Diabetic Eye Care
Diabetes is a disease that affects blood vessels throughout the body, particularly vessels in the kidneys and eyes. Patients with diabetes are at a higher risk of developing eye conditions as a complication of their disease. Diabetic-related eye problems develop from high blood sugar levels, which can cause damage to blood vessels. When diabetes affects the blood vessels in the eyes, it is called diabetic retinopathy.
What is Diabetic Retinopathy?
Diabetic retinopathy is a complication of diabetes. The longer a person has diabetes the higher the chance they will develop diabetic retinopathy. Diabetic retinopathy is the most common diabetic eye complication and specifically affects the blood vessels in the retina. The retina, located in the back of the eye, detects visual images and transmits them to the brain. When diabetes damages the retinal blood vessels they weaken, swell and leak. This results in a loss of vision and the ability to detect and transmit images. More than 40% of diabetics in the United States have some form of diabetic retinopathy which is the leading cause of blindness in America adults.
As diabetic retinopathy develops new blood vessels grow. These new vessels are your body’s attempt to overcome and replace the vessels that have been damaged by diabetes. However, these new vessels are not normal and may bleed, cause the vision to become hazy, and occasionally result in a complete loss of vision. In addition, abnormal blood vessels on the iris can lead to glaucoma and diabetic retinopathy can also cause the formation of cataracts.
What Is The First Sign Of Diabetic Retinopathy?
One of the scary things about diabetic retinopathy is that it often doesn’t show early symptoms. It usually affects both eyes and can begin to damage the person’s vision before it becomes noticeable. Still, the first sign is usually the appearance of new floaters in the field of vision, especially when looking at a background such as a cloudless sky. These floaters are actually shadows cast on the retina by bleeding from the abnormal blood vessels.
Diabetic Retinopathy Symptoms
If symptoms do appear they can present as:
- Blurred or double vision
- Seeing flashing lights, blank spots or dark floaters
- Pain or pressure in either or both eyes
- Problems with peripheral vision
- Severe vision loss if left untreated
- Irreversible blindness in advanced stages
What Causes Diabetic Eye Disease?
Chronic high blood sugar levels caused by diabetes are the cause of diabetic retinopathy. These high levels damage the tiny blood vessels in the retina, which is located on the back of the eye. These blood vessels become blocked. To compensate, the eye grows new blood vessels, but they don’t develop normally and can begin to leak. This distorts the patient’s vision. As the condition progresses, these abnormal blood vessels proliferate on the surface of the retina. This can lead to scarring and cell loss in the retina.
Stages of Diabetic Retinopathy
Basically, diabetic retinopathy can be broken down into two forms — nonproliferative and proliferative. The disease progresses through four stages:
- Mild nonproliferative retinopathy – Small areas of balloon-like swelling in the retina’s tiny blood vessels characterize this earliest stage. These “microaneurysms” may leak fluid into the retina, leading to the development of floaters. But in many cases, they don’t and the patient has no symptoms.
- Moderate nonproliferative retinopathy – Now the blood vessels that nourish the retina may swell and distort. They may also lose their ability to transport blood. Both conditions cause characteristic changes in the appearance of the retina and will likely lead to diabetic macular edema, a build-up of fluid in the macula. The macula is the area of the retina used for sharp, straight-ahead vision.
- Severe nonproliferative retinopathy – As more and more blood vessels in the retina become blocked, blood is deprived to areas of the retina. These areas respond by secreting growth factors that signal the retina to grow new blood vessels
- Proliferative retinopathy – The most advanced stage accelerates the growth of abnormal new blood vessels. They now grow along the inside surface of the retina and into the vitreous gel that fills the interior of the eye. These abnormal vessels are weak/fragile, and they are likely to leak and bleed. Scar tissue that has formed as vessels become blocked can contract at this point and pull on the retina, causing retinal detachment. This is where the retina pulls away from the back of the eye, and it can lead to permanent vision loss.
Who Is Likely To Get Diabetic Retinopathy?
If you have diabetes, you can develop diabetic retinopathy. It generally won’t develop, however, until a person has had diabetes for at least a decade. These factors increase your risk:
- Longer duration having diabetes
- Poor control of your blood sugar levels
- High cholesterol
- High blood pressure
- Tobacco use
- Being African American, Hispanic, or Native American
How Can I Prevent Diabetic Eye Disease?
Everyone who has diabetes is at risk for developing diabetic retinopathy, but not everyone develops it. Generally, diabetics don’t develop diabetic retinopathy until they’ve had diabetes for at least 10 years. However, changes in blood sugar levels increase the risk. Therefore, patients should be sure to keep their blood sugar under control as much as possible. This is done by monitoring their blood pressure, maintaining a healthy diet, exercising regularly, and getting an eye exam at least once a year. These prevention methods can reduce the risk of blindness by 95 percent.
Diagnosing Diabetic Retinopathy
An eye examination is often the only way to diagnose changes in the eye vessels and diabetic retinopathy, especially due to the lack of symptoms early on. Therefore, it is important for patients with diabetes to have routine eye examinations. During the examination, your Central Valley Eye Medical Group eye doctor may perform certain tests. This includes a visual acuity test, a dilated eye examination, tonometry test, and retinal exam.
Additionally, a fluorescein angiogram can test for diabetic retinopathy. This test involves an injection of orange-red dye, fluorescein, into the patient’s arm. The dye travels to your eye vessels and can be seen under a special filter. Our staff will take photographs of the retina through a green filtered camera with a flash of blue light. The pictures allow us to analyze and identify any damage to the lining of the retina or atypical blood vessels.
Diabetic Retinopathy Treatment at Central Valley Eye Medical Group
The best treatment is early diagnosis. Otherwise, vision damage may already have occurred. Treatment depends on if you have nonproliferative (early stage) or proliferative (advanced) diabetic retinopathy. In early stages, simply managing your blood sugar effectively can slow the progression of diabetic retinopathy. For decades, the main treatment for diabetic retinopathy, particular in the proliferative stage, was scatter laser surgery. Recently, new drugs have been developed and are proving to be effective for stopping the blood vessel development and decreasing fluid buildup of macular edema.
These are the treatments used to treat diabetic retinopathy:
- Anti-VEGF injection therapy — In this treatment, drugs are used to block a protein called vascular endothelial growth factor (VEGF), which stimulates the growth of the abnormal blood vessels. The drugs are injected into the vitreous gel of the eye. These drugs have proven to be effective for reversing abnormal blood vessel development and decreasing fluid in the eye. Brand names are Avastin, Lucentis, and Eylea.
- Focal laser treatment — In this procedure, laser energy is used to either stop or slow the leakage of blood and fluid in the eye. Also called photocoagulation, laser burns close the leaking vessels. This laser surgery may involve just a few small laser burns or up to hundreds, depending on the patient’s condition.
- Scatter laser treatment — Also known as pan-retinal photocoagulation, here the areas of the retina away from the macula are treated with 1,000 to 2,000 tiny scattered laser burns. These burns cause new abnormal blood vessels to shrink and scar. Scatter laser surgery works best before new, fragile blood vessels have started to bleed.
- Vitrectomy — This surgical procedure is used to treat severe bleeding into the vitreous. In the procedure, a tiny incision is made in your eye to remove blood from the vitreous, as well as the scar tissue that is pulling on the retina creating detachment.
These surgeries are very successful in preventing blindness in most people with diabetic retinopathy. Additionally, if your body has cataracts due to diabetic retinopathy, we can correct them with cataract surgery.
Can Diabetic Retinopathy Go Away Without Treatment?
In most cases, early nonproliferative retinopathy will progress to proliferative retinopathy if not treated. This will continue to worsen until the patient can become blind. If you have diabetes, managing your blood sugar levels can slow the progression, but it’s a dangerous line of thinking to hope this disease will go away without treatment. What will go away is your vision.
That’s why it is imperative if you have diabetes that you get a comprehensive eye exam with dilation with the team at Central Valley Eye Medical Group at least once each year.
Complications Of Diabetic Eye Disease
Complications from having diabetic retinopathy lead to serious vision damage:
- Vitreous hemorrhage — When the abnormal blood vessels bleed into the vitreous it may cause you to see a few dark spots if the bleeding is slight. But if the bleeding becomes more severe the vitreous cavity can fill with blood and completely block your vision. Vitreous hemorrhage won’t cause permanent vision loss, as the blood can clear or be removed.
- Retinal detachment — The abnormal blood vessels formed stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. In slight detachment, this will cause flashes of light and floaters. In severe detachment, vision loss can result.
- Glaucoma — As abnormal blood vessels grow, they can interfere with the normal flow of fluid through and out of the eye. This causes pressure to build in the eye, and this is glaucoma. If untreated, this pressure can eventually damage the optic nerve, permanently damaging vision.
- Blindness — Complete vision loss is the end result of untreated diabetic retinopathy.
Schedule A Consultation
If you are noticing symptoms of diabetic eye disease, contact Central Valley Eye Medical Group for a comprehensive eye exam. Call us at 1.800.244.9907 to schedule a consultation in Stockton or Manteca, CA.