Diabetes and Your Eyes

Hope in Sight—Managing the Threat of Vision Loss

Diabetes affects your entire body, including your eyes. According to The American Academy of Ophthalmology, diabetics are 25 times more likely to lose vision than those without this disease. The most common complication of diabetes is diabetic retinopathy, and the condition can develop in anyone who has either type 1 or type 2 diabetes. The longer you have diabetes, and the less controlled your blood sugar is, the more likely it is that you’ll develop diabetic retinopathy.

The high blood sugar levels associated with diabetes often affect blood vessels in the retina of the eye, which causes diabetic retinopathy. In the early and most treatable stages of diabetic retinopathy, there are usually no visual symptoms or pain. In fact, many times the disease can even progress to an advanced stage without your noticing subtle and gradual change in your vision.

Common symptoms may include:
. Abnormal patterns in the field of vision
. Dark streaks in your vision
. Sudden onset of decreased vision
. Distorted central vision
. Floaters
. Red film that blocks vision
. Blind spots
. Poor night vision
. Items may have a blue-yellow color tone,  interfering with color perception

One sometimes overlooked symptom of diabetic eye disease is nerve damage (neuropathy) affecting ocular muscles that control eye movements. Symptoms can include involuntary eye movement (nystagmus) and double vision.

The 2 Stages of Diabetic Retinopathy
There are 2 stages of classifications of diabetic retinopathy: non-proliferative or proliferative.

Non-proliferative retinopathy (NPDR), sometimes known as background diabetic retinopathy, is the most common form of the disease. This condition is first diagnosed when small retinal blood vessels start to swell. As the disease progresses, these blood vessels break and leak blood.

Proliferative retinopathy (PDR) is the more advanced stage of diabetic retinopathy. As the condition progresses, more and more blood vessels are blocked. Sensing the need for new blood vessels to supply nourishment, new blood vessels grow, but they are frail and abnormal, often hemorrhaging and scarring. Patients with this type of diabetic retinopathy can experience severe vision loss, and even blindness.

Diabetic macular edema is the term used for swelling in the central part of the retina, known as the macula. The macula is what allows you to see fine detail. When blood vessels that nourish the retina are weakened and begin to leak as a result of diabetes, loss of vision can result. Macular edema may occur separately from or in addition to NPDR or PDR.

It is worth noting that smoking accelerates the damaging effect that diabetes has on the retina. Several other influencing factors include your genes, your blood pressure levels, how long you have had diabetes and of course, your blood sugar level.

The Importance of Eye Exams
We strongly recommend that all diabetics have yearly comprehensive medical eye exams. Your eye doctor will dilate your eyes and check your retina, blood vessels and optic nerves for changes. We may also order fluorescein angiography to track and photograph dye as it flows through the blood vessels in the retina to determine if any of them are leaking.

We also commonly perform an Optical Coherence Tomography (OCT) to assess fluid accumulation (macular edema) in the retina of diabetics. The OCT can show areas of retinal thickening and is often a useful tool in assessing a patient’s response to a treatment.

How Diabetic Retinopathy Is Treated
The most important tool for treating diabetic retinopathy is good management of the underlying diabetic condition. In the very early stages, regular monitoring and well-controlled blood sugar can help control progression. Nevertheless, once diabetic retinopathy has presented itself, there are several methods of treatment if it continues to advance. Lasers are the mainstay; often used to treat the early stages by sealing leaking blood vessels. More advanced cases may require a vitrectomy, a surgical procedure needed when the vitreous, the gel in the eye, contains a great amount of blood.

The optimal time for treatment is before the patient experiences visual symptoms. Early detection and treatment is key, because diabetic retinopathy can progress into its advanced stages with no pain, and no recognizable vision loss. Preserving vision is the reason why it’s so important for all diabetics to get a yearly comprehensive medical eye examination.

If you are a diabetic, please take time to educate yourself, and any loved ones with diabetes, on the importance of regular eye exams, taking prescribed medication, sticking to a diet and exercise plan, controlling high blood pressure and avoiding alcohol and smoking. A working partnership between you and your eye doctor may not prevent diabetic retinopathy, but it can surely reduce the risk of developing more severe complications and slow the disease’s progression.

If you are diabetic and would like to schedule an appointment for a comprehensive medical exam at The Eye Associates, please call 941-792-2020.

Richard E. Hector, MD
Robert S. Friedman, MD
Cathleen McCabe, MD
Brian Foster, MD
Joshua Mali, MD
Charles Anthony II, MD
Todd Berger, MD
Jeffrey Kasper, MD
Ahmad Tarabishy, MD
Scott B. Han, OD
Michael Camp, OD
Edwin Detweiler III, OD
Lori Ann Long, OD
Robert Rego, OD

Toll Free: 1-866-865-2020
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