**Diabetic retinopathy is a silent threat to vision** Diabetic retinopathy is one of the most common and at the same time the most important eye complications of diabetes that silently affects the retina. This condition is caused by long-term damage to the tiny blood vessels in the retina caused by uncontrolled blood sugar. You should know that in the early stages, diabetic retinopathy usually does not have clear warning signs, which is why it is considered a "silent threat" to vision. Without timely diagnosis and intervention by a doctor, this disease can lead to permanent damage to the retina, intraocular bleeding, and finally severe vision loss in diabetic patients. In order to protect vision, one should be aware of this eye complication of diabetes and pay attention to regular eye screenings. Timely diagnosis of this disease provides the possibility of effective treatments that can prevent the progression of the disease and preserve the patient's vision for many years. Therefore, every person with diabetes should be aware of the risks of retinopathy and undergo regular eye examinations. **What is diabetic retinopathy?** One of the most serious eye complications of diabetes is diabetic retinopathy. This disease is caused by damage to the small blood vessels of the retina. The retina is a layer of light-sensitive tissue at the back of the eye that converts images into electrical signals and sends them to the brain. If diabetes is not controlled, high blood sugar levels will damage these delicate vessels over time and lead to vision impairment and eventually blindness. This disease is one of the most common causes of vision loss in diabetic patients. ### **Understanding the mechanism of retinal damage** The main mechanism of damage in diabetic retinopathy is caused by high blood sugar, which weakens and blocks retinal blood vessels. Initially, the walls of the blood vessels swell and fluid or blood may leak. This leakage leads to swelling of the retina (macular edema), which affects the central focus of vision. As the disease progresses, new and fragile blood vessels (neovascularization) grow on the surface of the retina to compensate for the lack of oxygen. These new and fragile vessels are very vulnerable and easily rupture and bleed, as well as causing scar tissue formation. Scar tissue can stretch the retina and lead to retinal detachment, an emergency situation with the risk of permanent blindness. **Read more: The impact of stress on eye health** **Types of diabetic retinopathy: comparison of stages of disease progression** Diabetic retinopathy is divided into two main types, non-proliferative (NPDR) and proliferative (PDR). This classification is based on the severity of retinal damage and the presence of new and abnormal blood vessels, and understanding it is critical for vision management in diabetic patients. This disease progresses with time and improper blood sugar control, and each stage has its own characteristics. ### **Nonproliferative diabetic retinopathy (NPDR)** Nonproliferative is the first stage of diabetic retinopathy, which is characterized by subtle changes in retinal blood vessels. This stage itself is divided into three subgroups: mild, moderate and severe. In mild NPDR, microneurisms (small bumps in the blood vessel walls) appear. As it progresses to the intermediate stage, small hemorrhages, exudates (fatty deposits) and macular edema (swelling in the center of vision) are also seen. Severe nonproliferative is characterized by a significant increase in microneurisms and more hemorrhages, as well as occlusion of small blood vessels in the retina. ### **Proliferative diabetic retinopathy (PDR)** The second stage is proliferative, which is the most advanced and severe form of diabetic retinopathy. At this stage, the retina begins to grow new and abnormal blood vessels (neovascularization) due to lack of oxygen. These new vessels are fragile and easily bleed into the vitreous. Vitreous hemorrhage can cause sudden and severe vision loss in diabetic patients. In more advanced cases, scar tissue from these vessels can stretch and detach the retina, leading to permanent vision loss. This stage requires medical intervention. **Signs and symptoms of diabetic retinopathy** Diabetic retinopathy, which is one of the most serious eye complications of diabetes, may not have significant symptoms in the early stages, so regular eye examinations are very important for diabetic patients. With the progression of retinal damage, warning signs appear little by little, the recognition of which can save vision in diabetic patients. ### **initial and subtle symptoms** In the early stages, the symptoms of diabetic retinopathy are more subtle. The patient may have mild blurred vision, variable vision, or difficulty distinguishing colors. These symptoms can be due to blood sugar fluctuations that are sometimes overlooked. But these symptoms can also be early signs of retinal damage. ### **advanced symptoms and the need for immediate medical intervention** As the disease progresses and retinal damage increases, the symptoms become clearer and more serious. These symptoms include spots, floating threads (like floaters), sudden loss of vision, eye pain or redness, or seeing flashing lights. These symptoms indicate bleeding in the eye or retinal detachment, and you should see an ophthalmologist immediately. **Diabetic retinopathy risk factors: who is most at risk?** **Blood pressure and other factors:** High blood pressure is one of the important factors that aggravate the risk of retinal damage. In addition, high cholesterol levels, kidney diseases and pregnancy in diabetic women also significantly increase the probability of diabetic retinopathy. **Duration and blood sugar control:** The longer the duration of diabetes, the higher the risk of diabetic retinopathy. Severe fluctuations and improper control of blood sugar are the main factors that accelerate damage to the delicate vessels of the retina. Diagnosing diabetic retinopathy: the importance of regular eye examinations Early diagnosis in this disease is necessary to preserve vision in diabetic patients. This condition may be asymptomatic in the early stages, but as it progresses, it can lead to retinal damage and eventually loss of vision. Therefore, regular eye examinations are very important, even if no symptoms are observed. ### **Methods for Diagnosing Diabetic Retinopathy** To diagnose this disease, the ophthalmologist uses several methods: - **Retinal imaging:** Fundus imaging and in some cases, the use of a laser imaging device (OCT) to examine the structure of the retina more closely and evaluate any swelling or fluid leakage. **Comprehensive eye examination and pupil dilation:** In this method, the doctor examines the retina completely and identifies microvascular changes or bleeding. **Diabetic retinopathy treatment methods** Diabetic retinopathy treatment aims to control the progression of the disease, preserve vision and prevent eye complications in diabetic patients. The choice of treatment depends on the severity of the disease and the type of retinal damage. ### **laser therapy** Laser therapy is one of the standard methods for managing this disease. Panretinal photocoagulation (PRP) is used to control the growth of abnormal new blood vessels and prevent severe bleeding. Focal laser is also used to reduce macular edema, which is the main cause of vision loss in diabetic patients. These treatments help reduce retinal damage. ### **Injection of anti-VEGF drugs** Injecting anti-VEGF drugs into the eye has been helpful in the treatment of diabetic retinopathy. Drugs such as ranibizumab (Lucentis), aflibercept (Eylea) and bevacizumab (Avastin) improve the patient's vision and reduce retinal edema by inhibiting the growth of new vessels and also reducing fluid leakage. Injections of these drugs are usually done periodically. ### **Vitrectomy** In severe cases of this disease, when bleeding in the vitreous or retinal detachment has occurred, vitrectomy surgery is necessary. In this surgery, the doctor helps to restore vision by removing blood or scar tissue from the vitreous (jelly substance inside the eye) and repairing the retina. This method is the last way to save vision in the most severe forms of eye complications of diabetes. How to prevent diabetic retinopathy As mentioned, diabetic retinopathy is one of the serious complications of diabetes that leads to retinal damage and vision loss in diabetic patients. Prevention is vital to maintain vision in these patients and has effective steps. ### **Control of sugar, blood pressure and fat** The most important measure to prevent this disease is blood sugar control. Also, controlling high blood pressure and blood lipids is very important in preventing the eye complications of diabetes. These factors damage the small vessels of the eye and increase the risk of developing diabetic retinopathy. ### **Having a healthy lifestyle and regular examinations** A healthy lifestyle can include things like a balanced diet, regular exercise, and quitting smoking. These cases reduce the risk of diabetic retinopathy. Regular ophthalmological examinations are also necessary for early diagnosis of this condition and preservation of vision. **Conclusion:** Diabetic retinopathy, which is a serious complication of diabetes, causes retinal damage and reduced vision in diabetic patients. Accurate control of blood sugar levels, blood pressure and lipids play an important role in preventing diabetic eye complications and minimizing retinal damage. Early diagnosis and timely treatment can significantly prevent vision loss in diabetic patients and improve their quality of life. Therefore, regular eye examinations are necessary, even in the absence of symptoms. Your vision is a precious treasure that can be preserved by properly managing your diabetes and working with your eye doctor. **