How to Help Patients Prevent Diabetic Retinopathy

For your patients with diabetes, managing the disease is about more than keeping their blood glucose levels under control. It’s also about managing the comorbidities that may develop alongside their diabetes.

One common comorbidity among patients with diabetes is diabetic retinopathy. Below, we’ll explain what it is, how it happens, and how healthcare teams can help patients prevent its onset or progression.

What Is Diabetic Retinopathy?

Diabetic retinopathy is a condition that damages the blood vessels in the retina and can result in vision loss. It can happen to patients with Type 1 or Type 2 diabetes and is the leading cause of blindness in adults in developed countries. In fact, the prevalence rate of retinopathy in the adult population with diabetes in the United States is 40.3%.

How Does Diabetic Retinopathy Happen?

Diabetic retinopathy occurs because of prolonged high blood sugar levels associated with diabetes:

• Elevated glucose levels can damage blood vessels throughout the body, including those in the retina, the eye’s light-sensing layer.
• The damage to these blood vessels can restrict blood flow and cause blockages.
• As these blockages accumulate, they may leak fluid or bleed. In response, the eye may attempt to form new blood vessels.
• These new vessels tend to be frail and prone to leakage, exacerbating the potential for vision impairment.

Symptoms of Diabetic Retinopathy

Most patients don’t experience many diabetic retinopathy symptoms at first, though some may notice trouble reading or seeing objects far into the distance, which can also be explained by aging or other factors.

But in the later stages of the disease, patients may start to see dark spots or streaks that resemble cobwebs. This happens because blood vessels in the retina start to bleed into the vitreous body (the gel-like fluid that fills the space between the lens and the retina).

Phases of Diabetic Retinopathy

Diabetic retinopathy can be categorized into two main clinical phases:

Non-Proliferative Diabetic Retinopathy (NPDR)

This initial stage is characterized by the appearance of microaneurysms, which are small bulges in the blood vessels of the retina, visible as tiny red or black dots across the back of the eye.

As NPDR advances, other signs, such as hemorrhages and hard exudates, may appear. These yellow deposits are leaked lipids from damaged blood vessels. Typically, this stage does not require specific treatment unless it progresses significantly.

Proliferative Diabetic Retinopathy (PDR)

This more advanced stage occurs when retinal blood vessels become occluded, leading to retinal ischemia and the subsequent growth of new blood vessels — a process driven by the release of vascular endothelial growth factors. These new vessels are delicate and prone to bleeding, which can fill the vitreous cavity and severely impair vision. Complications from PDR, including issues like traction retinal detachment, can lead to permanent vision loss if not managed properly.

Diabetic Maculopathy

This condition can develop at any stage of diabetic retinopathy and involves the macula — the central part of the retina that is crucial for clear, detailed vision. Changes in the macula, such as swelling from fluid leaks or the closure of nourishing blood vessels, can drastically affect visual acuity.

Risk Factors of Diabetic Retinopathy

Not everyone with diabetes will develop the disease. Risk factors that cause or exacerbate the disease include:

• Duration of diabetes
• Pregnancy
• Poor glycemic control
• Alcohol consumption
• Physical inactivity
• Smoking
• High blood pressure
• Obesity
• High cholesterol levels

Preventing Diabetic Retinopathy

Diabetes and vision loss don’t have to go hand-in-hand. Nurses and other healthcare professionals can play a pivotal role in the management and education of patients with diabetes. Here are some ways you can help patients preserve their vision.

Educate Patients About Blood Sugar Control

Emphasize the importance of maintaining optimal blood glucose levels to prevent the onset or progression of diabetic retinopathy. Encourage patients to stick to their medication schedules, dietary plans, and exercise routines to stabilize blood sugar levels.

Promote Regular Eye Exams

Early detection of diabetic retinopathy is key to preventing severe vision loss. Remind your patients about the importance of regular comprehensive eye exams, including dilated retinal screenings. Pregnant patients should have additional eye exams throughout pregnancy to monitor the development or progression of diabetic retinopathy.

Discuss Visual Symptoms

Educate patients on recognizing the early signs of diabetic retinopathy, such as an increase in floaters, blurriness, dark areas of vision, and difficulty perceiving colors. Encourage them to report these symptoms as soon as they experience them.

Support Lifestyle Modifications

Guide patients on lifestyle changes that can help manage diabetes more effectively. This includes healthy eating, regular physical activity, and smoking cessation. These factors play a large role in overall diabetes management, which in turn affects eye health.

Coordinate Care

Collaborate with dietitians, diabetes specialists, and ophthalmologists to create a comprehensive care plan for each patient. Integrated care approaches can lead to better management of diabetes and its complications.

Provide Emotional and Psychological Support

A diagnosis of diabetic retinopathy can be distressing for your patient. As a nurse, you have a unique opportunity to offer emotional support and connect patients with counseling services or support groups where they can share experiences and coping strategies with peers.

Use Technology

Introduce patients to helpful monitoring technologies such as continuous glucose monitors (CGMs). Explain how these devices can provide detailed insights into glucose patterns and help in tighter glucose management, reducing the risk of complications like retinopathy.

The Role of Technology in Diabetic Retinopathy Prevention

A CGM can be your secret weapon in helping a patient with diabetes maintain safe blood glucose levels, preventing diabetic retinopathy. Let’s take a closer look at how they can help.

Benefits of Continuous Glucose Monitors (CGMs)

Continuous glucose monitors (CGMs) have been proven effective in maintaining tighter glucose control, a crucial step for preventing the onset and progression of diabetic retinopathy. Studies have shown that the use of CGMs can lead to significant improvements in glycemic control, reducing the incidence and progression of diabetic retinopathy by allowing for timely adjustments in therapy before glucose levels become problematic.