Many patients who have diabetes think of it as a disease whereby the primary problem is difficulty in properly metabolizing glucose. In fact, this is correct. However, the effects of diabetes are more widespread than simply a "sugar problem". In fact, diabetes is a disease that affects the blood vessels throughout the body, thus leading to problems with the circulation to your legs, kidneys, heart, brain and eyes-especially the very small blood vessels of the eye found in the retina. When diabetes begins to affect the small blood vessels in the retina, it is called Diabetic Retinopathy.
Diabetic Macular Edema
The first effect of diabetes on the retina is to cause the blood vessels to begin to leak. These "leaky" blood vessels result in a complication called diabetic macular edema or retinal swelling. Since this swelling occurs in the central visual area of the retina, macular edema causes vision loss. To diagnose macular edema, it may be necessary to have an OCT or a fluorescein angiogram. An OCT is a computerized scan of all the layers of your retina that can detect the slightest amount of retinal swelling from leaky blood vessels. A fluorescein angiogram is performed by taking a series of photographs of the retina after a special dye has been injected into a vein in your arm in order to carefully observe the circulation and the integrity of the blood vessels. By using this diagnostic test, it is possible to determine the extent and the location of blood vessel leakage. Fortunately, leaking retinal blood vessels can often be treated by sealing them with a laser. With careful laser treatment it is possible to reduce the swelling and prevent further vision loss.
Proliferative Diabetic Retinopathy
In the progression of diabetic retinopathy, the normal retinal blood vessels begin to close. The closure of the retinal blood vessels results in a condition called retinal ischemia. In order to compensate and overcome this decreased circulation, the retina responds by growing new, but abnormal blood vessels, a process called neovascularization. Unfortunately, neovascularization produces blood vessels that are very fragile and can break quite easily. If left untreated, these "leaky" blood vessels often lead to a severe loss of vision due to hemorrhaging, scar tissue formation, and finally retinal detachment.
Proliferative diabetic retinopathy is treated with either laser treatment or laser treatment combined with a surgical procedure called vitrectomy, which is performed to remove the vitreous that may be filled with blood and/or scar tissue. In some instances, it is possible to have proliferative diabetic retinopathy and neovascularization and still have good vision. However the maintenance of good vision requires treatment of neovascularization.
Diabetic Eye Examinations
In order to maintain good vision and avoid the complications of diabetic retinopathy, it is necessary for diabetics to have a comprehensive eye exam at least once a year to detect the presence of diabetic retinopathy in its earliest stages. The use of "screening photographs", even with a dilated pupil, is not a substitute for a comprehensive diabetic eye examination by an eye physician. Screening photographs may miss the earliest signs of diabetic retinopathy in many patients. In addition, "photographic screening" will not detect other significant eye problems such as glaucoma and cataracts, which may also be complications of diabetic eye disease. Today, most insurance companies encourage and cover regular annual diabetic eye exams in order to ensure high quality diabetic eye care.
The American Diabetic Association (ADA) recommends yearly eye examinations for all diabetic patients. Further, current research indicates that even patients who are glucose intolerant, but do not have a definitive diagnosis of diabetes are at risk of developing diabetic retinopathy and thus should have annual eye exams.
Early Treatment of Diabetic Retinopathy
It is quite important for all diabetics to obtain regular eye exams because early and aggressive treatment of diabetic retinopathy has been proven to be extremely successful in prolonging vision and preventing severe vision loss. Federally funded, large scale, multi-center, controlled studies, such as the Early Treatment of Diabetic Retinopathy Study (ETDRS) have given us treatment guidelines indicating which patients may benefit from laser treatments to preserve vision and delay progression of vision loss. The studies have found that with early laser treatment, patients with diabetic retinopathy were only 50% as likely to progress and lose further vision.
Diabetes and Overall Health
It is important for diabetics to maintain their overall health. Staying healthy and controlling your blood glucose helps maintain the circulation in your heart, kidneys and eyes, as does lowering the key vascular disease risk factors by controlling high blood pressure, not smoking, exercising regularly, reducing dietary fat intake and lowering cholesterol and triglycerides. Always follow your physician's instructions carefully.
If you are diabetic or are glucose intolerant, and you wish to have a thorough diabetic eye examination, Drs. Berger, Howard and Kessler invite you to call Litchfield Hills Eye Physicians today. They will be pleased to provide your examination, consultation and answer all of your questions about diabetic eye problems.
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