Diabetic Retinopathy:
About Diabetes
Diabetes is one of the leading causes of visual loss in the United
States. Visual problems become more likely the longer that diabetes
has been present. Given enough time, about 85% of diabetics will
have some eye problems. Over many years, good blood sugar control
does limit, but does not prevent, eye problems.
Diabetes affects the eye in two
main ways. First, excess sugar can be trapped in the eye’s
lens causing blurry vision, a change in glasses prescription, and
cataracts (cloudy lens). Diabetics frequently require more changes
in their glasses prescription and need earlier cataract surgery
than the average patient. Second, diabetes causes the smallest blood
vessels in the back of the eye to close down or leak. Damage here,
in the retina, causes the most severe threat to vision.
What is Diabetic Retinopathy?
The eye is like a tiny camera, and the retina is the “film”
in the back of this camera. The center of the retina is a tiny spot
called the “macula”, which supplies all of our sharp,
central vision. The earliest form of diabetic retinal damage is
called “background diabetic retinopathy”. About 50%
of patients with diabetes for 10-15 years have some signs of this
such as bleeding, or swollen pockets within the retina. If these
swollen areas affect the macula, dim or blurry vision may result.
 If the eye disease worsens, areas
of the retina may not get enough blood. The eye responds by growing
thin new vessels. This is called “proliferative diabetic retinopathy”.
Unfortunately, these new vessels frequently break open and bleed,
filling the eye with blood and stimulating scar tissue to grow,
sometimes leading to retinal detachment. The early stages of this
condition can be treated with the laser. More advanced disease often
requires invasive surgery, called “vitrectomy”, which
involves removal of blood, scar tissue, and abnormal vessels within
the eye and repair of retinal detachment.
How is Diabetic Retinopathy
detected?
 In some cases, advanced damage may be present without the patient
even being aware. Also, most treatments for diabetic eye disease
work better at preventing and controlling the diabetic retinopathy
than at reversing it once it is well established. Because of this,
it is very important for diabetics to have a regular, complete eye
examination that should include drops to dilate the pupil. We recommend
regular eye examinations, in most cases once a year, to detect diabetic
eye problems before the patient recognizes visual problems. We routinely
report information about your exam to your primary care physician
and/or diabetes specialist to keep them updated on this part of
your health. In between scheduled eye examinations, patients should
report any changes in their vision, such as increased fuzziness,
new floating spots, restricted side vision, or pain.
In addition to regular eye examinations,
the diabetic patient should work with his or her physicians to control
the blood sugar level and keep blood pressure under control. Tests
to determine how well the kidneys are working may also be needed.
Over years, this has been shown to reduce the severity of diabetic
complications. Diabetic patients who become pregnant should have
even more frequent examinations of the retina.
How is Diabetic Retinopathy
treated?
When significant retinopathy is detected, a special test called
fluorescein angiography is sometimes performed. This is a photographic
test of the retina and does not involve X-rays. After color pictures
are taken, a yellow dye  called fluorescein is injected into the
arm vein and photographed as it passes through the retinal vessels.
This provides a very detailed "road map" of the retina,
identifying any weakened or abnormal blood vessels. This test is
helpful in deciding whether laser treatment is needed and in guiding
that treatment.
Laser surgery is the most common
treatment for diabetic retinopathy. Laser is a highly focused beam
of light that can be used to cauterize leaky blood vessels or stimulate
abnormal new vessels to shrink and stop bleeding. Laser surgery
is done in the office, using anesthetic eye drops or an anesthetic
injection. Usually laser involves little or no discomfort, and patients
go home immediately after treatment. Post-operative discomfort,
if it occurs, is usually controlled with non-prescription pain medication
such as Tylenol TM or Advil TM.
Laser surgery for retinal swelling
is called focal or grid laser therapy. This is effective in preventing
further vision loss and may result in some visual improvement. Once
this treatment has been performed, it may take several weeks or
months for the swelling to fully drain away. Occasionally, more
leaky spots develop requiring repeated focal treatment. Abnormal
new vessel growth can be treated with panretinal photocoagulation.
In this type of laser surgery, a large number of laser spots are
placed in the side portions of the retina. This causes abnormal
new vessels to shrink and reduces the risk of vision loss from bleeding
or retinal detachment.
Laser surgery is designed to stabilize
or improve vision. It cuts in half the risk of severe vision loss.
Even if vision is not improved, laser therapy may help to limit
visual loss that would have occurred without treatment. Some patients
experience side effects of laser, including m ild loss of side vision, blurry vision or spots in the vision, difficulty seeing in dim light, or sensitivity to light. These side effects, when noticed
at all, are usually mild and temporary, but on occasion they may
persist. Even then, this is far better than the serious visual loss
that can result without laser treatment.
Although laser treatment is very
successful at stabilizing diabetic retinopathy, it is not a cure.
Sometimes, damage may progress despite laser treatment. This damage
can include persisting hemorrhage in the central jelly, called Vitreous
Hemorrhage (shown at right), or scar tissue and detachment of the
retina. Vitrectomy surgery may be needed if further hemorrhage or
damage to the retina occurs in spite of laser or if laser has not
been performed before these more serious problems occur. This is
an operation in which the jelly in the back of the eye along with
any scar tissue or blood is removed. This is usually a very successful
procedure that is well tolerated by the eye. Your doctor can discuss
your case with you individually.
If you have any questions, please
call us at 419-578-2020 or toll free at 1-888-322-7070.
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