Diabetic Eye Disease
Diabetes is another common cause of vision loss. If you have diabetes, it is absolutely critical that you have a complete dilated eye exam every year. A complete eye exam doesn’t mean simply getting your glasses checked, but having an eye doctor perform a full dilated eye exam looking in the back of your eye for subtle signs of damage from diabetes. Just like with glaucoma, your best chance of preventing severe vision loss or blindness means catching problems early and treating them.
What is diabetic eye disease?
Diabetes is a very complicated disease. The changes we typically see in your eyes are from damage to very small blood vessels called capillaries. When someone has uncontrolled diabetes, the walls of their blood vessels are damaged and shut down causing lack of blood and oxygen to that area of the body. We call this “capillary drop out” and it is the same reason diabetic people are at higher risk for strokes, heart attacks, kidney damage, neuropathy and wounds that don’t heal. When we look in the back of your eye, we are looking directly at these small blood vessels and can see subtle signs of damage. Damage to the blood vessels in the back of the eye generally means the rest of your body has similar damage. This damage in the back of your eye is called “Diabetic Retinopathy”. |
The complications from damaged blood vessels in your eye can be mild or very severe. We generally categorize patients’ diabetes as non proliferative or proliferative. We further break down non proliferative into mild, moderate or severe. In the non proliferative stage, we closely observe the eye looking for any early signs of worsening or other complications. At this stage some patients have swelling in their retina called macular edema which can lead to central vision loss. We have ways of treating this swelling such as steroids, laser treatment or injections of medicines into the back of the eye. Overall, patients with non proliferative retinopathy have less risk of severe vision loss compared to those with the more severe, proliferative retinopathy.
What is proliferative diabetic retinopathy?
When a patient’s diabetic retinopathy progresses to the proliferative stage, things become very serious. The damage has become so severe that the retina does not have enough oxygen and sends out chemical signals which cause new blood vessels to grow or “proliferate”. These new blood vessels can cause severe problems. The vessels are fragile and can bleed into the back of the eye filling up the vitreous gel with blood and block your vision. This is called a vitreous hemorrhage. Unfortunately, often when this happens is the first time a patient comes in because they can no longer see out of one or both eyes and we discover they have very advanced diabetic retinopathy. Another problem with these new blood vessels is they can pull or cause traction on the retina. This traction can cause a retinal detachment and is another common cause of blindness from proliferative retinopathy.
How is diabetic retinopathy treated?
As mentioned above, we have multiple ways to treat retinopathy. For swelling or macular edema, we can use steroids, laser treatment or injections of medication. With the development of new medications called “Anti-VEGF” drugs, we have much better tools to treat swelling as well as other complications from diabetic retinopathy.
Proliferative retinopathy is more complicated. If we catch proliferative retinopathy before it causes any major complications such as vitreous hemorrhages or retinal detachments, we typically use laser. Laser treatment for proliferative retinopathy is called Panretinal Photocoagulation or “PRP”. PRP destroys the parts of the retina that are not getting enough oxygen from all the blood vessel damage. These areas of the retina are sending out the chemical signals that cause these new, problematic blood vessels to grow. By carefully lasering the peripheral retina we are able to stabilize the retina and preserve the central vision or “macula”. Laser PRP was first performed in the 1950’s and we are still doing it today because it works so well.
Patients with more advanced proliferative retinopathy that have bleeding in the vitreous and/or retinal detachments are usually referred to a retina surgeon. The retina surgeon does their best to remove the blood and reattach the retina.
The thing to remember with diabetic eye disease is that controlling your blood sugar is the most critical factor in reducing your risk of developing retinopathy as well as other complications elsewhere in your body. Other important factors to keep in mind are not smoking and controlling your blood pressure. If you have diabetes, please call and make an appointment to have your eyes examined every year.
Make an appointment today!
If you have diabetes you need to have a complete dilated eye exam at least once a year. Schedule an appointment with Dr. Zelenak! We proudly serve patients in Wixom, Novi, Northville, Livonia and the surrounding Metro Detroit areas.