diabetes_header

Diabetes

Diabetes is a disease that affects blood vessels throughout the body, particularly vessels in the kidneys and eyes. When the blood vessels in the eyes are affected, this is called diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness among adults. Approximately 25% of current diabetics have some form of the disease. The risk of developing diabetic retinopathy increases with the age of the diabetic person and how long the person has had the disease.

The retina is in the back of the eye. It detects visual images and transmits them to the brain. Major blood vessels lie on the front portion of the retina. When these blood vessels are damaged due to diabetes, they may leak fluid or blood and grow scar tissue. This leakage affects the ability of the retina to detect and transmit images.

During the early stages of diabetic retinopathy, vision is typically not affected. However, when retinopathy becomes advanced, new blood vessels grow in the retina. These new vessels are the body’s attempt to overcome and replace the vessels that have been damaged by diabetes. However, these new vessels are not normal. They may bleed and cause the vision to become hazy, occasionally resulting in a complete loss of vision. The new vessels also may damage the retina by forming scar tissue and pulling the retina away from its proper location. This is called retinal detachment and can lead to blindness if left untreated.

What is Diabetic Retinopathy?
There are two main forms of diabetic retinopathy. The first is the non-proliferative type, or background retinopathy. The second type is proliferative retinopathy. The background form is usually less severe. This type is a warning sign to the possible progression to proliferative retinopathy.

Background Diabetic Retinopathy
In background retinopathy, tiny vessel abnormalities, called micro-aneurysms, form in the retina. These weakened vessels may bleed within, or underneath the retina. Other signs include the formation of cotton wool spots, along with small bodies called exudates. These features of the non-proliferative type can become severe. Laser applications may slow this progression by sealing the leaking vessels. This is called photocoagulation. Without treatment, retinopathy may cause loss of vision.

Proliferative Diabetic Retinopathy
Proliferative retinopathy is noted by the growth of fibrovascular tissue. Vessels may bleed into the vitreous. When this advanced stage of retinopathy occurs, retinal laser is performed. During this procedure, a laser is used to destroy all of the dead areas of retina where blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to decrease or disappear.

Macular Edema
The macula provides our clearest, central vision. Macular edema can degrade this critical central vision. The area of the macula can thicken as fluid from leaking blood vessels pools within the retinal layers. Important retinal neurons, the special nerve cells critical to vision, can be damaged or lost. For treatment of macular edema, macular photocoagulation can be performed. Laser is applied around the macula. This reduces fluid leakage from vessels.

Symptoms of diabetic retinopathy:

  • There are usually no symptoms in the early stages of diabetic retinopathy
  • Floaters
  • Difficulty reading or doing close work
  • Double vision
  • If left untreated, severe vision loss can occur

Causes of diabetic retinopathy:
Diabetes: Everyone who has diabetes is at risk for developing diabetic retinopathy, but not everyone develops it. Changes in blood sugar levels increase the risk. Generally, diabetics don’t develop diabetic retinopathy until they’ve had diabetes for at least 10 years.

You can reduce your risk of developing diabetic retinopathy by:

  • keeping your blood sugar under control.
  • monitoring your blood pressure.
  • maintaining a healthy diet.
  • exercising regularly.
  • getting an eye exam by an ophthalmologist at least once a year.

Diagnosing diabetic retinopathy:
There are usually no symptoms in the early stages of diabetic retinopathy. Vision may not change until the disease becomes severe. An exam is often the only way to diagnose changes in the vessels of your eyes. This is why regular examinations for people with diabetes are extremely important.

Dr. Kessler may perform a test called fluorescein angiography. During the test, a harmless orange-red dye called Fluorescein will be injected into a vein in your arm. The dye will travel through your body to the blood vessels in your retina. Your doctor will use a special camera with a green filter to flash a blue light into your eye and take multiple photographs. The pictures will be analyzed to identify any damage to the lining of the retina or atypical new blood vessels.

Summary
For adults, diabetic retinopathy is the leading cause of blindness. The longer one has been diabetic with increasing age, increases the risk of developing retinopathy. Those with diabetes should have frequent eye exams. Early detection is very important to management of diabetic retinopathy. Treatments may halt, slow, or in some cases, fail to control the progression of this very serious and difficult eye disease. Any changes to your vision should be brought to Dr. Kessler’s attention immediately.