If you have been diagnosed with diabetes and are afraid of losing your vision, you are not alone. Diabetes has many faces—it affects people of all ages, races and nationalities. Of the almost 20 million people in the United States with diabetes, almost half of those will eventually develop some sort of diabetic eye disease.
What is Diabetic Eye Disease?
Diabetic eye disease refers to a group of eye problems that includes diabetic retinopathy, cataract, and glaucoma, all of which are worsened by inadequate blood sugar control. Diabetic retinopathy is one of the leading causes of vision impairment among adults with diabetes. It is often without symptoms in its early stages, and vision changes may not occur until the disease has progressed severely.
Who is at risk for this disease?
All people with diabetes are at risk--those with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset).
During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision
Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.
If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
Diabetic retinopathy has four stages:
1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.
2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result
Often there are no symptoms in the early stages of the disease, nor is there any pain. Don't wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.
Though vision may gradually become blurred, significant loss of sight does not usually occur with background retinopathy. Since the patient does not experience pain or external symptoms such as blood-shot eyes or discharge, changes in the retina can go unnoticed unless detected by an eye examination.
When bleeding occurs in proliferative retinopathy, the patient has clouding or complete loss of sight. Connective tissue pulling on the retina causes distortion and blurring. However, if abnormalities occur in the peripheral retina, the patient may not experience any symptoms.
Nonproliferative retinopathy does not require treatment. By controlling the levels of blood pressure, blood sugar, and cholesterol, the progression of nonproliferative retinopathy can be halted. However, if macular edema has begun, or if diabetic retinopathy has advanced to the proliferative stage, surgical treatment is usually required.
Laser Surgery is often helpful in treating diabetic retinopathy. To reduce macular edema, laser light is focused on the damaged retina to seal leaking retinal vessels. For abnormal blood vessel growth (neovascularization), the laser treatments are delivered over the peripheral retina. The small laser scars that result will reduce abnormal blood vessel growth and help bond the retina to the back of the eye, thus preventing retinal detachment. Laser surgery may be performed in your ophthalmologist's office or in an out-patient clinic. Laser surgery can greatly reduce the chance of severe visual impairment.
Intraocular Steroid Injection
Intraocular Steroid Injection is a newly emerging treatment for diabetic macular edema. This therapy helps reduce the amount of fluid leaking into the retina, resulting in visual improvement. Due to the chronic nature of diabetic eye disease, this treatment may need to be repeated or combined with laser therapy to obtain maximal or lasting effect.
When the growth of abnormal blood vessels in the retina has caused bleeding (vitreous hemorrhaging), a vitrectomy is usually required. This procedure removes blood clouding the vitreous gel at the center of the eye. During a vitrectomy, performed while the patient is under either general or local anesthesia, the ophthalmologist makes a very small incision in the eye, uses a tiny instrument to remove the vitreous gel, and replaces the gel with saline solution to restore clear vision. Typically done as an outpatient procedure, a vitrectomy requires the use of an eye patch and medicated eyedrops for several days following surgery.