Diabetic Eye Disease
What is diabetic eye disease?
Diabetic eye disease is a group of eye conditions that can affect patients who have diabetes and can cause severe vision loss. This includes glaucoma, cataracts and diabetic retinopathy (DR). Diabetes is a disease in which you do not process or store glucose properly, leading to elevated sugar levels, which can cause damage to the blood vessels.
What is Diabetic Retinopathy?
Diabetic retinopathy (DR) is damage to the retinal vessels due to diabetes. It is the leading cause of blindness among working age adults in the United States.
There are two different types of DR:
- Non-proliferative diabetic retinopathy (NPDR): This is an early stage of DR in which there is leakage of blood and fluid in the retina. There may be no changes in vision at this stage. Changes in vision can be caused by swelling in the center of the vision (diabetic macula edema) and/or loss of blood flow to the center of the vision (macula ischemia).
- Proliferative diabetic retinopathy (PDR): This is a later stage of DR in which there is growth of abnormal blood vessels which are fragile and bleed into the eye. These blood vessels also cause scar tissue that lifts the retina, leading to retinal detachment.
Symptoms of DR
There may be little to no symptoms early on in the disease even though damage is occurring. This is why it is important to see an eye doctor at regular intervals. Other symptoms can include blurry/decreased vision and floaters.
Detection of DR
Only a comprehensive dilated exam can detect DR. Diabetics should have their eyes examined at least once a year to determine if they need more frequent injections. An exam may include:
- A complete dilated eye exam which includes viewing the retina with special magnification
- Optical Coherence Tomography (OCT): A non-invasive and painless imaging technique that captures images of the macula at microscopic levels
- Fluorescein Angiography (FA): A vegetable based dye is injected into the arm and produces images of the retinal circulation to identify abnormal blood vessels.
Treatment of DR
- Controlling blood sugar, blood pressure and cholesterol are the most important things you can do to prevent vision loss.
- Laser Therapy may be recommended to help dry fluid in the center of the visual field as well as to help shrink abnormal blood vessels growing in the retina.
- Intraocular injections:
- Anti-VEGF injections: Patients typically require injections such as Avastin, Lucentis or Eylea every 4-6 weeks until the leakage is brought under control.
- Steroid injections: The effect is typically localized to the eye only. Steroids can last from 6 weeks to about 4 months.
- Surgery: If there is severe bleeding, retinal detachment or uncontrolled leaking vessels, surgery may be required to improve vision.