Diabetic retinopathy – colloquially called diabetic retinal disease – (Latin: retinopathia diabetica; synonyms: retinopathia diabetica; diabetic maculopathy; ICD-10-GM H36.0: retinopathia diabetica) refers to a deterioration of vision to the point of blindness caused by the high sugar levels associated with diabetes mellitus (diabetes). Diabetes mellitus is the most common cause of blindness in Western countries in the 30 to 60 age group.
Diabetic retinopathy and/or diabetic maculopathy (see below) are among the microvascular (“affecting small blood vessels (capillaries)”) complications of diabetes mellitus.
Diabetic retinopathy can be divided into:
- Nonproliferative diabetic retinopathy (NPDR) – disease remains confined to the retina of the eye; usually occurs earlier and may progress to the proliferative form
- Proliferative diabetic retinopathy (PDR) – in this form, due to the reduced supply to the eye, increased new blood vessels form, which infiltrate the vitreous and can thus severely compromise vision
In addition to the two forms, the so-called macular edema (accumulation of water at the point of sharpest vision) occurs in approximately 15% of those affected, which in turn also leads to severe visual impairment (= diabetic macular edema, DMÖ). Diabetic retinopathy is therefore divided into with or without diabetic macular edema (DME).
Diabetics with diabetes mellitus type 1 develop diabetic retinopathy with 40% about twice as often as diabetics with diabetes mellitus type 2. With the same duration of diabetes and with similarly good or poor metabolic control, the frequency of diabetic retinopathy in diabetes mellitus type 1 and in diabetes mellitus type 2 is approximately the same. Proliferating diabetic retinopathy is much more common in diabetes mellitus type 1 and maculopathy is predominant in diabetes mellitus type 2.
Peak incidence: The disease occurs predominantly between the ages of 30 and 60 years.
The prevalence (disease incidence) of diabetic retinopathy is 9-16% in patients with diabetes mellitus type 2 and 24-27% in patients with diabetes mellitus type 1 (in Germany).
Course and prognosis: Diabetic retinopathy is the most common complication of diabetes mellitus on the small vessels (microangiopathy). About 90 % of all diabetics with diabetes mellitus type 1 and about 25 % with diabetes mellitus type 2 have a diabetic retinopathy after 15 years of disease with the consequence of vision loss (visual loss or deterioration of another visual function). First changes can be seen after 10-13 years. This is why timely screening is so significant. Diabetics should go to their ophthalmologist for annual check-ups, as early stages (initial stages) of diabetic retinopathy can be asymptomatic for the patient. The therapy mainly includes an optimal adjustment of the blood sugar as well as the blood pressure, but also a weight reduction or optimization, more physical exercise and smoking cessation may be necessary. If the disease is detected early and treated adequately, only about 5 % have to expect severe visual impairment.The majority of people with diabetes mellitus type 2 do not develop retinal complications. Less than 1% of people with diabetes are blind (0.2-0.5%).