What’s the Difference Between Hypertensive and Diabetic Retinopathy?

Retinopathy refers to conditions or damage affecting the retina. Without treatment, it can cause blindness. Hypertensive retinopathy results from high blood pressure, while diabetic retinopathy is a diabetes complication.

Your retinas are part of your central nervous system. They convert light into electrical signals that are sent to your brain, which in turn creates the visual imagery that you see.

Both types of retinopathy can cause issues like double vision, headaches, and eventual vision loss. But you can manage them by treating the underlying condition.

In this article, we’ll look at the differences between hypertensive retinopathy and diabetic retinopathy. We’ll also provide prevention and treatment information for both conditions.

Hypertensive retinopathy

Hypertensive retinopathy results from long-term uncontrolled high blood pressure (hypertension) . In addition to hypertensive retinopathy, uncontrolled hypertension puts you at risk of other eye conditions.

Retinas need a steady blood supply to stay healthy. High blood pressure causes vasospasms, or tiny contractions, of the retina’s blood vessels. These spasms cause them to narrow, thicken, and become stiff, which can eventually lead to severely reduced vision or blindness .

In addition to affecting vision, hypertensive retinopathy is often a precursor to other complications. These include damage to your blood vessels and organs like the kidneys , heart, and brain.

Diabetic retinopathy

Diabetic retinopathy is a potential complication of diabetes . If you have uncontrolled high blood sugar , you may be at risk of this condition.

Diabetes can cause damage to blood vessels throughout the body, including those in your eyes. Having high levels of blood sugar can lead to blockages within the blood vessels that lead to your retinas, making them bleed or leak fluid.

Your eyes grow new, poorly operational blood vessels in response to this damage. These new blood vessels also leak fluid or bleed easily.

Diabetic retinopathy occurs in stages :

• Background retinopathy: Small bulging areas start to develop in the blood vessels, and they may bleed slightly.
• Pre-proliferative retinopathy: As damage to the blood vessels continues, there may be more bleeding in the eyes.
• Proliferative retinopathy: Scar tissue and new, weak blood vessels start to form.

Symptoms of hypertensive and diabetic retinopathy

Hypertensive retinopathy and diabetic retinopathy often don’t cause any symptoms in their early stages. You can have either of these conditions for months or years without noticing any vision changes.

Hypertensive retinopathy

The symptoms of advanced hypertensive retinopathy are:

• dim vision
• double vision
• vision loss
• headaches

If you experience any of these symptoms without warning, it may mean that your blood pressure has suddenly become very high. This is a medical emergency that requires immediate treatment.

Diabetic retinopathy

Some people experience early symptoms that they may not fully notice. These include vision changes that make it harder for them to see things close up or far away.

More often, symptoms start during the later stages of the condition, when the blood vessels to the retina start to bleed significantly. This can cause :

• floaters or cobweb-like streaks in your field of vision
• blurry, patchy, or dim vision
• eye pain
• eye redness
• gradually worsening vision
• sudden vision loss
• tiny white spots on the retina

Causes and risk factors

The main risk factors for retinopathy are uncontrolled hypertension and diabetes.

Additional risk factors for hypertensive retinopathy include:

• being of Afro-Caribbean descent
• being female
• smoking cigarettes or using tobacco products
• having a history of cardiovascular disease
• having high cholesterol
• having obesity

Additional risk factors for diabetic retinopathy include:

• being of Asian or Afro-Caribbean descent
• being pregnant
• having either type 1 or type 2 diabetes for a long time
• having high cholesterol
• having chronic high blood pressure

Diagnosis

Doctors diagnose retinopathy with a thorough eye exam that includes retinal screening tests. They’ll dilate your eyes before testing.

A specialist, such as an ophthalmologist, will take pictures of your retinas through a noninvasive imaging test called an optical coherence tomography angiography (OCTA). During an OCTA, the specialist will take 3D images of the blood vessels in your retina and other areas of the eye.

If you have long-term diabetes, you may have a fluorescein angiography (FA) test . During this test, a specialist will inject fluorescein dye into a vein in your arm. They’ll then use a camera to take pictures of each retina.

Treatment options

You can treat hypertensive retinopathy by controlling high blood pressure.

If you have hypertension, your doctor will recommend medications to lower it. They may also recommend lifestyle changes like:

• losing weight, if you need to
• eating heart-healthy foods
• exercising more, if you need to
• reducing your salt intake
• stopping smoking , if you smoke

You can treat diabetic retinopathy by keeping your blood sugar levels under control. Your doctor may recommend reducing your blood pressure and blood cholesterol levels as well.

Also, they may suggest eye treatments that can slow the progression of the condition. These include laser surgery to shrink or close leaky blood vessels and eye injections to reduce swelling.

Prevention and management

If you have high blood pressure or diabetes, make sure you take your medications as prescribed. Also, follow your doctor’s recommendations for living a healthy lifestyle by exercising regularly, reducing stress, and avoiding smoking.

Even if you’re feeling well, keep all of your medical appointments and screenings. Retinopathy and other serious eye conditions can sneak up on you. The sooner a doctor diagnoses them, the more likely you are to maintain your vision.

The bottom line

Hypertensive retinopathy results from uncontrolled high blood pressure, and diabetic retinopathy is due to diabetes. Both conditions cause damage to the blood vessels that supply the retina.

Controlling the causes of retinopathy is the best way to prevent retinal damage and vision loss.