Diabetes refers to a group of medical conditions that affect the body’s ability to control blood sugar levels, which may lead to blood glucose (sugar) levels that are unacceptable and dangerous if not reduced via treatment. Over time, high blood glucose levels may damage the small blood vessels in the back of your eyes, kidneys, and other vital organs. The blood vessels in your retina are particularly sensitive to damage resulting from poorly controlled diabetes. When diabetes causes damage to the retina and its blood vessels, we call this condition “diabetic retinopathy.”
Signs of Diabetic Retinopathy
In the early stages of diabetic retinopathy, tiny capillary blood vessels become twisted and small spots of blood appear. We call this stage “non-proliferative diabetic retinopathy.” Having your eye doctor closely monitor your retina is important because the damage can progress to the more serious stage known as “proliferative diabetic retinopathy,” that requires treatment to prevent blindness.
In addition to these forms of retinal damage, small capillary blood vessels injured from diabetes may leak fluid. In a normal retina, these capillaries are water-tight, like a water pipe, and they exchange oxygen and nutrients without leaking any blood or plasma. The fluid that leaks from diabetic blood vessels can build up in the retina, causing it to swell in blurred vision. We call this “diabetic macular edema.” Left untreated, diabetic macular edema can permanently damage the retinal nerve cells over time, causing permanent loss of vision.
Diabetic Macular Edema Treatment
To stop the leakage and reduce the swelling caused by diabetes (diabetic macular edema), Dr. Jiménez may inject special medication directly into the affected eye. In some cases, gentle laser treatment can also be used to cauterize the leaky vessels.
Typically, these treatments are repeated over time because the problem often recurs. Therapy for diabetic retinopathy and macular edema is quite effective in preventing further vision loss, but achieving significant improvements in cases where substantial amounts of vision have already been lost may prove challenging.
Controlling your blood sugar with the assistance of your primary medical doctor or endocrinologist is an important part of protecting your eyes from further damage. As part of your eye evaluation, Dr. Jiménez will likely order a computerized optical coherence tomography (OCT) scan or fluorescein angiography to help assess the level of damage and to aid in forming his treatment plans.
Other Diabetic Retina Problems
As diabetic retinopathy progresses, abnormal blood vessels may start to grow on the retinal surface. We call this “proliferative diabetic retinopathy.” These new blood vessels are very fragile and can break, causing bleeding into the interior of the eye, and are known as a “vitreous hemorrhage.”
A vitreous hemorrhage may cause your retina to detach, which carries a very real possibility of visual loss that may be permanent in the absence of timely surgical treatment. In such cases, more aggressive laser treatment may be applied to the retina to stop further blood vessel growth and prevent loss of vision or blindness.
Common side effects of proliferative diabetic retinopathy include worsening of your night and reading vision. In certain cases of advanced diabetic retinopathy, normal blood vessels may die off (called ischemia). The resulting nerve cell death from insufficient blood flow may cause permanent vision loss.
Advanced Treatments for Diabetic Retinopathy
In more severe forms of diabetic retinopathy, injected medicines and office-based laser treatments may be insufficient to prevent further loss of vision. In cases where the condition has become very advanced, a vitrectomy may be performed. The purpose of the vitrectomy surgery is to clear out the blood in the eye or to repair a retinal detachment, if one is present. This operation involves micro-surgical techniques to clean out and clear out the rear portion (posterior segment) of the eye, and is designed to help optimize the function of the retina.