Diabetic Eye Disease

Diabetic eye disease, also known as diabetic retinopathy, is a common complication of diabetes caused by damage to the blood vessels in the retina. The retina is part of the eye that senses light and transmits images to the brain.

Diabetic retinopathy develops when high blood sugar levels in diabetic patients cause the blood vessels in the retina to become weak and leaky, leading to swelling, bleeding, and the formation of abnormal blood vessels. If left untreated, diabetic retinopathy can cause vision loss and even blindness.

However, patients with diabetes face a higher risk of developing these complications. Research shows that over 40 percent of individuals diagnosed with diabetes develop some form of eye disease due to their condition.

One of the most common types of diabetic eye disease is diabetic retinopathy, which is also the leading cause of blindness in the United States. Individuals with diabetes must prioritize regular eye examinations to prevent and manage these potential complications. These potential complications include:

  • Diabetic retinopathy
  • Cataracts
  • Glaucoma

Symptoms of Diabetic Retinopathy

The early stages of diabetic retinopathy often do not exhibit any noticeable symptoms in affected individuals. In certain cases, medical treatment may not be required. However, consistent monitoring of blood sugar levels is essential to prevent the progression of the disease.

As the disease advances, prompt treatment is necessary to maintain vision. Most patients do not notice any changes during the early stages of diabetic retinopathy. But in later stages, the disease can cause tiny blood vessels in the retina to swell. If left untreated, this can lead to blood or fluids leaking into and damaging the retina, which permanently affects the patient’s sight.

Symptoms of diabetic retinopathy to look out for include the following:

  • Blurry or double vision, even if only temporary
  • Flashing lights in the field of vision
  • Blank spots in central or peripheral vision
  • Dark floaters or spots in the vision
  • Unusual pain or pressure in either or both eyes
  • Poor overall visual capacity or problems with peripheral vision
  • Severe vision loss or blindness

Stages of Diabetic Retinopathy

There are four significant stages of diabetic retinopathy caused by the gradual weakening of the blood vessels, and they are:

  1. Mild nonproliferative retinopathy
    In this stage, microaneurysms or tiny swelling spots develop in the tiny blood vessels of the retina. These small bulges in the blood vessels sometimes leak fluid or blood into the retina, leading to vision problems.

  2. Moderate nonproliferative retinopathy
    In this stage, the blood vessels to the retina begin to get blocked, leading to lesser blood circulation to the retina. The decrease in oxygen supply to the retina feeds into the growth of new blood vessels, which are highly fragile and prone to rupture.

  3. Severe nonproliferative retinopathy
    This stage is marked by the occurrence of numerous blocked blood vessels throughout the retina, causing widespread damage to blood and oxygen supply to the eyes. At this stage, the chances of vision loss become much higher, and the individual may experience significant visual impairments.

  4. Proliferative retinopathy
    The final stage is characterized by the growth of new blood vessels, replacing the blocked vessels. These new blood vessels, however, are highly abnormal, and they start spreading across the retina and into the vitreous fluid, the fluid between the eye’s lens and retina. This causes a decrease in vision, as well as an increased risk of retinal detachment or other complications.

It is important to note that during any stage of diabetic retinopathy, macular edema, a condition that causes the retina’s central portion to thicken and swell, can occur. As fluid accumulates in the retina’s cells, vision becomes blurry and distorted. Around fifty percent of proliferative retinopathy cases are diagnosed with macular edema, which can seriously affect the patient’s quality of life.

Diagnosis of Diabetic Retinopathy

After a thorough medical examination of the eyes, some of the following diagnostic tests will be conducted to confirm the diagnosis:

  1. Visual acuity test
    This is a common eye test that measures how well a patient can see with their eyes in a standardized setting. It typically involves reading letters on a chart from a distance to determine the individual’s visual acuity score.
  2. Dilated eye examination
    This type of eye exam uses eye drops to widen or dilate the pupil. This process enables our eye care professionals to examine the retina and optic nerve for any signs of eye disease or damage.
  3. Tonometry test
    This is a diagnostic eye examination that evaluates the pressure inside the eye. It is often used to uncover the risk of developing glaucoma, an eye disease wherein pressure build-up can damage the optic nerve.
  4. Retinal exam
    This is a comprehensive eye exam that focuses on assessing the retina, including the blood vessels, macula, and optic nerve. Our eye doctors use a variety of devices and tools to examine the retina, including specialized imaging machines.
  5. Fluorescein angiogram
    This eye exam involves the injection of a fluorescent dye into the bloodstream. The dye then highlights the blood vessels lining the retina, which can help our eye care professionals detect eye diseases such as diabetic retinopathy or macular degeneration.

Preventive measures

Some risk factors, such as age and genetic susceptibility, cannot be controlled or prevented, most factors that lead to the onset or progression of diabetic retinopathy can be managed through lifestyle changes and early intervention. Here are some ways to prevent or slow down the progression of diabetic retinopathy:

  1. Maintain healthy blood sugar levels
    High blood sugar levels are the leading factor that contributes to the development of diabetic retinopathy. In contrast, lower blood sugar levels prevent or slow the progression of the disease. To help maintain normal blood sugar levels:
        •  Monitor blood sugar levels regularly
        •  Maintain a healthy diet and avoid consuming sugary foods or drinks
        •  Exercise regularly with your doctor’s guidance
        •  Take prescribed medication on schedule
  2. Manage hypertension and cholesterol levels
    High blood pressure and high cholesterol levels are risk factors for diabetic retinopathy. To help manage hypertension and high cholesterol levels:
        •  Maintain a healthy diet and avoid consuming fatty or fried foods
        •  Take prescribed medication on schedule
        •  Exercise regularly with your doctor’s guidance
        •  Refrain from smoking or using other tobacco products
  3. Attend regular eye check-ups
    Patients with diabetes must have more frequent eye check-ups compared to the general population. Attend eye exams as per your doctor’s recommendation.
        •  Early detection improves the chances of slowing the onset and progression of diabetic retinopathy.
        •  Regular eye check-ups can help detect macular edema, diabetic retinopathy, and other eye complications associated with diabetes early on before they cause irreversible sight loss.
  4. Manage comorbid conditions
    Patients with diabetes mellitus often experience additional medical conditions that affect their overall health. It is essential for them to manage these conditions to prevent the onset and progression of diabetic retinopathy.
        •  Maintain a healthy weight and BMI
        •  Refrain from smoking or using other tobacco products
        •  Attend regular check-ups with healthcare professionals, including endocrinologists, podiatrists, and mental health professionals

By taking care of diabetes and following these recommendations, patients can significantly reduce their risk of developing diabetic retinopathy or slow down its progression.

Treatments for Diabetic Retinopathy

  1. Scatter Laser Treatment (Laser photocoagulation) – This procedure involves using high-energy laser beams to cauterize or seal the weak or leaking blood vessels in the retina. It helps reduce the swelling in the eye and reduces vision loss due to macular edema.

  2. Focal laser treatment (Laser photocoagulation) – This procedure specifically targets damaged blood vessels in the retina. This procedure is done by placing a contact lens over the eye and then using a Direct Photocoagulation (DP) machine to generate a focused, intense beam of light energy onto a particular area. The purpose of this is to stop any further leakage of blood vessels in the retina and prevent additional vision loss.

  3. Intravitreal injections – These are specialty medications, injected directly into the eye, that can slow down or halt the progression of retinal damage by either blocking vascular inflammation or promoting the healthy growth of new blood vessels.

  4. Vitrectomy surgery – In this procedure, the vitreous gel is removed from the eyeball and replaced with either a gas bubble or saline solution. This helps reduce scar tissue buildup, which can improve vision significantly in cases of proliferative diabetic retinopathy (PDR).

  5. Vitreolysis – This involves breaking up any remaining tough connective tissue inside the eye from PDR using a pulsed laser beam.

  6. Pars plana vitrectomy surgery – In this more invasive procedure, scar tissue buildup is surgically removed from underneath the retina to prevent further damage and preserve visual acuity as much as possible.
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