Hypertensive Retinopathy vs. Diabetic Retinopathy: What Are the Differences?

Retinopathy is a condition where the retina becomes damaged. The retina sends signals to your brain that help you see images. When retinopathy is untreated, it can cause blindness. Hypertensive and diabetic are two types of retinopathy. While both cause damage to the retina, they have different causes.

Hypertensive retinopathy is caused by hypertension (high blood pressure), while diabetic retinopathy is caused by diabetes (high blood sugar). In this article, you will learn about how symptoms for each condition are different.

Symptoms

In the early stages of retinopathy, there may not be any symptoms at all. Symptoms may come and go so quickly that you don’t think there is a problem. But as the disease progresses, changes in vision may become worse and happen more often.

Causes

Retinopathy from diabetes and hypertension have a lot in common. Both result in damage to the blood vessels of the eye. The damage can also cause abnormalities in the retina. But the root causes of each condition are still different.

Hypertensive Retinopathy

When your blood pressure is too high, it will eventually damage the blood vessels in the retina. That pressure causes blood vessels in the eye to rupture and bleed, damaging the nerves in the eye. Arteries that carry blood to the retina and veins that carry blood away from the retina become blocked.

Diabetic Retinopathy

High blood sugar creates blockages in the blood vessels of your eyes and causes them to bleed. Your eyes grow new blood vessels to compensate for this, but they are weaker and will begin to bleed as well.

Diagnosis

No matter what the cause is, retinopathy is diagnosed through an eye exam by an optometrist, a doctor who focuses on eye care. They can tell how well your eyes are working and identify any damage to the muscles and blood vessels in your eyes.

Some of the things they look for include:

• How sharp your vision is: You’ll be asked to read letters on an eye chart from far away. You may look through a phoropter, a device that tests nearsightedness, farsightedness, and astigmatism.
• Field of vision: This tests your peripheral or full range of vision.
• Color vision: Using images of colored dots, this test will check for color blindness.
• Physical health of the eye: Eye drops will make your pupils bigger (dilation). This allows your doctor to examine your cornea, retina, lens, optic nerves, and blood vessels. Sometimes this can be done without dilation using optical coherence tomography (OCT), a noninvasive test. This takes pictures of the inside of your eye.
• Eye pressure test: This checks for glaucoma, a condition where the optic nerve is damaged.
  

Treatment

Treatment plans for the two conditions may be different, but an early diagnosis will prevent further damage to your eyes.

Diabetic Retinopathy

If you’re in the early stages of diabetic retinopathy, your eye doctor may have you come in more often for check-ups to watch for any changes. If you’re having symptoms and there are signs of damage, you’ll start a treatment plan. Retina damage from diabetes is not reversible, but you can prevent it from getting worse and save your vision.

Treatments may include:

• Anti-VEGF injections: When blood vessels in the eyes are damaged, a protein called VEGF is produced. It causes blood vessels to leak and swelling in the retina. Anti-VEGF drugs block the production of this protein and help alleviate these symptoms. 
• Laser treatment: This procedure reduces inflammation by shrinking blood vessels.
• Vitrectomy: This eye surgery involves removing the vitreous, a gel-like fluid connected to the retina, and performing repairs on the retina. Afterward, the vitreous is replaced with another fluid, usually silicone oil.

Hypertensive Retinopathy

The only treatment for hypertensive retinopathy is lowering your high blood pressure. You may be able to reverse the damage because the retina can heal, but this depends on how severe the damage is.

Some eye doctors use different grading systems to determine retina damage. The Keith-Wagener-Barker classification system established four degrees of damage.

In Grade 1, you may not have any symptoms. In Grades 2 and 3, the retina may be inflamed, and blood vessels can leak. For Grade 4, the optic nerve, which carries visual information to the brain, may also be swollen. Grade 4 damage to the retina may be long-term even after you get your blood pressure under control.

But in recent years, some healthcare providers use the Mitchell-Wong grading system. It combines grades 1 and 2 into one stage.

Prevention

The only way to prevent retinopathy caused by hypertension is to control your blood pressure. Limiting the amount of salt in your diet, maintaining a healthy weight, and exercising regularly will help. Your healthcare provider may also prescribe blood pressure medications.

Controlling high blood sugar will help prevent diabetic retinopathy. This means getting regular exercise, taking your diabetes medications correctly, and eating a healthy diet. Sometimes when you do everything right, your blood sugar may still be hard to control. In that case, your healthcare provider may need to change your treatment plan to get your blood sugar back in control.

Summary

Diabetic and hypertensive retinopathy are similar. Both cause damage to the retina, but they have different causes. Diabetic retinopathy is caused by high blood sugar. Hypertensive retinopathy is caused by high blood pressure. Both conditions are diagnosed by an eye doctor. Treatment options may include surgery, laser treatments, or eye injections. Your healthcare provider may also recommend watching your condition more closely without treatment. Controlling your blood sugar and blood pressure is the only way to prevent retinopathy.

A Word From Verywell

Diabetic and hypertensive retinopathy are conditions that can feel like the diagnosis came out of nowhere. Especially since symptoms are often absent. Once they are noticeable, they can be highly concerning. The good news is two types of retinopathy are preventable.

Visit your healthcare provider regularly so that any issues with high blood sugar or high blood pressure can be found in their early stages. If you've been diagnosed with high blood pressure or diabetes, keep your condition under control with diet and medication. Consult with your eye doctor on how often you should get eye exams.