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What is diabetic retinopathy (DR)?

If a person has diabetes it can cause a problem with their eyes called diabetic retinopathy (DR). DR damages the small blood vessels in the light-sensitive tissue in the retina (nerve layer at the back of the eye) which leads to vision loss. At first DR may cause no symptoms or only mild vision problems, but if poor diabetes management continues it can result in blindness.

Diabetes is a sickness that happens when the body does not produce enough insulin (a hormone which controls the amount of sugar in our blood). The level of glucose (sugar) in our blood needs to be kept within narrow limits for all our organs to function properly, including our eyes. If a person has diabetes and does not control their blood glucose level (with medication and/or a healthy lifestyle) it can rise above these limits - this is when damage occurs to the eyes. More information about diabetes can be found at http://www.healthinfonet.ecu.edu.au/chronic-conditions/diabetes/plain-language/background-information

What are the risk factors for developing DR?

All people with diabetes are at risk of DR but there are certain factors that can increase the risk which include:

What causes diabetic retinopathy?

Diabetic retinopathy is caused by high blood glucose levels over long periods of time. The small blood vessels in the eye become blocked and the blood supply to the retina is cut-off. In response to the lack of blood supply the eye attempts to grow new blood vessels. Often these new blood vessels do not develop properly, so they are fragile and can leak easily. Leaking blood vessels can cause a loss of vision and scar tissue may also develop, which can pull the retina away from the back of the eye and possibly cause blindness. Raised blood glucose levels can also affect the lens of the eye. With high levels of glucose over long periods of time, the lenses can swell, providing another cause of vision loss.

What are the symptoms of diabetic retinopathy?

Symptoms of DR include:

How is diabetic retinopathy treated?

The treatment for DR will be different for each person depending on how long they have had diabetes and its severity. A retinal camera (a microscope with a camera attached used for viewing the inside of the eye) is used by an eye specialists to check for DR in a simple and pain-free procedure. DR may require laser surgery to repair leaking blood vessels or to discourage new leaky blood vessels from forming. Injections of medications into the eye may be needed to decrease inflammation (swelling/redness) or to stop the formation of new blood vessels. In more advanced cases, a surgical procedure to remove and replace the gel-like fluid in the back of the eye (the vitreous) may be needed. If the retina has detached this may also require surgery.

How can people with diabetes reduce the risk of vision loss from diabetic retinopathy?

All people with diabetes are at risk of developing DR. It is recommended for people with diabetes to:

What is known about diabetic retinopathy in Indigenous Australians?

Almost all of the vision loss caused by diabetes can be prevented if it is detected and treated early. Around 1 in 16 Indigenous people have diabetes, and of these people with diabetes around one in three have DR. Diabetes was the cause of 13% of vision loss and 9% of blindness among Indigenous adults in the 2008 National Indigenous Eye Health Survey. The survey also found that only one in five Indigenous people with diabetes has had an eye exam in the last year.

References and further reading

Australian Institute of Health and Welfare (2011) Eye health in Aboriginal and Torres Strait Islander people. Canberra: Australian Institute of Health and Welfare
Biotext (2008) Risk factors for eye disease and injury: literature review. Canberra: National Health and Medical Research Council, Australia
Office for Aboriginal and Torres Strait Islander Health (2001) Specialist eye health guidelines for use in Aboriginal and Torres Strait Islander populations. Canberra: Commonwealth Department of Health and Aged Care
Taylor HR, National Indigenous Eye Health Survey Team (2009) National Indigenous eye health survey: minum barreng (tracking eyes): full report. Melbourne: Indigenous Eye Health Unit, The University of Melbourne
Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics

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