Diabetic eye disease refers to a group of eye conditions that commonly affect people with diabetes. They can cause sudden or gradual blurry vision that can lead to permanent vision loss. In fact, diabetes is the leading cause of preventable vision loss among adults. November is Diabetic Eye Disease Awareness month, so it’s the perfect time to discuss these different conditions, their prevention, and some of the treatments available. It is important to note, prevention is the best defense for maintaining your vision.
If detected early enough, these diseases can be treated, but prevention is the best defense for avoiding permanent vision loss. There are many methods of prevention that those suffering from diabetes can take as well to reduce their chances of developing these diseases.
Types of Diabetic Eye Diseases
Diabetic retinopathy is the leading cause of blindness in adults as it affects 1 in 20 people with diabetes. It refers to damage sustained to the retina, specifically damage to the small blood vessels (capillaries) in the retina.
There are four stages of diabetic retinopathy. In the first three, while the disease is progressing, there are often no symptoms and no diabetic retinopathy treatment is required unless there are symptoms of other conditions. The fourth stage, proliferative diabetic retinopathy, occurs when new blood vessels on the retina begin to develop. These new blood vessels, referred to as neovascularization, are weak and leaky. In this stage, large bleeds can occur in the retina and vitreous, leading to sudden vision loss, as well as the formation of scar tissue, that when contracts, can lead to retinal detachments.
Diabetic retinopathy can be characterized by the appearance of small black spots in a patient’s vision. These are the result of small hemorrhages within the retina and poor blood supply. Blurry, fluctuating, or otherwise impaired vision can be other symptoms. This condition is also linked with another common diabetic eye disease, diabetic macular edema. In the case of the latter, central vision is blurred and/or distorted, leading to a loss of sharp acuity.
Diabetic Macular Edema
Diabetic macular edema (DME) is caused by leaking blood vessels in the eye that lead to fluid accumulation and swelling in the macular area (that part of the retina that is responsible for our sharpest detail vision). This causes the patient’s central vision to become blurry, affecting activities such as driving, reading, or recognizing faces.
DME occurs in about half of people already suffering from diabetic retinopathy. Although DME can occur at any stage of diabetic retinopathy, it typically develops when diabetic retinopathy worsens. If a patient is suffering from the early stages of diabetic retinopathy and DME develops, they will require treatment for both.
Glaucoma & Cataracts
Diabetics are at greater risk of developing glaucoma and cataracts. Changes in blood glucose (“sugar”) levels can lead to an increase in fluid pressure in the eye. High blood sugar levels affect the eye’s crystalline lens, causing it to lose its natural transparency. Cataracts are defined as a clouding of the lens of the eye, which blocks or obscures how light enters the eye.
Preventing Diabetic Eye Diseases with Diabetic Eye Exams
The best way to prevent diabetic eye diseases is by properly controlling and treating diabetes. Maintaining normal blood glucose levels, blood pressure control and cholesterol levels will reduce the incidence of diabetic retinopathy. Controlling diabetes by maintaining a healthy diet, regular exercise, and following your doctor’s prescribed medication therapy is best to preventing the ocular complications of diabetes.
In terms of eye health, getting a dilated eye exam at least once per year is advised for all diabetic patients and patients with gestational diabetes. A comprehensive eye exam allows the doctor to check the retina for changes in the lens, eye pressure, corneal nerve damage or dry eye, swelling of the macula, or the presence of leaking blood vessels. Diabetic retinopathy typically goes unnoticed until vision loss occurs. Regular diabetic eye exams can detect early changes even in the absence of symptoms. Early detection is the next best thing to prevention.
Treatment for Diabetic Eye Diseases
There are a variety of treatments for diabetic eye diseases. Sometimes the vision loss and damage can be irreversible, but if the diseases are caught early, they are much more likely to be successfully treated.
Anti-VEGF (VEGF stands for vascular endothelial growth factor) Injection Therapy is one of the most common treatments for proliferative diabetic retinopathy and diabetic macular edema. With this, drugs are injected into the vitreous gel (the largest part of the eyeball) to prevent the growth and leakage of new blood vessels.
Laser surgery may also be an option to be used in conjunction with, or instead of, anti-VEGF injections. Small laser spots are made to the surface of the retina, which can hold back the leakage of fluid or the stimulus for fragile blood vessels (neovascularization) to develop or retreat.
In more severe cases, surgery may be the best option. A vitrectomy is the surgical removal of the vitreous gel in the center of the eye, where blood vessels can grow in proliferative diabetic retinopathy. If a patient is suffering from severe bleeding in this area because of hemorrhaging blood vessels, removing it can often be the only solution. It’s typically performed under local anesthesia.
Contact Us Today
Dr. Jeff Sciberras can be part of your health care team to help maintain your eye health. Contact us today for your comprehensive diabetic eye exam and start preserving your vision today!
Watch these videos to learn more about a) non-proliferative and b) proliferative diabetic retinopathy.