| As a primary eye care practitioner, I am | | | | leaks into the center of the macula from |
| continually astonished by the number of diabetes | | | | damaged blood vessels, as described above, the |
| patients I see who have either never had a | | | | macula swells and is what we term macular |
| dilated eye exam or feel they don't require one | | | | edema. Macular edema can happen at any stage |
| (or at least not as often as I recommend). Then | | | | of diabetic retinopathy, but it can more likely |
| there are people with diabetes who are shocked | | | | occur as the disease advances, so much so that |
| to find out that their eye or vision problems are | | | | roughly half of diabetics with proliferative |
| related to their diabetes. As an eye doctor, I am | | | | retinopathy (Stage 4) also have macular edema. |
| very aware of the link between diabetes and the | | | | Symptoms of retinopathy vary, but what is most |
| potential for eye problems including blindness. One | | | | concerning is that often there are no symptoms, |
| of our jobs as an eye care provider is to talk to | | | | especially in the early stages. You can develop |
| our diabetes patients about the associated ocular | | | | both macular edema and proliferative retinopathy |
| health risks and dangers they may face as a | | | | and still see fine. The best way to prevent vision |
| result of their condition. One eye disease all people | | | | loss is early detection and timely treatment. |
| with diabetes should be aware of is diabetic | | | | Everyone with diabetes, type 1 or 2, is at risk and |
| retinopathy. If you are already aware of this | | | | should have a comprehensive dilated eye exam at |
| disease, then I am offering a reminder of how | | | | least once a year. If retinopathy is present, an |
| important it is for your to understand the | | | | eye exam may be needed more often and |
| symptoms, treatments and what you can do to | | | | treatment may be recommended to prevent |
| avoid this diabetes-related vision complication. | | | | progression. Also, women with diabetes who |
| It is at this point I recall the alarming statistics | | | | become pregnant should have an eye exam |
| that come across my desk on a weekly basis. | | | | within the first trimester, and should be watched |
| One of the most disturbing statistics to me is that | | | | closely thereafter, even into the first year |
| diabetes is the primary cause of blindness in | | | | postpartum. This does not apply to women who |
| Americans 75 years of age or younger and the | | | | develop gestational diabetes as they have no |
| primary cause of new cases of blindness, most | | | | increased risk for developing retinopathy. |
| commonly from diabetic retinopathy. | | | | The likelihood of developing diabetic retinopathy |
| Diabetic retinopathy is when diabetes affects the | | | | goes up the longer you have diabetes, but |
| retina, the inner light-sensitive tissue lining the back | | | | 40-45% of Americans diagnosed with diabetes |
| of the eye. This is called diabetic retinopathy. We | | | | have some stage of retinopathy. The best thing |
| like to think of the retina as the film in a camera. | | | | someone with diabetes can do to slow the onset |
| If it is damaged then the picture is never | | | | and progression of retinopathy is to control their |
| developed or seen - that is why retinopathy is | | | | blood sugar, as shown by the Diabetes Control |
| the main threat to vision. | | | | and Complications Trial. In addition, controlling |
| There are four stages of diabetic retinopathy: | | | | elevated blood pressure and cholesterol in addition |
| | | | can reduce the risk of vision loss, as hypertension |
| 1. Mild nonproliferative retinopathy: This is the | | | | is a major risk factor for developing macular |
| earliest phase which can begin after diabetes has | | | | edema. That is why I ask all of my diabetic |
| affected the circulatory system of the retina. The | | | | patients what their last blood sugar reading was, |
| walls of the retinal capillaries become weakened | | | | as well as their Hemoglobin A1C, their blood |
| and microaneurysms form, which are small | | | | pressure and cholesterol levels. |
| balloon-like outpouches of the petite blood vessels. | | | | Treatment for diabetic retinopathy depends on |
| Microaneurysms can leak blood, forming small | | | | the stage and specific problem. Often your eye |
| dot-like hemorrhages, as well as fluid leading to | | | | care professional will rely on special tests, |
| swelling or edema in the retina. | | | | fluorescein agiography, macular OCT imaging and |
| 2. Moderate nonproliferative retinopathy: In this | | | | even retinal photography to monitor progression |
| stage, the disease progresses or worsens, and | | | | and make decisions on appropriate treatment. |
| there is blockage of the nourishing blood vessels | | | | More often than not, you will be referred to a |
| of the retina. | | | | retinal specialist to assess the need and type of |
| 3. Severe nonproliferative retinopathy: As more | | | | treatment. Proliferative retinopathy is treated with |
| blood vessels are blocked, the retina becomes | | | | a scattered laser treatment over a wide area |
| deprived of oxygen or what we call "ischemic." In | | | | called PRP (panretinal photocoagulation). Macular |
| order to uphold adequate oxygen supply, the | | | | edema is treated with focal laser treatment to |
| retina sends a signal to the body to grow new | | | | the area surrounding the macula. Both are |
| fragile blood vessels in an attempt to bring in | | | | effective and have high success rates in reducing |
| nourishment. | | | | vision loss, but they do not cure diabetic |
| 4. Proliferative retinopathy: Once these new blood | | | | retinopathy. You will always be at risk for new |
| vessels are formed, this is known as | | | | bleeds. At times bleeding can be severe and |
| neovascularization and the condition has converted | | | | requires a surgical procedure called a vitrectomy |
| to proliferative retinopathy. Proliferate indicates | | | | to remove the blood from floating in the center |
| growth or flourishing of the new blood vessels not | | | | of the eye. Other possible treatments may be |
| only along the retinal surface, but also growth into | | | | needed if the initial ones aren't effective, or |
| the vitreous gel which fills the inside of the eye. | | | | further complications such as retinal detachment |
| Since these vessels are fragile and delicate they | | | | arise. |
| leak and bleed (hemorrhage) causing obscured | | | | As you can see, diabetes can take a toll on your |
| vision, blind spots, and if left untreated, blindness | | | | eyes and I cannot stress enough the importance |
| from retinal detachment. | | | | of being proactive and maintaining proper blood |
| These stages are important to understand. | | | | sugar levels. If you are one of the more than 18 |
| However, it is just as or even more important to | | | | million American children and adults affected by |
| understand there is the possibility of macular | | | | diabetes, I recommend you schedule regular eye |
| edema, which is usually the primary cause of | | | | exams to reduce the possibility of ocular |
| vision loss in diabetics. The macula is a very | | | | complications. The earlier a problem is caught, the |
| important part of our visual system and is where | | | | greater the success of treatment. |
| straight-ahead, detailed vision occurs. When fluid | | | | |