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Risk Factors for Diabetic Retinopathy

Updated on September 21, 2015
Daughter Of Maat profile image

Melissa Flagg is an ophthalmic technician with over 21 years of medical experience working with patients in the eye care field.

The neuronal layer of the retina cells. The rods and cones along with the ganglion and basal cells are destroyed by diabetic retinopathy.
The neuronal layer of the retina cells. The rods and cones along with the ganglion and basal cells are destroyed by diabetic retinopathy. | Source

About the Author

Melissa Flagg is an ophthalmic technician and has been examining patients on a daily basis for over 20 years.

She has had rigorous training under the supervision of an ophthalmologist and specialized in the cornea, cataracts, and retina as well as how systemic disease affects the eye. She has been certified by JCAHPO as a Certified Ophthalmic Assistant.

Diabetic retinopathy can be a devastating condition. It can cause blindness seemingly overnight, causing permanent damage to the delicate neuronal cells that send messages to the brain.

The retina is considered brain tissue because of its highly specialized cells. Because of this, the retina is very delicate (just like the brain).

Diabetes affects the entire body, but it’s usually seen in the eyes first because of this delicate nature.

With diabetic retinopathy blood vessels begin to break down and eventually start to leak blood onto the retina. This destroys the rods and cone cells that are responsible for taking images and sending them to the occipital lobe of the brain where they are processed.

Diabetics have difficulty controlling their blood sugar levels. When blood sugar levels are high, the excess sugar causes damage to nerves, and blood vessels all over the body including the eye.

Unfortunately, even the most meticulous diabetics will eventually have some damage from the condition. It’s the nature of the beast. But in brittle diabetic patients who have sugar spikes (when the sugar goes extremely high) regularly this damage happens much more quickly.

Risk Factors

There are also several risk factors for diabetic retinopathy. Most of these risk factors can be eliminated simply by changing your lifestyle, but some are related to the medication used to treat type 2 diabetes. These risk factors include:

  • Duration of disease (how long you have had diabetes)
  • Control of blood sugar levels
  • High blood pressure
  • High cholesterol
  • Pregnancy
  • Tobacco use
  • Use of medications such as Avandamet, Avandaryl or Avandia to control blood sugar levels

Let’s look at each of these individually to understand why they increase the risk of diabetic retinopathy.

Definition of Retinopathy

The term retinopathy simply means persistent and acute damage to the retina usually caused by chronic inflammation. Most diseases cause inflammation, most notably diabetes and high blood pressure.

Duration of the Disease

The longer you have diabetes, the more likely it is that you will have some diabetic retinopathy at some point, even if you are meticulous about your blood sugar levels.

The fact that the body can’t use its own insulin means the whole metabolic process is thrown off balance.

The side effect of this is a stiffening of the veins and arteries. When this happens, the vessels start to breakdown under the pressure of the blood coursing through them causing them to eventually leak. This is most noticeable in the eye, and the longer you have the disease, the more damage you will have.

Control of Blood Sugar Levels

This may seem redundant, but it’s a major concern. Many diabetics don’t take their blood sugar seriously for whatever reason.

I’ve seen it time and time again, and as a medical professional, it’s extremely frustrating because the damage to the eye diabetes causes can be delayed with well controlled blood sugar.

Limiting spikes in blood sugar is the main goal. For some diabetics this is virtually impossible, and these people are known as brittle diabetics.

They have extreme difficulty regulating their blood sugar levels with the usual methods such as insulin shots, oral medications etc. Because of this, their risk for developing retinopathy is significantly higher.

It’s important to check your blood sugar levels regularly. You can’t regulate your blood sugar if you don’t know what it is! Keep a log of your readings and bring it with you to both your endocrinologist and your ophthalmologist appointments. Your doctor may find a pattern in the log that you didn’t see, which can help your doctor treat you.

A Look at Diabetic Retinopathy

This is a retina with an advanced case of diabetic retinopathy.
This is a retina with an advanced case of diabetic retinopathy. | Source

High Blood Pressure

High blood pressure, or hypertension, causes its own problems, but when it coincides with diabetes the rate of damage is drastically increased.

Hypertension (HTN) puts undue stress on the heart and blood vessels due to the chronic inflammation it causes. Add this on top of the inflammation and stiffening caused by diabetes, and you have a recipe for disaster.

High blood pressure affects the eye as well, by causing a retinopathy. If you have both hypertension and diabetes, you are twice as likely to suffer from retinopathy.

The main problem with hypertensive retinopathy is trying to prevent it. Keeping the blood pressure low enough will delay the onset of the condition, but how low the blood pressure should actually be is the subject of much debate.

High Cholesterol

Cholesterol is a substance we’ve all heard of that is produced by the liver. It’s a waxy substance that is actually a necessary for us to live.

However, too much of a good thing can be bad, and this is definitely the case with cholesterol, specifically LDL cholesterol. LDL stands for low density lipoprotein, and it is one of the 5 major groups of lipoproteins.

Cholesterol can build up in the blood vessels, which, of course, is the main risk factor for cardiovascular disease.

It’s also a risk factor for diabetic retinopathy because it attaches to the walls of already weakened blood vessels where it can cause a clog. In a blood vessel weakened by diabetes, a clog can cause a rupture and blood to leak onto the retina thereby causing diabetic retinopathy.

Clogged veins and arteries in the eye can also cause a stroke in the eye known as an occlusion, and this cannot be reversed.

Pregnancy

Diabetes in pregnancy, either by the onset of gestational diabetes, or someone who is diabetic becoming pregnant, can cause significant retinopathy.

A woman’s blood volume doubles during pregnancy in response to the growing fetus. This puts a lot of pressure on the blood vessels for all women, but one with diabetes, the blood vessels in the retina can burst under the pressure, causing retinopathy.

It is vitally important that a woman with gestational diabetes keep her blood sugar within the limits set by her doctor, for both her safety and that of her child.

Tobacco Use

Yes, we know smoking is bad. But do you know why it’s bad for the eye? Smokers constantly deprive themselves of a molecule we depend on above all others: oxygen.

Instead of breathing in oxygen constantly, a smoker significantly lowers the amount of oxygen they intake by smoking a cigarette.

After awhile, the damage that is done to the lungs causes the amount of oxygen taken in with each breath to be dramatically decreased.

This oxygen deprivation causes neovascularization of the retina. The eye attempts to compensate by growing in new blood vessels.

In a smoker with no other health conditions, this isn’t usually a problem (although smoking does wreak havoc on the blood vessels and heart).

In diabetics, the risk of neovascularization (growth of new blood vessels) is already increased because of the weakening blood vessels. In a diabetic smoker, the development of neovascularization is essentially a guarantee of retinopathy because the new blood vessels are so weak.

Use of Specific Medications

Using drugs such as Avandia, Avandamet, and Avandaryl to control blood sugar levels can cause diabetic macular edema.

Macular edema is a swelling in the part of the retina that allows us to see detail. When this area swells, part of the retina separates from the choroid which is the layer that supplies the blood vessels to the retina.

When the choroid becomes separated from the rest of the retina, it tries to compensate for the lack of oxygen reaching the retina by growing new blood vessels.

Like all neovascularization the vessels are weak and prone to leakage. Retinopathy is inevitable depending on the severity of the edema.

Things to Remember

It’s important to keep in mind these points:

  • If you are diabetic, you should see your ophthalmologist every six months.
  • Check your blood sugar at least 3 times a day. This will allow you to see how stable your blood sugars are.
  • If you notice a sudden change in your blood sugar readings, see your doctor right away.
  • If you notice any blurry vision, or dark spots, spider webs or large floating globs of red, see your ophthalmologist RIGHT AWAY!!!

© Copyright 2012 - 2015 by Melissa "Daughter of Maat" Flagg ALL RIGHTS RESERVED

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    • Specialk3749 profile image

      Karen Metz 4 years ago from Michigan

      Very good hub! My husband has diabetes and thanfully he has not had any major side effects yet. He also got his diabetes under control, lost over 70 lbs and is running everyday and has changed his eating lifestyle. I am very proud of him for taking his disease seriously.

    • Janine Huldie profile image

      Janine Huldie 4 years ago from New York, New York

      Melissa, my dad actually just recently had tears on his retina and had to have cryo-surgery I believe a freezing technique is used. He does not have diabetes, but has been a habitual smoker for years. Do you know if this could have caused those tears and that issue? After reading your article, it just got me thinking and my curious nature kicked. Thanks and have voted, shared and tweeted as always :)

    • Marcy Goodfleisch profile image

      Marcy Goodfleisch 4 years ago from Planet Earth

      You've given us an excellent and very thorough article on this condition and what can cause it - thank you! It's so important for people to understand that certain habits and conditions pose risks to eyesight as well as the rest of your body and health. Voted up!

    • Daughter Of Maat profile image
      Author

      Melissa Flagg 4 years ago from Rural Central Florida

      @Specialk3749 Your husband's story is a lot like mine! I had gestational diabetes, which went away after my daughter was born, but came back about 4 years later. It was around the same time that I was starting to feel fat, and unsexy, and I had gained like 70lbs total, 40 with my pregnancy which I never lost, and 30 in the 4 years before all this started. So, I started working out religiously, 2 hours a day 7 days a week (I'd get up at 4am! lol) and I put myself on a strick high protein diet and lost 70lbs, dropped my high blood pressure from 138/92 WITH medication to 104/72 WITHOUT medication. And the diabetes is gone, in fact my last fasting blood sugar was 80, which is amazing!! It was all the weight, and the unhealthy eating. I have since stopped the high protein diet (it was mainly to trigger the metabolism and drop my sugar fast), and I'm now currently a vegan. I feel great!!

      Unfortunately, not enough people take it seriously. If they did, they'd have the same results your husband and I have had. But it does take discipline and a lot of work! I hope all my articles on diabetes help people to realize what can happen and that it can easily be overcome. I'm working on the Diet as treatment for diabetes hub next! :D Thank you so much for sharing you and your husband's story!

    • Daughter Of Maat profile image
      Author

      Melissa Flagg 4 years ago from Rural Central Florida

      @Janine, smoking definitely could have exacerbated a risk that was already there. Usually retinal tears occur in patients who are myopic (nearsighted). Even light myopia runs the risk of tears because the eye is too long and the retina is stretched. Smoking exacerbates the risk because of the neovascularization, it actually weakens the retinal tissue as well allowing it to tear more easily. So yes, definitely I would say it wasn't the direct cause because I don't know his exact history, but it definitely helped the process along! Interestingly, it's not the nicotine that causes the problem, it's the 4,000 other chemicals that are the main issue. I found that really interesting because we're told how bad nicotine is, but nicotine is really only a vasoconstrictor (it constricts blood vessels), which is innocuous unless you have health problems, which most people do.

      I hope that helped, thank you as always for your comments and sharing, I always love hearing from you!

    • Daughter Of Maat profile image
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      Melissa Flagg 4 years ago from Rural Central Florida

      @Mary, thank you!! I totally agree. My hope is that letting people know what can happen to their eyes may make them think about what's going on in their bodies as well! Or at least make some changes so they don't lose their eyesight which will benefit their overall health. I always found it so frustrating when patients would tell me they had no idea what their blood sugars were, and then say, "I don't really care." You don't know how many patients actually say that!! Drove me insane!!

    • Faith Reaper profile image

      Faith Reaper 4 years ago from southern USA

      Excellent and very informative hub here! Yikes, kind of scary to think about, but we must do so. Thank you very much for the heads up on this most important health issue. Voted Up In His Love, Faith Reaper

    • Daughter Of Maat profile image
      Author

      Melissa Flagg 4 years ago from Rural Central Florida

      @Faith Reaper Thank you!! It is scary to think about it, but it's better to be scared initially and prevent the problems than to have to suffer with it I think. Thank you for commenting and voting!! :D

    • lrc7815 profile image

      Linda Crist 4 years ago from Central Virginia

      Wow...packed full of good information. A great hub and one that is so important for people to understand. Great job! Voted up.

    • Daughter Of Maat profile image
      Author

      Melissa Flagg 4 years ago from Rural Central Florida

      @Irc thank you!! I agree, this is one of those topics for me that I'm really passionate about!

    • Eiddwen profile image

      Eiddwen 4 years ago from Wales

      Thank you for sharing this well informed hub. My partner has Diabetes class 2 and we are learning a little more about this all the time.

      Thanks for sharing and enjoy your weekend.

      Eddy.

    • Daughter Of Maat profile image
      Author

      Melissa Flagg 4 years ago from Rural Central Florida

      @Eiddwen there is so much we don't know about diabetes and yet there is so much information we do have on it. I plan on doing more on this subject as it's becoming more of a problem within our society. I wish you and your partner all the best!

    • skperdon profile image

      skperdon 2 years ago from Canada

      Thanks for sharing so much useful information. I'm diabetic and I didn't know how scary the effect on the eyes were. Your hub was a real eye opener.

    • Daughter Of Maat profile image
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      Melissa Flagg 8 months ago from Rural Central Florida

      Love the pun! :D Thanks for commenting.

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