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Retina or Macula: what are they? | |
Retina | The retina is a thin layer of tissue located at the back of the eye. It receives the light that enters the eye. Special cells called rods and cones convert light into electrical signals.These signals are sent through the optic nerve to the brain. |
Diseases of the retina affect vision. | |
Macula | The macula (Latin: macula lutea, meaning “yellow spot”) is a small area in the center of the retina. Responsible for sharp, central vision. At the center of the macula is the fovea, the point with the highest visual acuity. |
Diseases of the macula significantly impair vision, especially fine visual acuity, such as recognizing faces and reading. | |
In diabetes mellitus, retinopathy is the most common disease of the small blood vessels (microangiopathy). These vessels become leaky, fragile, and may rupture.
As a result, fluid accumulation and bleeding occur in the retina, along with vascular blockages and oxygen deficiency. In later stages, new fragile blood vessels form, which can lead to additional bleeding and retinal detachment.
Retinopathy occurs in about one quarter of all people with diabetes mellitus.
Signs of advanced retinopathy and maculopathy include:
Condition Warning Signs / Symptoms
Retinopathy Blurred or fluctuating vision
Dark spots or floaters in the visual field
Sudden vision loss
Difficulty seeing at night
Distorted or patchy vision
Seeing shadows or dark areas
Maculopathy Blurred central vision
Difficulty reading
Difficulty recognizing faces
Straight lines appearing wavy or distorted
Dark or empty spot in the center of vision
Reduced color perception
Warning Signs of Retinopathy and Maculopathy
People affected by retinopathy usually notice changes only after permanent damage has already occurred. Therefore, the back of the eye (fundus) must be examined regularly by an ophthalmologist.
If no or only minor changes are present, the examination should take place once a year; otherwise every six months or according to the ophthalmologist’s recommendation.
The frequency and findings of ophthalmological examinations should be recorded in the Diabetes Health Passport.
If blood sugar levels worsen or improve (for example during a new adjustment of diabetes therapy), visual disturbances may occur. These are caused by changes in the fluid content of the lens. They are temporary and do not represent permanent damage.
Retinopathy and Maculopathy Can Be Detected Well During an Ophthalmological Examination
Examination | Explanation (How the examination is performed) |
Visual acuity test | The patient reads letters or symbols from an eye chart (e.g., Snellen chart) at a defined distance. Each eye is tested separately to determine how clearly the patient can see. |
Slit-lamp examination | The ophthalmologist examines the front structures of the eye (cornea, lens, anterior chamber) using a slit lamp, which is a microscope with a bright, narrow beam of light. The patient rests their chin on a support while the doctor inspects the eye. |
Fundus examination (examination of the back of the eye) | The pupil is often dilated with eye drops. The ophthalmologist then examines the retina, macula, and optic nerve using special lenses and light to detect retinal or macular changes. |
Intraocular pressure measurement | The pressure inside the eye is measured, often using a device that gently touches the cornea or by a non-contact method using a short puff of air. This helps detect increased eye pressure. |
Fluorescein angiography | A fluorescent dye is injected into a vein in the arm. As the dye circulates through the blood vessels of the retina, photographs are taken to identify leakage, blockages, or abnormal vessels. |
Optical coherence tomography (OCT) | A non-invasive imaging technique that uses light waves to create detailed cross-sectional images of the retina. The patient looks into the device while the scanner captures high-resolution images of retinal layers. |
People with diabetes are more likely to develop clouding of the lens (cataract).
Signs of cataract include:
Retinopathy and maculopathy are typical complications of long-standing and poorly controlled diabetes mellitus. Early deterioration with well-controlled blood glucose levels is rare.
Additional risk factors include:
They also typically occur during periods of hormonal changes, particularly during pregnancy. During this time, shorter examination intervals are necessary.
Prevention and General Measures
Good control of blood glucose, blood pressure, and blood lipids plays a crucial role in preventing the development and progression of diabetic retinopathy and diabetic maculopathy.
Important preventive measures include:
The main goal of treatment is to prevent vision loss and slow or stop the progression of retinal damage.
Regular eye examinations by an ophthalmologist are essential for early detection and treatment.
Diagnostic Monitoring
Modern imaging techniques allow early detection and monitoring of retinal damage.
Important diagnostic methods include:
Treatment Options
The choice of treatment depends on the stage and severity of the disease. Several treatment options may be used individually or in combination.
Today, intravitreal injections of anti-VEGF medications are considered the first-line treatment for diabetic macular edema (DME).
These medications block vascular endothelial growth factor (VEGF), a substance that promotes abnormal blood vessel growth and leakage in the retina.
Commonly used medications include:
Procedure
The injection is usually performed on an outpatient basis under sterile conditions.
Multiple injections may be required to maintain the therapeutic effect.
Possible temporary side effects include:
Serious complications are rare.
In some cases, corticosteroid implants are used to reduce inflammation and retinal swelling.
Common medications include:
These treatments may be considered when anti-VEGF therapy is insufficient or not suitable.
Possible side effects include:
Laser photocoagulation has been used for many decades and remains an important treatment for certain stages of diabetic retinopathy.
Two main types are used:
Panretinal Photocoagulation (PRP)
Used mainly for proliferative diabetic retinopathy.
Laser spots are applied to peripheral areas of the retina to:
Focal or Grid Laser Therapy
Used in selected cases of diabetic macular edema to seal leaking blood vessels and stabilize vision.
In advanced stages of diabetic eye disease, vitrectomy surgery may be necessary.
This procedure is called pars plana vitrectomy.
It may be required in cases of:
During the procedure:
This surgery can help prevent severe vision loss or blindness.
Follow-Up and Long-Term Care
Diabetic retinopathy and maculopathy require long-term monitoring.
Patients should undergo regular eye examinations, usually:
Early diagnosis and timely treatment significantly reduce the risk of vision loss.
Treatment of Diabetic Retinopathy and Diabetic Maculopathy
Overview
Preventive Measure | Importance |
Good blood glucose control (HbA1c) | Reduces the risk of developing retinal damage |
Blood pressure control | High blood pressure accelerates retinal vessel damage |
Lipid control | High cholesterol and triglycerides increase vascular complications |
Smoking cessation | Smoking worsens microvascular damage |
Regular eye examinations | Allows early detection and timely treatment |
Examination | Purpose |
Visual acuity test | Measures the clarity of vision |
Fundus examination | Allows direct observation of the retina and optic nerve |
Optical Coherence Tomography (OCT) | Detects retinal swelling and macular edema |
Fluorescein angiography | Identifies leaking vessels and abnormal new vessel formation |
Intraocular pressure measurement | Screens for additional eye diseases such as glaucoma |
Treatment depends on the stage of diabetic retinopathy and the presence of diabetic macular edema (DME).
Treatment | Description | Main Purpose |
Anti-VEGF intravitreal injections | Medication injected into the vitreous body to block vascular endothelial growth factor (VEGF) | Reduces swelling and prevents abnormal vessel growth |
Intravitreal corticosteroids | Steroid implants placed inside the eye to reduce inflammation and edema | Used when anti-VEGF therapy is insufficient |
Laser photocoagulation | Targeted laser treatment applied to retinal areas | Prevents progression of retinal damage |
Vitrectomy surgery | Surgical removal of the vitreous gel and scar tissue | Treats advanced disease such as bleeding or retinal detachment |
Laser Technique | When It Is Used | Effect |
Panretinal photocoagulation (PRP) | Proliferative diabetic retinopathy | Reduces abnormal vessel growth |
Focal/Grid laser therapy | Selected cases of diabetic macular edema | Seals leaking retinal vessels |
Condition | Recommended Eye Examination Interval |
No signs of retinopathy | Once per year |
Mild to moderate retinopathy | Every 6–12 months |
Advanced retinopathy or active treatment | According to ophthalmologist recommendation |
Key Message
Early detection and appropriate treatment can significantly reduce the risk of severe vision loss or blindness in people with diabetes. Regular ophthalmologic examinations and good control of systemic risk factors are essential for protecting vision.