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Diabetes

Background

Diabetes is a systemic disease involving the blood sugar. It occurs when too much sugar travels through the blood stream and damages blood vessel walls. Diabetes can affect a person’s eyes in many ways. The basic types of diabetic retinopathy are:

  • Non-proliferative diabetic retinopathy
  • Clinically significant macular edema
  • Proliferative diabetic retinopathy

Non-Proliferative Diabetic Retinopathy

This is the earliest form of diabetic retinopathy and is a direct result of damage to the fine arteries and veins in the retina. Most patients who have had diabetes for more than 10 to 15 years will have some form of this condition. During a retinal exam, your doctor may find bleeding, microaneurysms, and cholesterol deposits (called exudates) in the retina, which can affect vision. If the center of the retina is involved, you may have clinically significant macular edema.

Clinically Significant Macular Edema

Bleeding in the retina (macula) may cause swelling of the retina and blurry vision that cannot be corrected with glasses.

Your retinal specialist can help stabilize your vision and, in some situations, improve your vision. Treatment options include LASER, injections of medicine into the eye, and combinations of the two. Multiple treatments are usually necessary.

Example of focal laser photocoagulation to treat diabetic macular edema.)

Example of focal laser photocoagulation to treat diabetic macular edema.)

Proliferative Diabetic Retinopathy

If a person’s diabetes continues to progress, more and more blood vessels can shut down. Without receiving the nutrients and oxygen it needs, the retina “starves” or “suffocates.” To compensate, your retina will release numerous chemicals to get more blood and oxygen. One is vascular endothelial growth factor (VEGF), which leads to the creation of new blood vessels; however, these new blood vessels are not normal. They break easily and fill the eye with blood (vitreous hemorrhage), causing vision loss. You can also develop retinal detachments as these blood vessels regress.

Proliferative diabetes with new blood vessels, hemorrhage, and ring-like fibrosis, leading to retinal detachment.

Proliferative diabetes with new blood vessels, hemorrhage, and ring-like fibrosis, leading to retinal detachment.

This is a serious condition that warrants very close follow-up with a retinal specialist. LASER is often required to stabilize the condition. This can be combined with intravitreal injections if there is too much blood present to perform laser. Ultimately, in the case of retinal detachment or severe vitreous hemorrhage, eye surgery may be required.

Most common symptoms

  • Blurry central vision
  • Small dark floaters in vision that often start as a dark streak
  • Total cloud over vision

Potential complications

  • Poor central vision despite treatment
  • Poor night vision
  • Neovascular glaucoma
  • Retinal detachment
  • Blindness

Treatment options

  • Laser for macula edema
  • Laser for proliferative retinopathy
  • Injections for macular edema or proliferative retinopathy
  • Pars plana vitrectomy with laser

What to do if you develop these symptoms

  • Schedule an appointment for evaluation or follow up with your retinal specialist.
  • Maintain excellent blood sugar, blood pressure, and cholesterol control with the help of your primary care physician/endocrinologist.
  • Eat healthy and establish an exercise routine.