Definition

Retinopathy refers to damage affecting the retina, the inner layer of the eye responsible for capturing light and transmitting it as nerve signals to the brain. This tissue requires a substantial supply of oxygen and nutrients from the blood. Consequently, any damage to the blood vessels can significantly impact the retina, making it more prone to injury.

Causes

Retinopathy can result from various conditions, with diabetic retinopathy being the most common. Poor blood sugar management in diabetes often leads to this condition. Diabetic retinopathy is classified into two types: nonproliferative and proliferative. Nonproliferative diabetic retinopathy occurs when the blood vessels in the eye become thin, potentially causing leaks or ruptures. If this affects the macula, a part of the optic nerve, swelling occurs, leading to vision impairment. In contrast, proliferative diabetic retinopathy involves the growth of fragile new blood vessels that form irregularly. These vessels are prone to rupture, allowing blood to obstruct light from reaching the retina.

Apart from diabetic retinopathy, hypertensive retinopathy is another common type, caused by high blood pressure (hypertension). Long-term hypertension can narrow and stiffen blood vessels, causing damage that leads to vessel thickening and narrowing.

Additionally, retinopathy of prematurity (ROP) occurs in premature infants due to excessive oxygen levels. Elevated oxygen levels induce cellular “stress,” resulting in damage.

Another age-related form is age-related macular degeneration (AMD), where macular damage due to aging impairs central vision.

Risk Factor

Risk factors for retinopathy include diabetes, high blood sugar levels, and hypertension. In diabetes, inflammation and antioxidant deficiencies also increase the risk. For hypertension, the duration of high blood pressure, older age, and elevated systolic blood pressure are contributing factors. ROP is associated with a birth weight of less than 1,250 grams, while AMD is more common in individuals over 60 years old.

Symptoms

Retinopathy typically causes a sudden decline in vision without eye redness. Other possible symptoms include seeing floating spots (floaters) and frequent stumbling due to a narrowed field of vision. Eye pain and headaches may occur if retinopathy is caused by excessively high blood pressure (malignant hypertension). However, mild damage may not present noticeable symptoms.

Diagnosis

Diagnosing retinopathy involves measuring blood pressure and blood sugar levels through random, fasting, or HbA1c tests to assess blood sugar control. Other general tests, such as checking heart sounds, lung function, and nerve function, can help detect complications related to hypertension. The doctor may inquire about your medical history, including diabetes and high blood pressure, as these are the most common risk factors for retinopathy. Additional medical history related to stroke, transient ischemic attack (TIA, a stroke-like event with symptoms that disappear within 24 hours), blood vessel disease, and heart failure may also be reviewed.

Next, eye examination is performed. This begins with assessing visual functions such as visual acuity, light reflexes, and visual field. The doctor may also examine the front of the eyeball for signs of eye damage caused by underlying conditions. In diabetic retinopathy, the doctor checks for cataracts and the presence of new blood vessels in the iris.

The inside of the eyeball is examined using an ophthalmoscope. Before the test, the doctor will apply eye drops that dilate the pupil (the black center of the eye). During the ophthalmoscope test, the doctor inspects the structure of blood vessels and the macula, looking for bleeding spots and fat or protein buildup.

Imaging tests such as fluorescein angiography are used to assess the extent of oxygen deprivation in tissue caused by blood vessel damage. This procedure also helps determine the extent of damage to the retinal blood vessels.

Management

The treatment of retinopathy depends on its type. ROP usually occurs in mild stages and may resolve on its own. However, retinopathy caused by diabetes, hypertension, or AMD can only be managed to prevent further deterioration. Doctors may administer injections to reduce vascular epithelial growth factor (VEGF), a substance that promotes the formation of fragile new blood vessels.

For proliferative diabetic retinopathy, laser photocoagulation is the primary treatment. This procedure releases blocked blood vessels that lack oxygen, preventing VEGF production. In hypertensive retinopathy, controlling blood pressure through antihypertensive medication is essential.

If you have been diagnosed with retinopathy, exercise should be approached with caution, as it can increase the risk of blood vessel rupture or retinal detachment. Avoid exercises that raise blood pressure and opt for light physical activity. Consult your doctor for personalized exercise recommendations.

Complications

Retinopathy complications include vitreous hemorrhage, which occurs when fragile blood vessels rupture, causing bleeding into the gel-like fluid that gives the eyeball its shape. Retinal detachment may also occur as a result of this condition. The growth of new blood vessels in the iris can lead to glaucoma, as these vessels can obstruct fluid drainage in the front of the eye. Hypertensive retinopathy may cause blood vessel blockages in the eye. In severe cases, damage to the optic nerve can result in blindness.

Prevention

In most cases, retinopathy can be prevented, especially when related to diabetes and hypertension. The following measures can help reduce the risk:

• Follow your doctor’s medication recommendations. Taking medications as prescribed helps control blood sugar and blood pressure levels.
• Maintain a healthy weight. An ideal weight lowers the risk of complications from diabetes and hypertension.
• Adopt a balanced diet. A healthy diet can help regulate blood sugar levels and may include proper dietary management.
• Practice a healthy lifestyle. Avoid smoking and alcohol consumption to prevent blood vessel damage and maintain balanced fat and protein levels in the body.

When to See a Doctor?

If you notice a gradual decline in vision that worsens over time, especially if you have diabetes or high blood pressure, seek medical attention promptly. Although these symptoms are not exclusive to retinopathy, they may indicate its presence. Retinopathy is a sign that your blood sugar or blood pressure control may be insufficient to prevent complications associated with diabetes or hypertension.

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