Diabetes is a common medical problem, effects millions of people. Diabetes affects the body’s ability to effectively to control blood sugar (glucose) levels. Although glucose is an important source of energy for the body’s cells, too much glucose in the blood for a long time can cause damage in many parts of the body, including the heart, kidneys, blood vessels and the small blood vessels in the eyes.
It is called DIABETIC RETINOPATHY, when the blood vessels in the eye’s retina (the light sensitive tissue lining the back of the eye) swell, leak or close off completely — or if abnormal new blood vessels grow on the surface of the retina. People who are at greater risk of developing diabetic retinopathy are those who have poor blood sugar control, women who are pregnant, and people with high blood pressure, high blood lipids or both. Also, people who are from certain ethnic groups, such as African-Americans, Hispanics and Native Americans, are more likely to develop diabetic retinopathy.
in early stage of disease, damages blood vessels in the retina, which causes leakage of fluid and small amounts of blood into the macula (critical central portion of retina for seeing) causing macular edema. The macula doesn’t function properly when it is swollen. Macular edema is the most common cause of vision loss in diabetes . As the diabetes advances, eye develops abnormal blood vessels on the retina which lead to multiple problems including bleeding in the back of the eye, development of scar tissue and detachment of retina. In addition it can cause special type of glaucoma, where eye pressure is significantly increased. All these problems if not corrected in time will ultimately leads to blindness.
In the early stages of the diabetic eye disease, often don’t notice changes in vision. As the disease progresses, diabetic retinopathy symptoms may include – spots, dots or floaters; blurred vision; blank or dark areas in your field of vision; poor night vision; colors appear washed out or different. In some people, it causes sudden loss of vision, in some cases cannot be reversed.
To detect early stages of diabetic retinopathy
when it can be controlled with good success, it is very crucial that patients are screened during that stage; The American Academy of Ophthalmology recommends the following diabetic eye screening schedule for people with diabetes:
Type 1 Diabetes: Within five years of being diagnosed and then yearly.
Type 2 Diabetes: At the time of diabetes diagnosis and then yearly.
During pregnancy: Pregnant women with diabetes should schedule an appointment with their ophthalmologist in the first trimester because retinopathy can progress quickly during pregnancy.
The only way to detect diabetic retinopathy and to monitor its progression is through a complete eye examination. Either Ophthalmologist or Optometrist usually does this eye exam. During the visit, vision is checked, the front of the eye examined with slit lamp and then pupils are dilated with eye drops. After dilation of the eyes, back of the eye is examined with an ophthalmoscope to see the details of retina where the damage from diabetes occurs.. If any significant damage is detected, then they refer to retina specialist for further evaluation.
is an ophthalmologist with special training in taking care of various medical and surgical problems of retina. Diabetic retinopathy
is one of the common condition retinal specialist manage. They not only exam the patients in detail but also use specialized instruments to evaluate the retina including –
· Fluorescein angiography – uses a special camera to take a series of photographs of the retina after a small amount of yellow dye (fluorescein) is injected into a vein. The photographs of fluorescein dye traveling throughout the retinal vessels show: details of blood vessel leakage, blood vessel closure and presence of abnormal blood vessels.
· Optical coherence tomography (OCT) – is a non-invasive test that provides high-resolution images of the retina giving detailed information about the presence and severity of swelling of retina. It is helpful to diagnose and follow up with new treatments.
· Ultrasound –If ophthalmologist cannot see the retina because of bleeding in the back of the eye, an ultrasound test may be done in the office. The ultrasound can “see” through the blood to determine if retina has detached. If there is detachment near the macula, this often calls for prompt surgery
Treatment: The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss. Treatment usually won’t cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses to advanced stages ultimately leading to blindness.
Laser surgery- The laser is a very bright, finely focused light. Laser treatment is recommended to control macular edema (swelling of retina)and to decrease problems due to growth of abnormal blood vessels. Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.
Medication injections – recently medications are used to help treat diabetic retinopathy and its complications. These medications reduce or control swelling or bleeding in the eye. These medications include steroids, anti-vascular endothelial growth factors. These medications are injected into the vitreous or jelly-like substance in the back chamber of the eye. The medication reduces the swelling, leakage, and growth of unwanted blood vessel growth in the retina, and may improve vision. . Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks.
Vitrectomy surgery– Diabetic retinopathy in advanced stages develops scar tissue in the back of the eye, which leads bleeding and detachment of retina. Vitrectomy is a surgical procedure to remove blood and scar tissue from the back of the eye and to fix the retina if it is detached.
Diabetic eye disease is easily controllable in early stages and treatments are excellent. In spite of advances in treatment, due to delayed presentation of patients to eye examinations, often retinal specialists
see patients in incurable stages. So, eye examination should be part of the comprehensive diabetic care and strictly followed by patients and their families.
If you are diabetic, you should have your eyes checked once a year for DIABETIC RETINOPATHY. Dr. Lakshmana Kooragayala of the Marietta Eye Clinic in Marietta
Georgia specializes in the management and treatment of diabetic eye disease. He can be reached for an appointment at (770)427-8111 (www.mariettaeye.com