Prevention
There are several reliable ways to lower your risk of impaired vision from retinopathy. First, get a yearly eye exam from an eye doctor (ophthalmologist or optometrist). Adults with type 1 diabetes need a dilated eye exam within five years after the onset of diabetes. Adults with type 2 diabetes need an eye exam shortly after diagnosis.  Your eyes should be dilated for the exam. The early detection of any eye problems is critical to keeping your vision.

Second, keep your blood glucose levels as near to normal as possible. The DCCT found the most striking results of intensive management in preventing retinopathy.  The UKPDS showed that people with type 2 diabetes who lowered their blood glucose and blood pressure also lowered their risk of retinopathy. So the third step is to lower your blood pressure.
The fourth is to stop smoking.

The bottom line, whether you have type 1 or type 2 diabetes, is that you can significantly reduce your chances of developing retinopathy or of having your retinopathy worsen. See your eye care specialist if one of the following occurs:

• your vision becomes blurry
• you have trouble reading
• you see double
• one or both of your eyes hurt
• you feel pressure in your eye
• you see spots or floaters
• you lose peripheral vision

Treatment
The best way to treat proliferative retinopathy, oddly enough, is with light - an intense beam of light called a laser - using a procedure called photocoagulation. An ophthalmologist aims the laser beam at the retina. This creates hundreds of tiny burns in the retina. These burns will destroy abnormal blood vessels, patch leaky ones, and slow the formation of new fragile blood vessels. If you have the more serious form of retinopathy, proliferative retinopathy, or macular edema, photocoagulation can usually prevent blindness.

Photocoagulation may not be for everyone,  however.  It may not work if the retina has bled a lot or has detached. In these cases, a surgery called a vitrectomy can remove the excess blood and scar tissue, stop the bleeding, replace some of the vitreous humor - the clear jelly-like substance that fills the eye - with salt solution, and repair the detached retina.

If you need either of these procedures, choose an ophthalmologist who specializes in retinal disease and who has a lot of experience in treating patients with diabetes. Don’t put off visiting your eye specialist. The earlier you get treated, the greater your chances of preventing blindness or further eye damage.

—
Martha M. Funnell, MS, RN, CDE
Michigan Diabetes Research and Training Center
University of Michigan Medical School
Ann Arbor, Michigan

Robert M. Anderson, EdD
Michigan Diabetes Research and Training Center
University of Michigan Medical School
Ann Arbor, Michigan

Shereen Arent, JD
National Director of Legal Advocacy
American Diabetes Association

American Diabetes Association Complete Guide to Diabetes