How Diabetes Causes Blindness - Topic Overview
Over time, high blood sugar levels from diabetes lead to
damage of the retina, the layer on the back of the eye that captures images and
sends them as nerve signals to the brain. Whether diabetic retinopathy develops
depends in part on how high blood sugar levels have been and how long they have
been above a target range. Other things that may increase your risk for
diabetic retinopathy include high blood pressure, pregnancy, a family history
of the condition, kidney disease, high cholesterol, and whether you
The early stages of retinal damage
are called nonproliferative retinopathy. First, tiny blood vessels called
capillaries in the retina develop weakened areas in their walls called
microaneurysms. When red blood cells escape through these weakened walls, tiny
amounts of bleeding (hemorrhages) become visible when the retina is viewed
through an instrument called an ophthalmoscope. To clearly see your retina, the
ophthalmologist will enlarge (dilate) your pupils (which serve as a window to
the back of your eye) and may also use a special dye to help identify blood
vessels that may be leaking.
Fluid from the blood also escapes,
leading to yellowish "hard exudates." This type of damage does not cause
problems with vision unless some of the leaking fluid is near the macula. (The macula
is the area of the retina that is responsible for central vision.) An
ophthalmologist who specializes in the treatment of retinal problems will
attempt to stop blood leakage by using a laser in a process called
photocoagulation. By using an appropriately selected laser, your
ophthalmologist may seal the small blood vessels that can leak when a person
has nonproliferative and proliferative retinopathy. More recently, ophthalmologists have been using injectable medicines to treat retinal leakage.
leaks out near the macula, it can disrupt vision. This is called macular edema.
As retinopathy becomes more severe, parts of the abnormal capillaries can
become closed off. This kills parts of the retina that the capillaries previously
supplied with blood. These tiny damaged parts of the retina are called "cotton
wool" spots and can be seen using an ophthalmoscope.