Diabetes is one of the leading causes of vision loss in the United States. Visual manifestations are more likely to occur the longer diabetes has been present. Good blood sugar control can help limit the development of eye problems.
What is Diabetic Retinopathy?
The eye is like a tiny camera, and the retina is the “film” in the back of this camera. The center of the retina is an area called the macula, which supplies all of our sharp, central vision. The earliest form of diabetic retinal damage is called background diabetic retinopathy (BDR). About 50% of patients with diabetes for 10-15 years have some signs of BDR such as small areas of bleeding or swelling within the retina. If swelling occurs within the macula, dim or blurred vision may result.
If the eye disease worsens, areas of the retina may not receive enough blood flow. The natural response is to grow new vessels. This is called proliferative diabetic retinopathy (PDR). Unfortunately, these new vessels are inefficient and bleed, filling the eye with blood and stimulating scar tissue to grow, sometimes leading to retinal detachment. The early stages of this condition can be treated with the laser or intraocular injections. More advanced disease often requires invasive surgery, called vitrectomy, which involves removal of blood, scar tissue, and abnormal vessels within the eye and repair of retinal detachment.
How is Diabetic Retinopathy Detected and treated?
In some cases, advanced damage may be present without the patient even being aware. Also, most treatments for diabetic eye disease work better at preventing and controlling the diabetic retinopathy than for treating it once it is well established. Because of this, it is very important for diabetics to have a regular, complete eye examinations that should include drops to dilate the pupil. We recommend regular eye examinations, in most cases once a year, to detect diabetic eye problems before the patient recognizes visual problems. We routinely report information about your exam to your primary care physicians to keep them updated on this part of your health. In between scheduled eye examinations, patients should report any changes in their vision such as increased fuzziness, new floating spots, restricted side vision, or pain.
In addition to regular eye examinations, the diabetic patient should work with his or her physicians to control the blood sugar level and keep blood pressure under control. Tests to determine how well the kidneys are working may also be needed. Over years, this has been shown to reduce the severity of diabetic complications. Diabetic patients who become pregnant should have even more frequent examinations of the retina.