Diabetes and Eye
Diabetic eye disease is a group of eye problems that can affect people with diabetes.
These conditions include diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma.
Over time, diabetes can cause damage to your eyes that can lead to poor vision or even blindness.
But you can take steps to prevent diabetic eye disease, or keep it from getting worse, by taking care of your diabetes.
The best ways to manage your diabetes and keep your eyes healthy are to
-
manage your blood glucose, blood pressure, and cholesterol
-
If you smoke, get help to quit smoking
-
have a dilated eye exam once a year
​​
​
​
​
​
​
​
​
​
​
Diabetic Retinopathy Symptoms
You can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, you will notice symptoms such as:
seeing an increasing number of floaters,
having blurry vision,
having vision that changes sometimes from blurry to clear,
seeing blank or dark areas in your field of vision,
having poor night vision, and
noticing colors appear faded or washed out
Losing vision.
Diabetic retinopathy symptoms usually affect both eyes.
​
Four Stages of Diabetic Retinopathy
​
STAGE 1: MILD NPDR
These patients have at least one but micro aneurysms Findings are often subtle, so close inspection and monitoring are essential.
​
STAGE 2: MODERATE NPDR
These patients have intraretinal hemorrhages or micro aneurysms in one to three retinal quadrants and/or cotton wool spots, hard exudates, or venous beading
​
STAGE 3: SEVERE NPDR
These patients have retinal hemorrhages (> 20 in each quadrant), venous beading in two or more quadrants, or an IRMA in one or more quadrants,These findings must be in the absence of neovascularization, which would indicate PDR.
STAGE 4: PROLIFERATIVE DIABETIC RETINOPATHY
These patients had NPDR that has progressed to PDR, and they exhibit either neovascularization of the disc/elsewhere or vitreous/pre retinal hemorrhage
These patients require immediate referral to a retina specialist for further testing and treatment.
Treatment for Diabetic Retinopathy
The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long term risk of vision loss. Treatment usually will not cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses steadily from minimal to severe stages.
Laser Treatment
The laser is a very bright, finely focused light. Laser shrinks abnormal new vessels and reduces macular swelling. Treatment is often recommended for people with macular edema, proliferative diabetic retinopathy (PDR) and neovascular Glaucoma.
With laser treatment for macular edema, tiny laser burns are applied near the macula to reduce fluid leakage. The main goal of treatment is to prevent further loss of vision by reducing the swelling of the macula. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement.
In PDR, the laser is applied to all parts of the retina except the macula (called PRP or pan retinal photocoagulation). This treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. Pan retinal laser has proven to be very effective for preventing severe vision loss from vitreous haemorrhage and traction retinal detachment.
Multiple laser treatments may be necessary over time. Laser does not cure diabetic retinopathy and does not always prevent further loss of vision.
Medication injections
In some cases, medication may be used to help treat diabetic retinopathy. Sometimes a steroid medication is used. In other cases you may be given an anti-VEGF medication. This medication works by blocking a substance known as vascular endothelial growth factor or VEGF. This substance contributes to abnormal blood vessel growth in the eye which can affect your vision. An anti-VEGF drug can help reduce the growth of these abnormal blood vessels.
After your pupil is dilated and your eye is numbed with anesthesia, the medication is injected into the vitreous, or jelly like substance in the back chamber of the eye. The medication reduces the swelling, leakage, and growth of unwanted blood vessel growth in the retina and may improve how well you see.
Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks or as determined by Mr. Golchin.
Vitrectomy surgery
Vitrectomy is a surgical procedure performed in a hospital operating room. Either a local or general anesthetic may be used.
Vitrectomy often prevents further vitreous hemorrhage by removing the abnormal vessels that caused the bleeding. Removal of the scar tissue helps the retina return to its normal location. Laser surgery may be performed during vitrectomy surgery.
To help the retina heal in place, your retinal specialist may place a gas or oil bubble in the vitreous space. You may be told to keep your head in certain positions while the bubble helps to heal the retina. It is important to follow your ophthalmologists instructions so your eye will heal properly.
​
