Diabetes is a disease in which the body has trouble maintaining blood sugar levels under a certain normal range. Over time, the high sugar levels in the blood cause damage to many parts of the body including the heart, kidneys, nerves, and the eye. It is very important that people with diabetes be followed very closely by a primary care physician or endocrinologist. The keys to maintaining eye health in those with diabetes is to eat healthy, exercise, watch blood sugar levels, and maintain a normal blood pressure.
Did you know that either Type I or Type II diabetes may cause trouble with vision? In fact, people with diabetes can to develop the following eye issues:
- Earlier cataracts
- Commonly blurred vision due to fluctuations in blood sugar
- Diabetic Retinopathy
- Some forms of glaucoma
Diabetic retinopathy is due to damage of the very small blood vessels that supply the retina. As a result of the damage, the tiny retinal vessels bleed and become leaky. If too many blood vessels are involved, blood delivery to the retina becomes poor leading to retinal swelling and vision loss. It is estimated that nearly 90% of people with Diabetes longer that 15 years will develop some form of diabetic retinopathy.
It is important to remember that there are little or no symptoms of diabetic retinopathy in its early stages. For this reason, it is strongly recommended that diabetics have, at the very least, yearly eye examinations. As with any disease, early diagnosis is the key for a good long-term visual prognosis
Symptoms of diabetic retinopathy include:
- Seeing many spots or floaters vision
- Blurred vision or sudden loss of vision
- Having a dark or empty spot in the center of your vision
- Distortions in the vision
- Trouble with night vision
- Micropsia – or seeing objects smaller out of one eye as compared to the other eye
Diabetic Retinopathy is currently categorized into two stages:
Non-proliferative diabetic retinopathy
Non-proliferative diabetic retinopathy (NPDR) is the early stage of the retinopathy that is usually asymptomatic. In NPDR, the blood vessels in the retina are weakened causing microanuerysms which leak fluid into the retina. This leakage leads to swelling of the macula called diabetic or clinically significant macular edema, which may cause significant vision loss.
Proliferative diabetic retinopathy
Proliferative diabetic retinopathy (PDR) is the later and more dangerous stage of retinopathy that may quickly cause loss of vision. In PDR, the blood vessels have become so damaged that the retinal blood supply is very poor. As a result of this, the eye forms new blood vessels in a process called neovascularization. Unfortunately, these neovascular vessels are not helpful. They are very fragile and may lead to the eye filling up with blood, a condition known as a vitreous hemorrhage. If not taken care of, the bleeding may lead to scarring and detachment of the retina. Many times, surgery is required to remove the blood and correct the retinal detachments.
Another devastating complication of PDR is neovascular glaucoma. This occurs then the neovascular vessls cause scarring in the drainage channels of the eye, leading to a very high eye pressure. At this point, a glaucoma surgery is usually the treatment of choice.
How is diabetic retinopathy treated?
- Observation and regular eye exams
- Maintaining healthy diet, blood sugars and blood pressure
- Pan-Retinal Photocoagulation (PRP) or Focal Laser – Laser treatment used to stop the leakage of blood and fluid into the retina and macula
- Injections of medication to help clear up the bleeding or swelling
- Vitrectomy – surgical procedure to remove significant amounts of blood and to correct retinal detachment.