Diabetes & Eye Problems

Diabetic eye problems often develop without any noticeable vision loss or pain. Significant damage may already be present by the time patients notice any symptoms. Early detection of diabetic eye disease can help prevent permanent damage. Diabetic eye problems develop from high blood sugar levels, which can cause damage to blood vessels in the eye. Over 40% of diabetics will develop some form of eye disease in their lifetime. The risk of developing eye problems can be reduced through regular eye exams and by keeping blood sugar levels under control through a healthy diet, regular exercise, and medications if needed. If a person’s diabetes affects their eye, it is called diabetic retinopathy.

View Video

Diabetic Retinopathy

Diabetic retinopathy is caused by damage to the lining of the blood vessels in the retina. These damaged blood vessels develop thinning and may leak fluid, protein, or blood. Additionally, blood vessels may become blocked and this can lead to additional retinal damage due to a lack of oxygen to these tissues. As new blood vessels develop to compensate for this, they can also leak and cause hemorrhages, scarring, and permanent damage to the retina. The risk of developing diabetic retinopathy increases the longer a person has diabetes and the less they control their blood sugar levels.

Types of Diabetic Retinopathy

NON-PROLIFERATIVE (BACKGROUND) RETINOPATHY

This is the earlier stage of diabetic retinopathy. In this stage, fine blood vessels leak blood, protein, and fluid. This may cause the retina to hemorrhage, swell, or develop protein deposits called exudates. Sight is usually not seriously affected. However, it can rapidly lead to more advanced stages if not treated properly.

PROLIFERATIVE RETINOPATHY

This consists of the more serious changes that occur when new, abnormal blood vessels begin growing on the surface of the optic nerve or the retina. These new blood vessels are weaker and more fragile and may rupture and cause significant bleeding inside the eye. This can lead to severe scarring, retinal detachment, and glaucoma.

Progression & Treatment

A comprehensive eye examination and appropriate treatment by an ophthalmologist is the best protection against eye damage due to diabetes. This includes a dilated eye exam to examine the retina, iris, optic nerve, and eye pressures. Additional testing may be done to evaluate retinal thickness (ocular computed tomography) and evaluate the status of the retinal blood vessels (fluorescein angiography). When diabetic retinopathy is discovered, your doctor will consider several factors before deciding if observation or treatment is most appropriate. Treatment for early stages of diabetic retinopathy usually focuses on maintaining blood sugar levels, blood pressure, and blood cholesterol levels under good control. When ocular treatment is needed, a laser alone, or in combination with a series of intra-ocular injections, is usually used to seal or shrink the abnormal and leaking blood vessels. In very severe cases, an intra-ocular surgery can be done to clean out and remove any bleeding inside the eye (vitrectomy).

Diabetic treatments

PRP (PANRETINAL PHOTOCOAGULATION)

This is recommended when patients have abnormal blood vessels growing in the eye due to diabetes. These blood vessels are very delicate and are prone to bleeding. This treatment is used to prevent or shrink abnormal blood vessels growing in the eye. This laser treats the periphery of the retina inside the eye. It is NOT used in the central part of the eye. It can be done as a single treatment or as several small treatment sessions.

INTRA-VITREAL INJECTIONS

This is the most common way to treat significant diabetic eye problems. Special medicines, called anti-VEGF, and/or anti-inflammatory medications are injected directly into the middle (vitreous) of the eye. Intra-vitreal injections are extremely effective because the delivery of the medication into the vitreous allows for quick and easy absorption into the retina. The procedure is performed in the doctor’s office and only requires a local anesthetic (despite the way it sounds). Patients may require one or a series of several injections. In most cases, these injections will help improve vision and keep vision loss to a minimum.