Diabetic Evaluation & Care
People with diabetes are at an increased risk of developing eye diseases that can lead to vision loss and blindness, including diabetic retinopathy, cataracts and glaucoma. Diabetes is the leading cause of blindness in the United States.
Diabetic eye conditions often develop without any noticeable vision loss or pain. Significant damage may have already occurred by the time the patient notices any symptoms. For this reason, it is very important for diabetic patients to have an annual comprehensive eye exam. Early detection of diabetic eye disease and prompt treatment can help prevent permanent damage.
Diabetic-related eye problems develop from high blood sugar levels, which can cause damage to blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. This damage is referred to as diabetic retinopathy.
Over 40 percent of diabetic patients will develop some form of eye disease in their life. The risk of developing eye problems can be reduced significantly through regular eye exams and by keeping blood sugar levels and blood pressure under control through a healthy diet, regular exercise and medication.
Types of Diabetic Retinopathy
There are two types of diabetic retinopathy: background or non-proliferative diabetic retinopathy (NPDR) and proliferative retinopathy (PDR).
NPDR or background retinopathy is an early stage of diabetic retinopathy. The tiny blood vessels within the retina develop microaneurysms and begin to leak blood or fluid. Many diabetics have mild NPDR which does not affect their vision. Fluid accumulation in (macular edema) and poor circulation to (macular ischemia) the macula (center of retina that allows us to see fine details clearly) can cause significant loss of vision in more advanced cases.
PDR occurs when abnormal blood vessels begin growing on the surface of the retina and optic nerve. This is due to poor circulation which is a common complication of diabetes throughout the body. These new blood vessels are quite fragile and prone to bleeding. This type of bleeding is called a vitreous hemorrhage and can cause severe vision loss.
Other complications of PDR include traction retinal detachment which occurs from scarring following vitreous hemorrhage. The scar tissue can pull the retina out of position causing distortion and/or more severe vision loss. Neovascular glaucoma is a severe form of glaucoma which can occur in individuals with long-standing diabetes.
Treatment of Diabetic Retinopathy
Treatment for the early stages of diabetic retinopathy focuses on maintaining appropriate levels of blood sugar, blood pressure and blood cholesterol. Strict control of these factors significantly reduces the long-term risk of vision loss from diabetic retinopathy.
Laser surgery is used to treat macular edema, PDR, and neovascular glaucoma. Laser treatments are performed in a doctor's office; anesthetic eye drops are used to minimize discomfort during the procedure. Though generally successful in slowing down the progression of disease and preventing or treating vision loss, laser surgery does not cure diabetic retinopathy. Close monitoring for the rest of the patient’s life required.
In advanced PDR, surgery called vitrectomy to remove blood from the vitreous may be required. This is an out-patient procedure which is usually successful in restoring vision.