Signs and Symptoms of Diabetic Retinopathy

Your patient may experience no symptoms of diabetic retinopathy, especially in the nonproliferative and preproliferative stages. Symptoms-such as floaters, blurred vision despite corrective lenses, or flashing lights-are generally late indicators of diabetic retinopathy. A diabetic patient should report them immediately to her physician.

Some More Facts

Teach your patient that diabetic retinopathy is a common complication of diabetes and that she may have the disease without experiencing any symptoms.

If your patient has hypertension, explain the relationship between diabetic retinopathy and hypertension, which also damages capillary walls and increases the risk of capillary rupture. Stress the importance of controlling blood pressure and review specific measures she should take, such as controlling her weight and eating a low-sodium diet.

Explain to your patient that uncontrolled hyperglycemia can cause diabetic retinopathy or speed its progression. Encourage her to closely monitor her blood glucose levels at home so that she can keep them as close to normal as possible. Also, encourage her to adjust her diet and exercise in response to her blood glucose levels.

Recommend that all diabetic patients have yearly eye examinations to detect retinopathy early or to monitor its progress. If your patient is pregnant, recommend that she have an examination during the first trimester and then one every 3 months until delivery.

Tell your patient that a routine eye examination includes a history of eye or eye related symptoms, vision testing, measurement of intra-ocular pressure, and an ophthalmoscopic examination. Explain to her that the ophthalmoscopic examination is painless but that she may experience minor discomfort when the ophthalmologist administers eye drops to dilate the pupils. Also, tell her that the eye drops may cause blurred near vision and light sensitivity for a short time. Suggest that she arrange for someone to drive her home, and instruct her to wear sunglasses until the effects of the eye drops wear off.

Tell your patient that if her ophthalmologist suspects diabetic retinopathy but can't confirm it by ophthalmoscopic examination, she may under-go fluoresce in angiography. Explain that this procedure is safe and generally painless, that fluoresce in is not a radioactive substance, and that the test does not require X-rays. Tell her that she may experience some nausea while the dye is injected. Explain that the fluoresce in dye may cause her skin and urine to become yellow for up to 24 hours. Tell her to contact her physician immediately if she experiences an allergic reaction, such as hives or itching.

If your patient has diabetic retinopathy, the ophthalmologist may perform laser photocoagulation therapy. Explain the procedure to your patient and tell her that she may lose some visual acuity, peripheral vision, or night vision. Inform her that during diabetes treatment, she'll see hundreds of bright flashing lights, which may make her feel tired. Although the treatment isn't usually painful, it may be uncomfortable because some parts of the retina are highly sensitive to light. Assure your patient that she'll receive anesthetic eye drops to control her discomfort. Explain that the procedure is usually done on an outpatient basis and that she'll have to restrict her activities the following day. She may be required to avoid activities that require the Val salvia maneuver, such as weight lifting, because this will increase her intraocular pressure, which can interfere with healing and cause further retinal damage.

If your patient is undergoing vitrectomy, explain that she may be required to stay overnight in the hospital. Tell her that after surgery she'll wear a pressure patch and eye shield over the treated eye. If a silicone gas or oil is used to hold the retina in place, inform your patient that she may have to lie in a position that keeps the surgical wound toward the back, with the gas or oil above it. She may need to remain in this position for about half of each day for a week after surgery. If indicated, tell her to avoid activities that increase intraocular pressure and to keep her head above her stomach. Explain that her affected eye may be red and sensitive for a short time. Demonstrate how to administer the prescribed eye drops.

If your patient lives alone, assess her ability to prepare her meals and travel to her appointments. If needed, refer her to a home care or other community agency. Also, assess whether impaired vision affects her ability to test her blood glucose levels or to administer the proper dose of insulin. Tell your patient about adaptive tools for blood glucose monitoring that are available for visually impaired patients.