Diabetic Eye Disease

What is Diabetes?

Diabetes is a long-lasting, chronic health condition that leads to high blood glucose levels, which affects how your body turns food into energy. Once it is broken down into sugar, it releases into your bloodstream.

There are three main types of diabetes: Gestational, Type 1, and Type 2 diabetes. When the pancreas fails to produce just enough to control a person’s blood glucose level, that’s when it's considered Type 1. Type 2 is when the body isn’t producing enough insulin or is resisting it, which affects the ability to absorb glucose. Gestational diabetes is a form of high blood sugar affecting pregnant women who don’t already have the condition.

Diabetic Eye Conditions:

  • Cataracts: People with diabetes have a higher risk of developing cataracts by sixty times the normal amount. This could also develop at an earlier age than most.

  • Diabetic Retinopathy: This condition is the primary cause of vision loss in patients that have Type 1 or Type 2 diabetes. The supply to your retina starts to leak fluid due to damage to the retinal blood vessels. This can lead to retinal tissue being deprived of oxygen.

Types of Diabetic Retinopathy:

  1. Nonproliferative Diabetic Retinopathy (NPDR)

  2. Proliferative Diabetic Retinopathy (PDR)

Nonproliferative Diabetic Retinopathy

NPDR is an early stage of diabetic retinopathy that is commonly known as background retinopathy. Within this stage, small blood vessels in the retina start to leak blood or fluid. This leaking causes swelling of the retina, or they start to form deposits called exudates. There are many people that have mild NPDR, but this normally does not have an effect on their vision. However, when vision is affected, it's usually a result of macular edema or macular ischemia, or sometimes both.

  • Macular Edema: This is when there is swelling or thickening in the macula, which is the small area in the center of the retina that permits people to see details clearly. Macular Edema is the most common cause of vision loss for those with diabetes. Fortunately, peripheral vision continues to function.

  • Macular Ischemia: This is when a person’s small blood vessels close and vision starts to blur. It starts to blur because there is not sufficient blood supply in the macula to work with.

Proliferative Diabetic Retinopathy

PDR is when abnormal new vessels known as neovascularization begin to grow on the surface of the optic nerve or the retina. The main cause of this advanced stage of diabetic retinopathy is the extensive closure of the retinal blood vessels, which does not allow adequate blood flow. When this occurs, the retina begins to grow new blood vessels so that the area where the original blood vessels closed have a supply of blood. Unfortunately, the retina’s attempt to supply blood would fail due to the fact that the new abnormal vessels cannot resupply the retina with normal blood flow.

Compared to NPDR, PDR can cause much more severe vision loss due to it affecting both the central and peripheral vision. Proliferative Diabetic Retinopathy causes visual loss in the following ways:

  • Vitreous Hemorrhage: This occurs when fragile new vessels bleed into the vitreous, which is a clear and gel-like substance that fills the eye’s center. A person may only see a few new, dark floaters if the vitreous hemorrhage is small, but a large one might block out all vision. Depending on the amount of blood that is present, it can take days, weeks, months, or maybe even years to reabsorb it. If the eye cannot clear the blood sufficiently within a reasonable time, vitrectomy surgery can be recommended. Once the blood is cleared, vision may be restored to how it was before unless the macular is too damaged.

  • Traction Retinal Detachment: This occurs when the scar tissues associated with neovascularization and PDR can shrink, which causes the wrinkling and pulling of the retina. The wrinkling may cause visual distortion. If the macula or large areas of the retina become detached, even more severe vision loss may occur.

  • Neovascular Glaucoma: This is a severe eye disease that causes damage to the optic nerve. New abnormal blood vessels will grow on the iris and in the drainage channels, which is in the front of the eye, due to extensive retinal vessel closure. This then blocks our normal flow of fluid out of the eye. After this, the pressure builds up in the eye resulting in neovascular glaucoma.

How is Diabetic Retinopathy Diagnosed?

The best way to diagnose and detect any changes in your eye would be to get a medical eye examination. The initial exam is a dilated eye exam. Patients will need to be followed up every year to check for diabetic eye disease.

If the ophthalmologist finds diabetic retinopathy, they may choose to see the patient more often (every 3 to 6 months.) They may also order color photographs of your retina or get a special test called fluorescein angiography to see if treatment is needed. With a fluorescein angiography, a dye would be injected into your arm and then photos would be taken of your eye to detect where the fluid is leaking.

How is Diabetic Retinopathy Treated?

The goal of treatments is to prevent the development of diabetic retinopathy as much as possible. To greatly reduce the long-term risk of vision loss from retinopathy, you must strictly and efficiently control your blood sugar.

Some ways to further treat diabetic retinopathy can be through medical treatments, laser surgery, and a vitrectomy. For medical treatments, there are injections of an anti-VEGF medication that would be inserted in the eye. This can stop the development of new blood vessels and subsequent bleeding. Steroid medication may be used, as well. For people with macular edema, neovascular glaucoma, and PDR, laser surgery is often recommended. In some cases, getting multiple laser treatments over time becomes necessary. When it comes to a vitrectomy, which is a microsurgical procedure, it would remove the blood-filled vitreous. On some occasions, your ophthalmologist may choose to wait many months to see if the blood will resolve on its own before deciding on a vitrectomy.

At Advanced Eye Care Center, we make sure patients with diabetes get regularly checked in order to detect any signs and/or symptoms of diabetic eye disease as early as possible. Together we can prevent vision loss. For more information on our diabetic eye treatments, please contact us at (940) 240-8711.

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