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Diabetic Eye Diseases

WHAT ARE DIABETIC EYE DISEASES ?

Diabetic eye disease, Diabetic Retinopathy

Every person with long standing diabetes has a risk of loosing his eyesight because of damage to retina caused by diabetes. This can begin as an asymptomatic occurance, the blood vessels in the retina get damaged and leak fluid or blood. The longer a person has diabetes, the more is the risk of developing diabetic retinopathy.

Symptoms of diabetic eye disease

the issue with diabetic reinopathy is that the early stage usually has no symptoms. This stage is called the non proliferative stage.  Gradual blurring of vision may occur if fluid leaks in the central part of the retina (the macula). 

In late diabetic retinopathy, new abnormal blood vessels begin growing on the surface of the retina or the optic nerve. This stage is called the proliferative stage.  These vessels have weak walls and leak blood out into the retina and vitreous.  Vitreous gel is the jelly that fills most of the back part of the eye. Presence of blood in the path of light entering the eye blocks this light, resulting in impaired vision or vision loss.

How often should diabetics get their eyes examined ?

It is mandatory for every diabetic patient irrespective of their vision or symptoms to get an annual dilated retinal checkup done.  Dilated eye examination is the key word here.  This is where doctors put certain drops in your eyes.  These drops dilate the pupil.  Dilating the pupils is like opening the window of the eye.  Once this window is open its possible for us doctors to look within and see your retina.  

Frequently Asked Questions

Diabetic eye disease refers to a group of eye problems that people with diabetes may face. All can cause severe vision loss or even blindness.

Diabetic eye disease may include:

  • Diabetic retinopathy
  • Cataract—clouding of the eye’s lens
  • Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage

Diabetic retinopathy is the most common diabetic eye disease. It is caused by changes in the blood vessels of the retina.

In some, blood vessels may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

Diabetic retinopathy has four stages:

  1. Mild Nonproliferative Retinopathy. At this earliest stage, small areas of balloon-like swelling in the retina’s tiny blood vessels develop.
  2. Moderate Nonproliferative Retinopathy. Some blood vessels that nourish the retina are blocked.
  3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas of the retina send signals to the body to grow new blood vessels.
  4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. These new blood vessels are abnormal and fragile. If they leak blood, severe vision loss and even blindness can result.

 

  1. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision.
  2. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema.

All people with diabetes–both type 1 and type 2–are at risk. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy.

During pregnancy, diabetic retinopathy may be a problem for women with diabetes. Every diabetic pregnant woman should have a comprehensive eye exam as soon as possible.

If you have diabetes get a comprehensive dilated eye exam at least once a year
If you have diabetic retinopathy, you may need an eye exam more often. People can reduce their risk of blindness by 95 % with timely treatment and appropriate follow-up care.

There are no symptoms in the early stages of the disease.

Blurred vision may occur when the macula swells from leaking fluid. This condition is called macular edema.

If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision. You may need treatment before more serious bleeding occurs.

Diabetic retinopathy and macular edema are detected during a comprehensive eye exam at your eye doctor’s clinic.

Your eye care professional may suggest a fluorescein angiogram. The test allows your eye care professional to identify any leaking blood vessels.

A complete eye examination is required for the detection of diabetic retinopathy. Retina examination is done after dilatation of pupils to diagnose the condition. If diabetic retinopathy is found, a special test called fundus fluorescein angiography (FFA) may be performed where a dye is injected in the vein and photographs of the retina are taken to pin point or locate the areas of leakages.

Anti VEGF injections

These injections which are given in the eye prevent VEGF which is a substance which causes the new vessels to develop. The new vessels gradually regress and thus the leakage reduces. The central retina or macula returns toward normal thickness as the leakage gradually reduces. Usually these injections are given once a month and are given for three consecutive months. These monthly injections may continue after three months also depending on your retinal condition.

Laser treatment

Laser photocoagulation involves the focusing of a powerful beam of laser light on the damaged retina to seal leaking retinal blood vessels and stop abnormal blood vessel (neovascularization) growth.

Surgery

Vitrectomy – In the event of the patient presenting with very advanced diabetic retinopathy, a surgical procedure known as vitrectomy is recommended. Blood-filled vitreous gel of the eye is replaced with a clear solution to aid in restoring vision. Sometimes the retina may also be detached and then the surgery involves reattaching the retina as well.

Prevention of diabetic retinopathy and accompanying visual loss is a team effort involving the patient and our diabetic eye specialist. Early detection of diabetic retinopathy is the best protection against loss of vision. All diabetics must have their retinas examined at least once a year.

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