Diabetic Eye Disease Month is held each November in conjunction with National Diabetes Month and World Diabetes Day. Over the course of approximately the last 15 years there has been an increase in the number of diagnosed cases of diabetes from 10.4 to 21 million, and in turn an increase from 4.2 to 7.7. million cases of diabetic retinopathy in individuals over the age of 40. Even more staggering is that those with untreated or uncontrolled diabetes are at 25 times greater risk for blindness compared to the general population. Dr. Raymond B. Theodosis, ophthalmologist at Shepherd Eye Center, sees and treats many of these patients.
What is Diabetic Retinopathy?
“Diabetic Retinopathy is a change in the blood vessels in the retina,” Theodosis said. “It is one of the most common diseases we see among our patients with diabetes and typically affects both eyes. In the early stages of the disease, often referred to as non-proliferative or background retinopathy, vessels may leak extra fluid and small amounts of blood. This can cause microaneurysms, hemorrhages, exudates (deposits of cholesterol or fat), or ischemia, which is the closing off of vessels.”
“In another form of the disease, called proliferative retinopathy,” he said, “the lack of blood flow is so pronounced that the eye attempts to grow new blood vessels. The vessels are weak and easily bleed, in turn causing cloudiness in the vitreous which can blur vision, but worse than this is the potential development of scar tissue which can lead to a retinal detachment.”
Fortunately, proactive steps, like a yearly dilated eye exam can help patients with diabetes prevent vision loss and blindness which often develops slowly over time.
What will the doctor do during the exam and what is he/she looking for?
“When we have a patient in for an exam we are using the slit lamp along with dilating drops to enable us to view the retina in the back of the eye where the effect of diabetes usually occurs,” Theodosis said. “We are looking for significant changes in the retinal blood vessels along with bleeding, swelling of the retina or growth of new, undesirable blood vessels.”
At the time of your exam you doctor may ask you about whether or not you have experienced the following: floaters, or cobwebs; blurred vision or changes in vision; blank or dark areas in your area of vision; poor night vision; or any loss of vision.
What are the risk factors?
“I cannot stress how important it is to be proactive,” Theodosis said. “Patients with diabetic retinopathy will not notice any differences in their vision. When it does become noticeable, the damage is often irreversible.”
Risk factors for developing diabetic retinopathy include: uncontrolled blood sugars, high blood pressure, and high cholesterol (which results in protein deposits leaking into the retina).
“What some patients don’t realize is that these risk factors also make you more susceptible for other eye conditions,” he said. “If sugars aren’t controlled you are 60 percent more likely to develop cataracts at a younger age and at a faster pace. If blood pressure is not managed, the risk for glaucoma increases 40 percent. Overall, the longer a person has diabetes, the greater the risk for developing diabetic retinopathy.”
Certain ethnic groups are also at greater risk for diabetic retinopathy, including: African Americans, Latinos and Native Americans. Pregnant women with existing diabetes prior to conception are at increased risk of developing diabetic retinopathy. Additionally, pregnant women who have been previously diagnosed with diabetic retinopathy need to be aware that the condition can worsen during pregnancy.
What treatments are available?
“As physicians it is our hope to be able to prevent the disease or catch it early enough to treat it in order to limit the amount of vision loss,” Theodosis said. “However, the disease sometimes necessitates more aggressive treatment. In that case, we can use a number of different methods to treat different problems.”
A laser treatment near the macula can reduce fluid leakage, while a laser treatment of the retinal periphery can shrink abnormal vessels and minimize the chance of them recurring. In a vitrectomy, which is sometimes needed, the vitreous along with non-clearing blood is removed from the back of the eye. Or a retinal detachment is repaired by releasing traction on the retina caused by proliferative retinopathy. Other intravitreal injections are used to prevent the future growth of abnormal vessels, or to decrease swelling in the retina.
Your sight is precious. Luckily, many conditions and diseases of the eyes can be prevented, or treatments started, by simply being seen regularly by an ophthalmologist, in order to preserve this vital sense.