What Is Diabetic Retinopathy?
Diabetic retinopathy is an eye condition caused by type 1 and type 2 diabetes. If blood sugar is not consistently well controlled, blood vessels in the retina (light-sensitive nerve tissue lining the back of the eye) will swell and leak, close off and starve the retina of nutrients, or grow abnormally across the surface of the retina.
The retina contains photoreceptor cells that convert incoming light into electrical impulses which are carried to the brain and interpreted as visual images. There are two types of photoreceptor cells: the rods, which more densely cover the peripheral, or outlying, portion of the retina and are responsible for peripheral vision and vision in low light as well as the cones, which more densely cover the central portion of the retina and are responsible for color perception, sharp visual acuity (detailed vision), and central vision.
Diabetic retinopathy can deteriorate both the rods and the cones, depending on the location and severity of the damaged blood vessels. If diabetes is left unmanaged or inconsistently managed, the deterioration progresses over time and can lead to total blindness.
How Is Diabetic Retinopathy Diagnosed?
It is imperative your child not wait for changes in vision before having his or her eyes examined. Diabetic retinopathy causes damage to the retina long before sight has deteriorated.
Your child should be evaluated with a dilated eye exam by an ophthalmologist for diabetic retinopathy immediately after a diagnosis of diabetes and should be routinely examined per direction of your ophthalmologist.
The ophthalmologist will exam the retinas for signs of retinopathy, including leaked blood vessels, scar tissue, fat deposits, and partial or total retinal detachment.
School-aged children can be diagnosed with diabetic retinopathy, though most cases of childhood diabetic retinopathy are diagnosed around the age of puberty.
Are There Treatments for Diabetic Retinopathy?
There is currently no method for restoring lost vision caused by diabetic retinopathy. However, vision can stabilize with management of diabetes. Leaking blood vessels can be sealed with laser surgery, and the fluid of the eye (vitreous fluid) which has been streaked or filled with blood can be replaced with a salt solution.
How Would You Describe the Eyesight of One with Diabetic Retinopathy and How Will My Child Function with It?
Before discussing the visual impact of diabetic retinopathy, it is important to understand the emotional impact of diabetic retinopathy. Likely your child is experiencing puberty, already a turbulent season of life, when he or she hears, “You have permanently lost vision and could go blind.” Encourage your child to acknowledge fear and anger and regret instead of suppressing it; connect with other teens or adults with diabetic retinopathy, and utilize professional counseling. There is life beyond vision loss, though it may take much grieving (occurring all over again if vision noticeably deteriorates) and time before the entire family recognizes it.
Diabetic retinopathy typically manifests with fluctuating vision, loss of detailed or sharp vision, blind spots, or loss of color vision. If diabetes is not consistently well managed, your child can become totally blind.
Your child’s teacher of students with visual impairments should perform a functional vision assessment to determine how your child uses his or her vision in everyday life and a learning media assessment to determine which senses your child primarily uses to get information from the environment. These assessments, along with an orientation and mobility assessment conducted by a mobility specialist, will give the team information needed to make specific recommendations for your child to best access learning material and his or her environment.
If your child has fluctuating vision, he or she will have difficulty relying on useful vision. It will be difficult to understand (and explain to others) what can and cannot be seen. Furthermore, he will need to be prepared to use a variety of assistive technology, use task lighting when needed, move to a preferred seat, and request or decline accommodations and assistance.
If your child has lost sharp or detailed vision, it will be difficult to recognize faces and facial expressions, access information from a classroom board or wall, view a speaker or performance, read print, and perform visual tasks of fine detail such as threading a needle. In order to best use remaining vision, your child can be taught to increase the contrast of the environment, increase the contrast of print by using a CCTV or screen-magnification software, increase print size by using a magnifier, and increase brightness at a workstation by using task lighting. Furthermore, your teen should sit in a preferred seat of a room for optimal viewing, whether near or far from the lecture or activity.
If your child has blind spots, it will difficult to gather comprehensive visual information in an environment; he or she will benefit from learning visual efficiency skills such as scanning an environment in an organized manner and possibly using a reverse telescope to minimize the appearance of an image and see its entirety within the remaining field of vision. Additionally, the individual is likely to bump into undetected obstacles; he or she should utilize orientation and mobility skills, such as the use of a cane, to travel safely.
If your child has lost color vision, he or she will see the world with less vibrancy. Additionally, your child will need a system of coordinating outfits by color. Color identification labels can be affixed to clothing, or complementary colors can be hung in the closet together.
Should your child lose all useful vision, he or she will learn to accomplish tasks without vision. Braille can be used for reading and writing; screen-reading software can be used for computer use, and vision-loss related skills and accommodations can be learned from the teacher of students with visual impairments and orientation and mobility specialist.
Resources for Families of Children with Diabetic Retinopathy
- 8 Key Resources on Diabetes, Diabetic Retinopathy, and Vision Loss from the American Foundation for the Blind
- The Eyes and Diabetes, a Lecture by Michelle Brochner, MD
- The American Academy of Ophthalmology’s Guide to Diabetic Retinopathy
- National Eye Institute’s Guide to Diabetic Eye Disease