Diabetic Eye Disease
Diabetic retinopathy is the leading cause of blindness in the 35-60 years old group. The longer the duration of diabetes mellitus, the greater the odds of developing retinopathy. Up to 95% of cases of blindness related to diabetes can be prevented with early diagnosis and treatment. This requires periodic dilated retinal exams to be properly diagnosed. Many patients with sight threatening retinopathy present with very good vision initially, thus having very good sight does not guarantee that your eyes are fine and do not require urgent treatment. Since diabetes damages the blood vessel walls, these become weakened and are more sensitive to mild blood pressure elevation, so controlling the pressure is very important. Cholesterol deposits in the retina can also cause permanent damage and lipid control is essential to improve the odds of maintaining good vision.
There are two stages of Diabetic Retinopathy:
Background Diabetic Retinopathy: Small hemorrhages (or broken blood vessels) can occur in the retina, they may not require immediate treatment but should be closely monitored for any change.
Proliferative Diabetic Retinopathy: this occurs when small retinal vessels close, depriving the retina of oxygen. If this occurs within the portion of the retina known as the Macula, vision will often be impaired. As this condition worsens, new blood vessels may grow or “proliferate” on the surface of the retina. This sometimes results in bleeding into the clear vitreous gel that fills most of the inside of the eye. This may cause vision to be blocked or become distorted.
In addition, at any stage there can be Exudative Diabetic Retinopathy: Tiny blood vessels are weakened, resulting in leakage of fluid into the retina. This leads to Macular Edema, a condition in which the “central vision” portion of the retina becomes swollen like a sponge and results in a decrease in the central vision.
It has been well documented the chronic sugar elevation (as measured by glycosylated hemoglobin or Hgb A1c) is an extremely important factor associated with progression of Diabetic Retinopathy. Besides control of sugar, blood pressure and cholesterol, the best way to prevent loss of vision from Diabetes is early detection through routine eye exams. The eye examination may include a fluorescein angiography, in which a yellow dye is used to track the path of weakened or abnormal retinal blood vessels. In early stages, Diabetic Retinopathy is usually treated with a laser that can be performed as outpatient in the physician’s office. Another modern treatment consists of injections in the eye of substances that decrease retinal swelling or that help eliminate abnormal vessels. In advanced stages, procedures can be performed to clear bleeding inside the eye or to restore normal anatomy by removing scar tissue. At Southern Eye Center we have pioneered the field of outpatient retinal surgery and these are also done in our Ambulatory Surgery Center under local anesthesia. Managing properly your diabetes and having regular eye exams will help patients to decrease their risk for blindness.