Diabetic Eye Disease

Patients with diabetes are at a higher risk for developing eye conditions as a complication their disease. Over 40 percent of patients diagnosed with diabetes develop some form of eye disease as a result of their disease. Diabetic retinopathy is the most common diabetic eye disease and the primary cause of blindness in the United States.

Diabetes can damage blood vessels in the eye, causing blood or fluid to leak from the retina, the light-sensitive tissue at the back of the eye. It can also cause new blood vessels to grow on the surface of the retina, leading to significant damage to vision and the overall quality of life.

Diabetic eye disease is a combination of various eye conditions that develop as a result of diabetes. These conditions include:

  • Diabetic retinopathy
  • Cataracts
  • Glaucoma

Diabetic Retinopathy

Stages Of Diabetic Retinopathy

There are four distinct stages of diabetic retinopathy. They are:

  • Mild nonproliferative retinopathy – microaneurysms develop in the tiny blood vessels of the retina
  • Moderate nonproliferative retinopathy – blood vessels to the retina become blocked
  • Severe nonproliferative retinopathy – the blood supply to the retina is blocked
  • Proliferative retinopathy – New blood vessels, to replace the blocked blood vessels, grow alongside the retina

During any stage of diabetic retinopathy a condition known as macular edema can develop. Macular edema is the buildup of fluid in the macula, the light-sensitive part of the retina that allows us to see objects with great detail. As the macula swells vision becomes blurred. About half of the people with proliferative retinopathy are diagnosed with macular edema.

Symptoms Of Diabetic Retinopathy

Early stages of diabetic retinopathy usually do not show symptoms. Treatment is not always required. Patients need to monitor their blood sugar level to prevent the disease from progressing. If the disease does progress, prompt treatment will be necessary to preserve your vision.

Patients who develop diabetic retinopathy may not notice any changes to their vision at first. In its earliest stages, this condition causes tiny areas of swelling in the small blood vessels of the retina.

Symptoms of diabetic retinopathy may include the following:

  • Vision that may be blurry or doubled
  • Flashing lights
  • Blank spots
  • Dark floaters or spots in the vision
  • Pain or pressure in either or both eyes
  • Problems with peripheral vision
  • Severe vision loss or blindness

Diagnosis Of Diabetic Retinopathy

After a thorough medical examination of the eyes, some of the following diagnostic tests will be conducted to confirm diagnosis:

  • Visual acuity test
  • Dilated eye examination
  • Tonometry test
  • Retinal exam
  • Fluorescein angiogram

Treatment Of Diabetic Retinopathy

Other than controlling blood pressure, blood cholesterol and the levels of blood sugar, treatment is not needed during the first three stages of diabetic retinopathy. The fourth stage, proliferative retinopathy is treated with a laser surgery procedure known as scatter laser treatment. During the procedure the abnormal blood vessels are ablated causing them to shrink. This procedure works best once the blood vessels begin to bleed. Severe blood vessel bleeding may need to surgically corrected with a vitrectomy procedure to remove the blood from the eye.

Treatment for macular edema usually includes a laser procedure called focal laser treatment. During this procedure, several hundred small laser burns are placed in the areas of retinal leakage around the macula to prevent leakage from occurring and reduce the amount of fluid in the retina. This helps reduce the risk of vision loss and may improve lost vision in a small number of cases. Focal laser treatment is performed in your doctor’s office and can usually be completed in just one session.

Reducing The Risks Of Developing Diabetic Retinopathy

Patients with diabetes need to have an annual comprehensive dilated eye exam. The length of time a patient has diabetes will determine the likelihood of developing diabetic retinopathy. Over 40 percent of patients in the United States, diagnosed with diabetes, have a form of diabetic retinopathy.

The risks of developing diabetic eye disease can be minimized by:

  • Monitoring changes in vision
  • Keeping A1C levels under 7%
  • Monitoring and managing blood pressure levels
  • Eating a healthy diet
  • Participating in a regular exercise routine
  • Monitoring and managing cholesterol levels

Proliferative Diabetic Retinopathy

Proliferative diabetic retinopathy is the most advanced stage of diabetic retinopathy, and is classified by the growth of new blood vessels on the retina. These blood vessels are abnormal and fragile, and are susceptible to leaking blood and fluid onto the retina, which can cause severe vision loss and even blindness.

If blood leaks onto the retina, patients may begin to notice floaters in their vision, which are actually specks of blood that appear in front of your vision. While floaters can sometimes clear up on their own, it is important to see your doctor as soon as you notice them, as they can recur and lead to severely blurred vision and vision loss.

Patients with proliferative diabetic retinopathy usually seek laser surgery to treat their condition. This treatment is known as scatter laser treatment and is used to shrink the newly developed abnormal blood vessels using up to 2,000 laser burns in the area of the retina. This treatment is usually performed in two or more sessions because of the high number of laser burns necessary. Scatter laser treatment is most effective before new blood vessels have started to leak, and may slightly reduce patients’ color and night vision, while preserving your central vision. Severe bleeding may require a vitrectomy, or removal of the vitreous, to remove blood from the center of the eye.


Diabetic Macular Edema

Macular edema is a serious condition that can occur at any stage of diabetic retinopathy and involves a buildup of fluid in the macula, the light-sensitive part of the retina that allows us to see objects with great detail. Macular edema can cause difficulty reading or doing close work, and can often greatly affect a patient’s quality of life by interfering with regular activities.

Your doctor can diagnose macular edema during your regular eye exam before symptoms are present, but you should seek prompt medical attention at the earliest signs of this condition. Retinal swelling may indicate an early sign of macular edema.

Treatment for macular edema usually includes a laser procedure called focal laser treatment. During this procedure, several hundred small laser burns are placed in the areas of retinal leakage around the macula to prevent leakage from occurring and reduce the amount of fluid in the retina. This helps reduce the risk of vision and can even improve lost vision in a small number of cases. Focal laser treatment is performed in your doctor’s office and can usually be completed in just one session.

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