What is Diabetic Retinopathy?

By Ron Gross, MD

Dr. Ron Gross is a board-certified ophthalmologist. His areas of particular interest include eye disease evaluation and population health. He currently serves as Chief Medical Officer for IRIS and plays an integral role in maintaining the high standards of the reading center platform, quality assurance, and research projects, working closely with the product and business development teams. Prior to joining IRIS, he served on the IRIS Board of Advisors and was also an IRIS customer. He served as chairman of the Department of Ophthalmology and Director of the WVU Eye Institute from 2013 through 2018 and helped bring the IRIS solution to their rural primary care clinics. He is currently also Professor of Ophthalmology at Baylor College of Medicine.

Read on to learn more about diabetic retinopathy and how it affects vision as explained by Dr. Gross!

Diabetes is known for the way it impacts the quality of life for many individuals living with the disease. What is often overlooked is the reality of unexpected health problems that can arise as a result of diabetes, such as foot problems and eye diseases like diabetic retinopathy. So, what is diabetic retinopathy?

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in individuals with diabetes. This occurs because diabetes affects blood vessels everywhere in the body, including in the retina, the light-sensitive layer of tissue in the back of the eye. Initially, it causes blood vessels to leak blood and fluid into the surrounding tissue. The same mechanism occurs elsewhere, including the kidneys, nerves, and heart.

How Does Diabetic Retinopathy Affect Vision?

The earliest diabetic retinopathy stages are usually undetectable, leaving many patients unaware of the problem. Some people notice changes in their vision like difficulty reading or seeing far-away objects, but may not be aware of the need for a retinal screening. Over time, about half of people with diabetic retinopathy will develop swelling in the macula, the part of the retina responsible for reading vision, when blood vessels in the retina leak fluid.

When this happens, their vision will become blurry because of the extra fluid (vision-threatening diabetic retinopathy -VTDR). In later diabetic retinopathy stages, blood vessels in the retina grow (proliferative diabetic retinopathy) and start to bleed into the vitreous, the gel-like fluid in the center of the eye. If this happens, they may see dark, floating spots or streaks that look like cobwebs.

Sometimes the spots clear up on their own but it’s important to get immediate treatment regardless of how your symptoms are perceived. Without treatment, the bleeding can happen again, get worse, or cause scarring leading to blindness.

The Benefits of Early Detection

Early identification of diabetic retinopathy has been shown to preserve and may improve vision. Specifically, a patient with diabetic retinopathy is 25 times as likely as the general population to develop blindness. Diabetic retinopathy is the number one cause of blindness among working-age Americans. However, with diagnosis and appropriate treatment, the risk of vision loss is substantially reduced to less than 10%.

There is evidence for disparities in diabetic retinopathy according to geographic location, with those living in rural areas of the US experiencing a higher prevalence of diabetic retinopathy compared to those living in urban areas (25.8% vs. 22.0%). Additionally, a lower-income socioeconomic status is associated with an increased likelihood of diabetic retinopathy.

Despite the known risks of the disease, the recommendation from the American Diabetes Association for a yearly retina examination by an eye doctor has resulted in fewer than half (42%) of people at greatest risk for visual impairment being evaluated.

IRIS Retinal Screening Solutions

To address this problem, telemedicine provides an efficient, reliable, and cost-effective retinal evaluation and diagnostic process that enables remote and timely consultations. For example, the IRIS retinal solution reduces access disparities in rural, underserved, and geographically isolated communities. Instead of patients traveling long distances to consult experts, telemedicine leverages technology to enable remote and timely consultations, bringing services closer to those who need them.

The benefits of retinal screening in diabetes are well studied and documented, allowing quick and accurate patient assessment and early detection to minimize preventable vision loss. Diabetic Retinopathy by the Numbers

Source: Preventblindness.org 

Globally, the number of people with diabetic retinopathy will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number of people with vision-threatening diabetic retinopathy will increase from 37.3 million to 56.3 million.

A pooled analysis using individual participant data from population-based studies around the world (35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any diabetic retinopathy, 6.96% (6.87–7.04) for proliferative diabetic retinopathy, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) vision-threatening diabetic retinopathy.

There are approximately 93 million people with diabetic retinopathy, 17 million with proliferative diabetic retinopathy, 21 million with diabetic macular edema, and 28 million with vision-threatening diabetic retinopathy worldwide.

The Impact of Visual Impairment

Visual impairment underlies some of the health outcomes most costly to human health, human capital (disability, quality of life), and the economy. Globally, at least 2.2 billion people have visual impairment or blindness, of whom at least 1 billion could have been prevented (WHO 2019).

The risk of visual impairment increases with older age—1 in 6 Americans over 70 years old has some form of visual impairment. Extensive research has demonstrated an association that shows visual impairment among older adults significantly increases the risk of falls, accidents, death, depression, and suicide while reducing the ability to live independently.

Visual impairment has an even greater impact among lower-income Americans—older Americans who live below the poverty level experience impairment rates 50% higher than all other older adults. As the U.S. population ages, the number of Americans with visual impairment is estimated to double by 2050 (Rohit Varma, MD). Nearly 80% of blindness can be prevented or treated, which leads to more independence to perform daily activities, increased participation in social activities, lower rates of depression, decreased likelihood of falls and injury, and higher employment resulting from a decrease in permanent sickness and poorer general health (Rupert R A Bourne, MD).

The number of people living with diabetes rose from 200 million in 1990 to 830 million in 2022. In 2022, 14% of adults aged 18 years and older were living with diabetes, an increase from 7% in 1990. (WHO)

The IRIS Team works tirelessly to increase accessibility to our retinal screening solution. It is our company mission to end preventable blindness which can only be achieved by increasing access to preventative diabetic retinopathy exams.

To get more insights on how we can help you save eyesight, contact us!

FAQs

What is diabetic retinopathy?

Diabetic retinopathy is an eye condition that affects blood vessels in the retina. Without proper evaluation and preventative care, this condition can lead to vision loss and blindness.

What are diabetic retinopathy causes?

Diabetic retinopathy is caused by both type 1 and type 2 diabetes. It occurs more frequently the longer duration and poorer control of diabetes.

What is the first sign of diabetic retinopathy?

Diabetic retinopathy stages begin with blurred vision, but can later progress into eyesight obscured by black spots until full blindness occurs.

How does an IRIS retinal screening help with diabetic retinopathy?

An IRIS retinal screening is an innovative and accessible way for ophthalmologists, rural doctors, and home healthcare providers to conduct teleretinal imaging for diabetic retinopathy detection to facilitate adequate treatment.