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Nonproliferative Diabetic Retinopathy

If you have diabetes mellitus, your body does not use and store glucose properly. Over time, diabetes can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as “diabetic retinopathy.”

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Nonproliferative diabetic retinopathy (NPDR), commonly known as “background retinopathy,” is damage to the retina in which abnormal vessels do not form, distinguishing it from “proliferative retinopathy.” In this stage, tiny blood vessels (capillaries) within the retina leak blood or fluid, or become clogged. The leaking fluid causes the retina to swell or to form deposits called exudates. The capillaries can also become obstructed and then disappear entirely, depriving parts of the retina of blood supply.

Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is the result of macular edema or macular ischemia, or both.

Macular edema is swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from the retina’s blood vessels. It is the most common cause of visual loss in people with diabetes. Vision loss may be mild to severe, but even in the worst cases, peripheral (side) vision continues to function. Laser treatment can be used to help control vision loss from macular edema. Medications injected directly into the eye can be effective too. These include steroids and the new anti-VEGF drugs. In severe or intractable cases, it is necessary to do an operation called a vitrectomy.

Macular ischemia occurs when capillaries close. Vision blurs because the macula no longer receives sufficient bloody supply to work properly. Unfortunately, there are no effective treatments for macular ischemia.

A medical eye examination is the only way to discover any changes inside your eye. If your ophthalmologist (Eye M.D.) or optometrist finds diabetic retinopathy, he or she may order color photographs of the retina, a special test called fluorescein angiography, or a retinal scan called optical coherence tomography (OCT) to find out if you need treatment. Usually, these types of exams and treatment for diabetic retinopathy are done by retina specialists.

If you have diabetes, early detection of diabetic retinopathy is the best protection against loss of vision. You can significantly lower your risk of vision loss by maintaining strict control of your blood glucose, blood pressure, and cholesterol level. People with diabetes should have eye examinations at least once a year. Pregnant woman with diabetes should schedule an appointment in their first trimester, because retinopathy can progress quickly during pregnancy. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy.

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