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Understanding Diabetic Eye Disease

Diabetes is a common condition, with over 30 million Americans living with diabetes. Diabetes can affect every part of your body, including your eyes. The diabetes-related changes to the circulatory system can affect blood flow to your eyes, putting you at risk for diabetic retinopathy. Regular eye exams can help you detect diabetic retinopathy and manage it before it causes vision loss.

A patient receiving fluorescein angiography

About Diabetic Retinopathy

Diabetic retinopathy is damage to the eye as a side effect of diabetes. The retina is the rear portion of the eyeball. It is made of layers of light-sensitive nerve tissue that receives visual images and sends them to the brain. Like all organs, the eye relies on energy provided by blood flow to work properly. Over time, the excess sugar in the bloodstream from diabetes can affect blood vessels and reduce blood flow. The tiny vessels in the retina are susceptible to this sort of damage.

If the blood vessels in the retina become damaged, they can stop working. Your eye will attempt to make new vessels to replace the damaged ones, but they are likely to develop improperly. The weak new vessels can leak and cause blood to seep into other areas of the eye, which is known as a vitreous hemorrhage. Over time, this can lead to permanent damage and vision loss.

There are distinct phases of diabetic retinopathy:

  1. Non-Proliferative Diabetic Retinopathy (NPDR): NPDR is the early phase of diabetic retinopathy when the vessels in the retina start to swell and leak. This can lead to swelling over the eye, called macular edema. Some vessels may start to close off, reducing the overall blood flow to your eye. There are often no symptoms of NPDR, though it can be detected in an eye exam.
  2. Proliferative Diabetic Retinopathy (PDR): PDR is a more advanced stage of diabetic retinopathy. The damaged vessels in the eye start to close off, and new, fragile vessels develop. These are prone to leaking blood, which can cause you to see spots or floaters in your field of vision. This process can lead to scarring, which puts you at risk for complications like a detached retina or glaucoma. Without treatment, PDR can cause significant vision loss.


Diabetic Retinopathy Symptoms

The early stages of diabetic retinopathy may not cause any symptoms. However, if the condition gets worse, you may notice changes to your vision, such as:

  • Blurred vision
  • Dark areas or blank spots in your field of vision
  • Double vision
  • Flashing lights
  • Fluctuating vision
  • Spots, rings, or dark lines floating in your vision
  • Vision loss
  • Pain or pressure in one or both of your eyes

If you notice any of these symptoms, you should see your eye doctor as soon as possible.

Diagnosing Diabetic Retinopathy

During your eye exam, your retina specialist can diagnose diabetic retinopathy, even if you are not currently experiencing any symptoms. Your doctor will ask you about your medical history, particularly your diabetes diagnosis and how you manage the condition. They will also do visual acuity tests to measure any problems or changes in your vision.

In addition to the vision exam, there are a variety of tests that can let your doctor examine the structure of your eye and look for blood vessel damage, swelling, or other signs of diabetic retinopathy.

  • Pupil dilation: This is a standard part of comprehensive eye exams. Your doctor will give you special drops to dilate your pupil, which is the black circle in the center of your eye. This allows them to look into the back of the eye and examine the retina.
  • Tonometry: This is a test to check the pressure of your eyeball, as increased pressure can be a sign of diabetic retinopathy. Your doctor will use a special device to painlessly touch the surface of the eye and measure the pressure levels.
  • Ophthalmoscopy: Your doctor can use a tool called an ophthalmoscope to see into the back of your eyes. The ophthalmoscope allows your doctor to see the retina and identify any signs of damage.
  • Fluorescein angiography: Your doctor may suggest fluorescein angiography to identify the precise areas of blood vessel damage in your eyes. They will inject an organic dye into your bloodstream. The dye will travel to the vessels in the eye and show which blood vessels are leaking or not providing blood supply to the eye.
  • Optical coherence tomography: Your doctor may want to have imaging tests of your retinas. Optical coherence tomography provides detailed images of your eyes so your doctor can assess your eye health.


Diabetic Retinopathy Treatment

There are several treatments available for diabetic retinopathy. If you are in the earliest stages of the condition, you may not need treatment right away, and your doctor may recommend that you get periodic eye exams to monitor your eye health. They may also suggest ways to manage your diabetes to reduce the chance of your diabetic retinopathy growing worse over time.

If you have more advanced diabetic retinopathy, your doctor will recommend an appropriate treatment plan, such as:

  • Medication injections: There are medications that can be injected into the eye to prevent new blood vessels from forming and reduce pressure in your eyes. Your doctor will use numbing drops to prevent discomfort during treatment, and you may experience pain and redness after your appointment. You may need to come in for regular injections to manage diabetic retinopathy over time.
  • Laser treatments: Focal photocoagulation and pan-retinal photocoagulation are laser treatments that can stop blood vessels from leaking and shrink enlarged blood vessels. These procedures can be performed in the doctor’s office. If you have vision loss or blurred vision, these treatments may not return your vision to normal, but they can reduce the risk of further problems.
  • Vitrectomy: This is a procedure to remove excess blood and fluid from inside the eye, as well as remove any scar tissue affecting the retina. A vitrectomy is a surgery that requires general anesthesia and must be performed in a hospital or surgical center.

Treatment can slow the progress of diabetic retinopathy, but there is no cure for the condition. You should get regular eye exams to check the health of your eyes and ensure you get prompt treatment if there are any changes. You can reduce your risk of complications by managing your diabetes through diet, exercise, and any medications your doctor recommends, including insulin treatment if necessary.

Schedule Your Eye Exam Today

If you believe you may be at risk of diabetic retinopathy, contact the doctors at Aiello Eye Institute today.

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