Types of Retinopathy

At the back of the eye, your retina, which is a sensory membrane, takes light focused on it and converts this into nerve signals sent to the visual centers in the brain. In the brain, images are then created by these signals.

If the retina is not functioning as it should, you may be told that you have retinopathy. This is an umbrella term that encompasses a variety of conditions that may lead to retina-related vision loss.

The blood supply to the retina plays an important role. A normal healthy retina has blood vessels within it to bring needed oxygen and nutrients to function.

In retinopathy, the blood vessels may leak, overrun the retina, or grow right through it. The retina can begin to break down or may detach, causing vision loss and maybe even blindness in some cases.

Retinopathy affects many different people. Diabetic retinopathy, which affects those with diabetes, is expected to affect 11 million people in the United States by 2030 and 14.6 million by 2050.

This article will discuss the symptoms, causes, and treatments for four major types of retinopathy, including diabetic retinopathy, retinopathy of prematurity, hypertensive retinopathy, and central serous retinopathy.

Diabetic Retinopathy

Diabetic retinopathy, a complication of diabetes, can be a sight-threatening disease. The high blood sugar that is the hallmark of diabetes can affect the eyes. It can eventually damage small blood vessels in the retina, which may leak fluid. Because of this, the retina may swell, causing vision to blur or become cloudy.

Also, when there is high blood sugar in the system for an extended period, the lens of the eye accumulates fluid, which changes the curvature. However, when the blood sugar drops, this can return to normal.

However, the same is not true for damage to the retina. New abnormal blood vessels may form on the retinal surface to try to improve blood circulation there. But since these are fragile, they leak blood, block vision, and ultimately damage the retina.

The growth of new blood vessels is called neovascularization. Tests can be done to look for it.

Factors influencing the risk for developing diabetic retinopathy include:

• Diabetes: There is an increased risk in both type 1 and type 2 diabetes, particularly if it is not well controlled. The longer someone has had diabetes, the more likely they are to develop diabetic retinopathy.
• Family history of diabetic retinopathy: If you have close family members with this condition, that can also put you at greater risk.
• Other medical conditions: Having high blood pressure or high cholesterol can put you at greater risk for having this condition.
• Race: Those at greatest risk of developing diabetic retinopathy are those of Latinx or Black descent.
• Gestational diabetes: Those who have developed gestational diabetes during pregnancy are at heightened risk of going on to later have diabetes and develop diabetic retinopathy.

Symptoms of the condition to be alert for include:

• Blurred vision
• Noticing floaters or other spots
• Night vision difficulties
• Having a blank spot in your central vision
• Newly developed color blindness or fading of colors
• Tends to occur in both eyes

Diabetic retinopathy occurs in two stages, non-proliferative and proliferative.

Non-Proliferative Retinopathy

This is the early stage of the disease, the hallmark of which is leaking blood vessels. Early on, there may be retinal hemorrhages (bleeding) or leakage of fluid or lipid (fat). Over time, the blood vessels close, causing poor blood flow to the retina.

Proliferative Retinopathy

In response to the poor blood flow, abnormal new blood vessels begin to grow. These may begin to leak blood into the vitreous (the jelly-like substance that fills your eyes), clouding vision. This may cause scar tissue to form in the area and may eventually lead to a retinal detachment with severe vision loss.

Also, new blood vessels may grow into the area where fluid drains from the eye, blocking it. This causes a type of glaucoma, with increased eye pressure and damage to the optic nerve with permanent vision loss.

Treatment

Treatment for diabetic retinopathy depends on the stage of the disease. Initially, your practitioner may want to watch it, especially if you have good vision. This may include regular eye exams every two to four months.

As the disease progresses, other options include injecting medications into the eye to help keep new blood vessels from forming.

If you are at a somewhat later stage, laser treatment may be tried to seal blood vessel leaks. Or, a pattern of scattered laser burns in parts of the retina with abnormal blood vessels may be used to shrink them. While this can cause some peripheral vision loss, it may also help preserve important central vision.

Retinopathy of Prematurity

This form of retinopathy usually affects premature infants, particularly those weighing 2 and 3/4 pounds or less. Retinopathy of prematurity (ROP) also tends to occur in babies born before 31 weeks of gestation. It tends to occur in both eyes and is a common cause of vision loss in children.

In ROP, an abundant number of abnormal blood vessels spread across the retina. These blood vessels tend to be fragile and leaky and cause scarring of the retina, as well as the potential for retinal detachment. It is the retinal detachment that is the main source of vision loss.

The reason that ROP develops appears to be linked to the baby's development. During the early part of pregnancy, the blood vessels of the baby's retina supplying oxygen and nutrients grow gradually toward the edges. The rapid development of the retina, however, doesn't take place until the last 12 weeks of gestation.

But if a baby is born prematurely, blood vessel growth may stop before reaching the periphery of the retina. So, the retina won't be getting the nutrition it needs and may send out signals for new blood vessels to grow. But these new blood vessels are fragile and leak. This can lead to scarring and eventually to retinal detachment.

Determining if your child has this condition will likely require an retina specialist or retinologist to see what's going on inside the eye. Still, there can be some signs in more severe cases. These include:

• Nystagmus (rapid side-to-side eye movements)
• Leukoria (white pupils)

The need for treatment depends on the severity of the ROP. In mild cases, it is only necessary to closely watch the condition with frequent examinations. Remember that since the abnormal blood vessels can begin growing at any point, it's important to follow through on this monitoring.

Treatments here may be as follows:

• Cryoretinopexy: The tip of a very cold cryoprobe is placed on the outside of the eye. The idea is to freeze the abnormal retinal blood vessels, keeping these from growing and making them shrink.
• Laser photocoagulation: A laser is focused on a tiny area of the retina, heating it to stop blood vessel growth.
• Scleral buckling: This is used in the case of a retinal detachment, which can otherwise lead to severe vision loss. It is akin to placing a rubber band around the eyeball. The scleral buckling pushes the retina up against the inside of the eye giving it a chance to reattach. The band is removed when the retina reattaches, or the eye outgrows it.
• Vitrectomy: This may be used if there is a large number of abnormal blood vessels and scar tissue. It involves removing the gel-like fluid that fills the eye. Also, the surgeon will remove any scar tissue that may be pulling on the retina to help prevent a retinal detachment.

In addition to immediate issues, children with ROP are at greater risk later in life for nearsightedness, lazy eye, crossed eyes, glaucoma, and retinal detachment, some of which can be managed or treated.

Hypertensive Retinopathy

Those who have high blood pressure are at risk of developing hypertensive retinopathy. This is caused by a narrowing of the tiny blood vessels that feed the retina. Visual clarity can be lost if this goes untreated.

While this can happen to anyone with high blood pressure, the risk is greatest for those who have had high blood pressure longer and have the most elevated pressure.

Often, there are no symptoms until damage has been done to the retina. Some indications that you may have this condition include:

• Headaches
• Dimmer vision than usual or seeing double
• Sudden vision loss or other visual anomalies

If you have any of these symptoms, you should seek immediate attention.

To determine if you have this condition, your eye practitioner will check for signs of narrowing or leaking of your blood vessels, as well as the degree of damage.

At the mildest stage, the narrowing of your arteries may be barely detectable. However, in severe cases, this may involve swelling of the optic nerve and the macula (the oval area in the center of the retina responsible for sharp, straight-ahead vision).

Treating this condition can only be done by controlling your blood pressure and ensuring that this does not become elevated. Your doctor may also recommend lifestyle changes such as eating healthier and losing weight.

In addition to vision issues, those with the severe form of this condition tend to be at greater risk of stroke, as well as heart and kidney problems.

Central Serous Retinopathy

While not as much is known about central serous retinopathy, with this condition, there is a buildup of fluid under the retina. This occurs in a layer known as the retinal pigment epithelium. If fluid builds up here, it can cause visual distortion and even a detachment.

This condition tends to occur in men between the ages of 30 and 50 and seems to be stress-related. Additional factors that tend to lead to this condition include:

• Using steroids
• Having an autoimmune disorder
• Being infected with helicobacter pylori (something that's associated with ulcers)
• Having insomnia, sleep apnea, or another sleep-related disorder
• Having high blood pressure
• Being highly competitive or aggressive by nature (type A personality)

In most cases, treatment for this isn't necessary, and people retain good vision, although perhaps not as good as before. Central serous retinopathy tends to clear up on its own.

However, if this doesn't happen and fluid leakage persists, the doctor may prescribe oral medication.

Summary

Retinopathy is a general term for conditions affecting the retina. These often involve the tiny blood vessels supplying this light-sensitive area of the eye, leading to damage, leakage of fluid, or growth of new vessels that are fragile and can leak or bleed.

In diabetic retinopathy, high blood sugar leads to damage of the blood vessels. High blood pressure (also often seen in diabetes) may also cause this damage. Premature infants may have retinopathy of prematurity. Central serous retinopathy usually occurs in middle-aged adults due to fluid buildup under the retina.

A Word From Verywell

Having a regular comprehensive eye examination can catch early signs of eye conditions that can risk your sight. Additionally, many people do not realize they have diabetes or high blood pressure. A regular medical check-up can help you control these conditions so they do not raise your health risks from many serious conditions.