Diabetes and Eye Problems

There are a group of eye problems which diabetics may develop as a common complication of diabetes. These can cause relentless vision loss or even total loss of sight.

Eye disease from diabetes may include

Diabetic retinopathy – is damage or injury in the retina to the blood vessels
Cataract – eye’s lens become cloudy. This tends to start at a younger age in diabetics.
Glaucoma – is an increase in the pressure of fluid in the eye that can cause damage to the optic nerve and also loss of vision. Diabetics have double the chance of getting glaucoma as other adults.

Diabetic retinopathy is considered the more common of the diabetic eye diseases and is a leading cause of blindness. Diabetic retinopathy is caused by problems with blood vessels of the retina. In some diabetics, blood vessels may enlarge and seep out fluid. In others, abnormal new blood vessels can grow on the surface of the retina.

Diabetic retinopathy as well as macular edema can be diagnosed when detected during a very comprehensive eye examination which includes:

Visual acuity test

This is the eye chart that we all are familiar with and which measures your vision at different distances.

Dilate eye exam

This is when drops are put in the eyes to dilate or widen the pupils. This allows the eye doctor or medical professional to see most of the inside of the eyes to check for signs of disease. A special magnifying lens is used by your eye doctor to examine the optic nerve and retina for any signs of damage and other problems. After having your eyes dilated, your close up vision may stay blurred for several hours.

Tonometry

This instrument will measure the pressure in the eye. Drops to numb the eye may be used.

Your eye doctor will check your retina for early signs of disease. These include:

• Leaky blood vessels
• Macular edema or retinal swelling
• Damaged nerve system tissue
• Fatty, pale deposits on the retina which is a sign of blood vessels which are leaking
• Nerve tissues that are damaged
• Changes in blood vessels

If your doctor determines you need further treatment because you have macular edema, she may recommend a fluorescein angiogram. This is a test where a special dye is injected in the arm. Pictures are then taken when the dye passes thru the blood vessels in your retina. This test allows the doctor to id any blood vessels which may be leaking and will recommend treatment.

Diabetic retinopathy involves 4 stages:

1. Mild nonproliferative retinopathy

This is an early stage when microaneurysms occur. These are tiny areas of expanded swelling in the retina’s small blood vessels.

2. Moderate nonproliferative retinopathy

Blood vessels that support the retina become blocked as the disease progresses.

3. Severe nonproliferative retinopathy

As the disease becomes severe, many blood vessels become blocked, which deprives areas of the retina from their blood supply. These areas send signals to the body to grow new blood vessels for nutrition.

4. Proliferative retinopathy

This is the most advanced stage, when new blood vessels have been triggered to grow. These new blood vessels are fragile as well as abnormal as they grow along the retina and along the surface of the clear vitreous gel which fills the inside of the eye. Because of how thin and fragile the walls are they leak blood, which causes relentless vision failure and in some cases blindness can occur.

Throughout the first 3 stages of the eye disease diabetic retinopathy, there is no treatment needed, unless you also have macular edema. In order to prevent the evolution of diabetic retinopathy, the diabetic will need to take management control of their levels of blood sugar, cholesterol and blood pressure.

Proliferative retinopathy which is the last stage in the disease of diabetic retinopathy can be treated with laser surgery. This process is known as a scatter laser treatment. This treatment will help to shrink the blood vessels which are abnormal. Your doctor will place 1000 – 2000 burns of the laser in the regions in the retina away from the macular, which will cause the abnormal vessels to shrink. Because a high number of burns are needed, two or so sessions usually are required to complete treatment. You may notice a loss of side vision but this laser treatment will save the remainder of your sight. But there may be a slight reduction of your color vision as well as night vision.

Scatter laser treatment seems to work better before new fragile blood vessels have begun to bleed. This is why it is so vital to have fully comprehensive dilated eye examinations regularly. But, even if the retinal bleeding has already begun, this treatment will still be probable. This depends on the amount of bleeding.

If the bleeding is relentless, you could need a surgery procedure called a vitrectomy. During the vitrectomy, blood can be eliminated from the eye.

Macular edema is when the macula swells from leaking fluid. The macula is part of the retina which provides central sharp vision. When it swells from fluid your vision will become blurred.

Macular edema is also treated by laser surgery. This treatment is known, as focal laser treatment. The surgeon will place several hundred small burns from the laser in the locales of retinal seepage around the macula. These laser burns will slow the leaking of fluid as well as also reduce the fluid amount in the retina. Surgery is usually done in just one session but other treatments may be needed.

The diabetic could need laser surgery several times in order to control the fluid which is leaking. If macular edema is in each eye and you need laser surgery in both, they usually will only treat one eye each time, 2-3 weeks apart.

This form of laser treatment will stabilize the eye sight. This treatment can reduce the risk of any loss of vision by 50%. In a few cases, if you experience loss of vision, it will be improved.

Both types of laser treatments can be performed in the doctor’s office or eye clinic. Before the surgery, the doctor or nurse will dilate the pupil of your eye and also apply numbing drops in the eye. The area behind the eye also may be numbed to prevent any discomfort.

On the day of the procedure, light in the room will be soft. You will be sitting across from the laser treatment machine. The doctor with a special lens will put it up to your eye. While this treatment continues, you will see light flashing and these flashes could create a sensation of stinging that can make you uncomfortable. You will need a ride home after this procedure. Since your eye will remain dilated for several hours, you should bring sunglasses to your visit. Your vision will be slightly blurry for the rest of the day. Your doctor will suggest a treatment for you if your eyes hurt.

This laser treatment as well as follow up care will usually reduce the risk of losing your sight by over 90%. But, laser treatments do not guarantee to restore vision which has already gone. This is the reason that it is so important to find diabetic retinopathy as early as possible as this is the best way to prevent vision loss.

If your eye has a large volume of blood (vitreous gel) a vitrectomy will be needed to restore your vision. If both eyes need this treatment, they will be scheduled several weeks apart.

The vitrectomy will be done under either general or local anesthesia. The doctor will first make a small opening in the eye. The vitreous gel if clouded with blood will be removed by a small surgical instrument. The doctor then replaces this vitreous gel with a solution of salt. Since the removed vitreous gel is mostly water, there will not be any difference in vision between the original vitreous gel and the salt solution.

Normally you will be able to go home after the vitrectomy. Some patients may stay overnight in the hospital. Your eye will be sensitive and red. You will need an eye patch to wear for several days or weeks to protect the eye. Also, you will be given some medicated drops for your eye to use in order to defend against any infection.

All diabetics with both Type-1 and Type-2 are at risk for diabetic retinopathy. That is the reason everyone with diabetes needs to get a complete dilated eye exam at least once a year. The longer that a person has diabetes, the more probable he/she will contract diabetic retinopathy. If you have developed diabetic retinopathy, your eye doctor will suggest treatment to help avoid its progression. Forty to forty-five percent of those who have diabetes also have some phase of diabetic retinopathy.

For women with diabetes who are pregnant, diabetic retinopathy can become a problem. In order to avert this, a pregnant woman with diabetes needs to have a total dilated eye exam as soon as possible. The doctor will probably propose additional exams during the pregnancy.

If you are diabetic your primary doctor will advise you to get a comprehensive dilated eye examination at least once a year and also remember:

• Proliferative retinopathy usually grows without any symptoms. At this advanced stage, you are at a very elevated risk for vision loss.
• Macular edema can also develop without symptoms during any of the 4 stages of diabetic retinopathy.
• You may develop both macular edema and proliferative retinopathy and still be able to see fine. But you are at a elevated risk for vision loss.
• Your eye doctor will tell you if you have developed macular edema as well as any of the four stages of diabetic retinopathy. Whether you have symptoms or not early discovery and appropriate treatment can avert vision loss.

If you do have diabetic retinopathy, you could need regular eye exams much more often. Diabetics with proliferative retinopathy can lessen their risk of blindness by 95% with appropriate treatment and proper follow up care.

The Diabetes Control and Complications Trial (DCCT) shows that better management of blood sugar levels will slow the commencement and development of retinopathy. People with diabetes who keep their blood sugar levels close to normal also have much less kidney and nerve disease. Better blood sugar control also decreases the need for sight-saving laser surgery.

This level of blood sugar management may not be best for everyone, especially some elderly diabetics, children under 13 years of age or those with heart problems. It is best to get advice from your doctor to see if such a program of control is right for you.

There are several other research studies which have shown that managing elevated blood pressure and cholesterol can also diminish the risk of lost vision. Controlling all of these will also help your health as well as help protect your vision.