How fast will my diabetic retinopathy progress?

The normal retina, (From "Diabetic Eye Disease - Don't Go Blind From Diabetes")

The normal retina, (From “Diabetic Eye Disease – Don’t Go Blind From Diabetes,” by David Khorram, MD)

A 77 year-old woman with diabetes for 15 years wrote with the following question on Diabetes Forum.  I thought it could serve more people if I answered it here.

“My eye doctor recently told me that I had a bit of diabetic retinopathy, and that I should come back in 9 months instead of the usual 12 months.  He also said that I might need laser in the next year.  He was pretty vague about these things.  How fast will my retinopathy progress?”

Great question!  Here is what I have to say.  I’m sorry you left your doctor’s office feeling like things were “vague.”   At our clinic, we take retinal photographs of our patients’ retinopathy, and review the photos with them and their families, so they have a very clear understanding of what is going on, and what my concerns are.  Of course, “what is going to happen” may not be clear, but “what is going on” should be very clear.  So, even though you shouldn’t have to, ask the doctor to take a retinal photograph and review it with you.  I think that will help in the future.

In a more general sense, the rate of progression depends on the current level of retinopathy (is it mild, moderate, severe, very severe), and on how well your blood sugar and blood pressure are controlled.  I also find that whether or not someone smokes makes a huge impact on how quickly retinopathy progresses.  If you’ve had diabetes for 15 years, your general medical status hasn’t changed much, and you don’t smoke, the retinopathy is probably going to progress at the same rate that it already has, which sounds to be “slowly”.

On the other hand, a lot depends on where the retinopathy is at the moment.  The macula is the area of the retina that is involved with your sharpest clearest vision.  If the retinopathy is near the macula, even if it is mild, then the concerns are higher, because even a little bit of progression can cause some loss in vision.  When your doctor says, “you may need laser soon” it sounds to me like the retinopathy may be close to the macula (or more specifically, to the fovea, which is the name we give to the center of the macula), and thus of greater concern.

There is quite a bit of retinopathy present, but it’s only that little bit of hard exudate (HE) and edema (E) close to the fovea (the center of the macula) that is threatening the vision and must be followed closely. (From “Diabetic Eye Disease – Don’t Go Blind From Diabetes,” by David Khorram, MD)

In my book, I spend a chapter discussing the various types of findings in diabetic retinopathy, when those are of concern, and also a chapter on what affects how quickly we need to see you again.  It also has pictures to illustrate the sorts of things I explain.  I also spend a lot of time explaining the new “standard of care” for treatment of some forms of diabetic retinopathy (it’s no longer just laser), and I think that’s important for you to understand since your doctor is mentioning laser.

I hope this brief explanation is helpful.  I don’t want this to be a sales pitch for my book, but the truth is, I’ve found that those people who have a better understanding of how diabetes affects their eyes are the ones that keep their vision.  And that’s why I wrote it.

I welcome questions.  Just post them in the comments section, and I’ll take some of them and incorporate them into posts like this one.


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