina. If macular edema decreases vision, treatment is required to prevent permanent vision loss.
Advanced diabetic retinopathy. Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina. These new blood vessels are fragile and can leak into the clear, jellylike substance that fills the center of your eye (vitreous).
Eventually, scar tissue from the growth of new blood vessels can cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure can build in the eyeball. This buildup can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma.
Hypertensive Retinopathy
Symptoms of hypertensive retinopathy
You probably won’t have any symptoms until the condition has progressed extensively. Possible signs and symptoms include:
- reduced vision
- eye swelling
- bursting of a blood vessel
- double vision accompanied by headaches
Get medical help immediately if your blood pressure is high and you suddenly have changes in your vision.
What causes hypertensive retinopathy?
Prolonged high blood pressure, or hypertension, is the main cause of HR. High blood pressure is a chronic problem in which the force of the blood against your arteries is too high.
The force is a result of the blood pumping out of the heart and into the arteries, as well as the force created as the heart rests between heartbeats.
When the blood moves through the body at a higher pressure, the tissue that makes up the arteries will begin to stretch and eventually become damaged. This leads to many problems over time.
HR generally occurs after your blood pressure has been consistently high over a prolonged period. Your blood pressure levels can be affected by:
- a lack of physical activity
- being overweight
- eating too much salt
- a stressful lifestyle
High blood pressure also runs in families.
In the United States, high blood pressure is fairly common. According to the Food and Drug Administration (FDA),Trusted Source the condition affects 1 in 3 adults in the United States. It’s called a “silent killer” because it usually has no symptoms.
Risk factors for hypertensive retinopathy
The following conditions put you at a higher risk for HR:
- prolonged high blood pressure
- heart disease
- atherosclerosis
- diabetes
- smoking
- high cholesterol
- being overweight
- eating an unhealthy diet that’s high in fat proteins, trans fats, sugary foods, and sodium
- heavy alcohol consumption
Additionally, the condition is more common in people of African descent, particularly Afro-Caribbean people, according to research from 2003Trusted Source. Women are also more likely to be affected by blood vessel damage than men.
retinal detachment
Symptoms
Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as:
- The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision
- Flashes of light in one or both eyes (photopsia)
- Blurred vision
- Gradually reduced side (peripheral) vision
- A curtain-like shadow over your field of vision
When to see a doctor
Seek immediate medical attention if you are experiencing the signs or symptoms of retinal detachment. Retinal detachment is a medical emergency in which you can permanently lose your vision.
Causes
There are three different types of retinal detachment:
Rhegmatogenous (reg-ma-TODGE-uh-nus). These types of retinal detachments are the most common. Rhegmatogenous detachments are caused by a hole or tear in the retina that allows fluid to pass through and collect underneath the retina. This fluid builds up and causes the retina to pull away from underlying tissues. The areas where the retina detaches lose their blood supply and stop working, causing you to lose vision.
The most common cause of rhegmatogenous detachment is aging. As you age, the gel-like material that fills the inside of your eye, known as the vitreous (VIT-ree-us), may change in consistency and shrink or become more liquid. Normally, the vitreous separates from the surface of the retina without any complications — a common condition called posterior vitreous detachment (PVD). One complication of this separation is a tear.
As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a retinal tear. Left untreated, the liquid vitreous can pass through the tear into the space behind the retina, causing the retina to become detached.
- Tractional. This type of detachment can occur when scar tissue grows on the retina’s surface, causing the retina to pull away from the back of the eye. Tractional detachment is typically seen in people who have poorly controlled diabetes or other conditions.
- Exudative. In this type of detachment, fluid accumulates beneath the retina, but there are no holes or tears in the retina. Exudative detachment can be caused by age-related macular degeneration, injury to the eye, tumors or inflammatory disorders.
Risk factors
The following factors increase your risk of retinal detachment:
- Aging — retinal detachment is more common in people over age 50
- Previous retinal detachment in one eye
- Family history of retinal detachment
- Extreme nearsightedness (myopia)
- Previous eye surgery, such as cataract removal
- Previous severe eye injury
- Previous other eye disease or disorder, including retinoschisis, uveitis or thinning of the peripheral retina (lattice degeneration)
Age related macular dystrophy
What causes age-related macular degeneration?
AMD is a type of inherited eye disease. However, the disease also develops in people with no family history of the disease. AMD occurs when the macula at the back of the eye starts to deteriorate for unknown reasons.
What are the symptoms of age-related macular degeneration?
The macula helps send images from the eye’s optic nerve to the brain. If you have a damaged macula, your brain can’t understand or read the images that your eyes see.
Many people with age-related macular degeneration don’t have symptoms until the disease progresses. You may experience:
- Blurred (low) vision.
- Blank or dark spots in your field of vision.
- The appearance of waves or curves in straight lines.
How is age-related macular degeneration diagnosed?
Because AMD rarely causes symptoms in its early stages, annual eye examinations are key to detecting the disease and starting treatments when they’re most effective. During an eye exam, your eye healthcare provider checks for changes to the retina and macula. You may get one or more of these tests:
- Visual field test: An Amsler grid has a grid of straight lines with a large dot in the center. Your healthcare provider may ask you to identify lines or sections on the grid that look blurry, wavy or broken. A lot of distortion may indicate that you have AMD or the disease is worsening. You can use this visual field test at home to monitor your vision.
- Dilated eye exam: Eye drops dilate, or widen, your pupils. Once your eyes are dilated, your healthcare provider uses a special lens to look inside your eyes.
- Fluorescein angiography: Your healthcare provider injects a yellow dye called fluorescein into a vein in your arm. A special camera tracks the dye as it travels through blood vessels in the eye. The photos can reveal any leakage under the macula.
- Optical coherence tomography (OCT): This imaging machine takes detailed images of the back of the eye, including the retina and macula. Optical coherence tomography isn’t invasive or painful. You simply look into a lens while the machine takes pictures.
- Optical coherence tomography angiography (OCTA): This diagnostic tool uses laser light reflection (instead of fluorescein dye) and the OCT scanning device. It takes just a few moments and produces 3D images of blood flow through the eye