Diabetes mellitus causes the body to not use and store sugar correctly. High blood glucose levels can damage the blood vessels in the retina and lead to diabetic retinopathy. The best treatment for diabetic retinopathy is prevention of the development of retinopathy. Strict blood sugar control can significantly decrease the long-term risk of vision loss. Diabetic eye care treatment is meant to prevent blood vessels from leaking or to eliminate abnormal blood vessels. This can be accomplished with medical treatment, laser eye surgery and/or traditional surgery.
Diabetics are more susceptible to a multitude of ocular problems than non-diabetics. High glucose levels and high blood pressure put diabetics at higher risk for developing cataracts, glaucoma, and diabetic retinopathy. Dr. Reena Patel offers diabetic eye care in Wichita at her full-service ophthalmology practice. She encourages people with diabetes to schedule regular dilated eye exams so that any early signs of diabetic complications can be diagnosed and treatment can be initiated quickly.
Common Eye Problems in Diabetics
Diabetic Retinopathy: The most common diabetes-related eye condition is diabetic retinopathy, which affects the retina. The retina has tiny blood vessels that are susceptible to damage. In diabetics, these blood vessels are more likely to swell, weaken or become clogged. There are two types of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR is an early stage of diabetic retinopathy whereas PDR is a late stage of diabetic retinopathy.
With NPDR, tiny retinal blood vessels leak blood or fluid in the retina. The fluid can cause the retina to swell or to form small deposits called exudates. Many diabetics who have early NPDR may not have any visual changes.
Vision is usually impaired when macular edema or macular ischemia is present. Macular edema is a thickening or a swelling of the macula, which is the small central area of the retina that allows us to distinguish fine details. Macular edema is caused by fluid leaking from retinal blood vessels and is the most common cause of vision loss in diabetes. Macular ischemia occurs when small blood vessels close off in the central portion of the retina. Vision becomes blurred because the macula receives an insufficient blood supply to function properly.
Proliferative diabetic retinopathy occurs when abnormal blood vessels (neovascularization) start to form on the optic nerve or retinal surface. The neovascularization usually occurs because multiple retinal blood vessels closed, preventing sufficient blood flow. The retina then responds by forming new blood vessels to try to supply blood flow to an area where the original blood vessels closed. The new blood vessels do not work properly and are usually associated with scar tissue, which can cause detachment or wrinkling of the retina. PDR can cause severe vision loss because it can affect both central and peripheral vision. Proliferative diabetic retinopathy can cause vitreous hemorrhage, traction retinal detachment, and/or neovascular glaucoma.
The best treatment for diabetic retinopathy is prevention. However, if diabetic retinopathy is present, treatment may be needed. Medical treatment can include injections of anti-VEGF medication to stop the growth of new blood vessels and bleeding. Anti-VEGF injections can also reduce swelling due to diabetic macular edema.
Laser surgery can be recommended for macular edema, proliferative diabetic retinopathy, and neovascular glaucoma. The main goal of laser treatment for macular edema is to prevent further vision loss. For proliferative diabetic retinopathy, laser treatment is focused on all parts of the retina except the macula. This panretinal photocoagulation (PRP) treatment causes abnormal blood vessels to shrink and prevents further blood vessels from growing in the future. PRP also reduces the chance of vitreous hemorrhage and traction retinal detachment. Some diabetics may need multiple laser treatments over time as laser surgery does not cure diabetic retinopathy and does not guarantee further vision loss.
Some patients with advanced PDR may need a vitrectomy. A vitrectomy is a surgery in which the blood-filled vitreous is replaced with a clear solution. A vitrectomy can prevent further bleeding by removing abnormal blood vessels that cause bleeding.
Cataracts: People with diabetes are 60 percent more likely to develop cataracts than people who do not have diabetes. A cataract is a clouding of the eye’s natural lens which blurs vision. If cataracts interfere with a person’s ability to perform necessary daily tasks such as driving or reading, cataract surgery may be necessary. During cataract surgery, Dr. Patel breaks up the eye’s lens, removes it and replaces it with an intraocular lens that remains permanently in place. To learn more about cataract surgery, please visit our cataract page.
Glaucoma: Glaucoma is the result of an increase in intraocular pressure, and it is more common in diabetics than in non-diabetics. In fact, people with diabetes are 40 percent more likely to develop glaucoma than people without diabetes. Glaucoma occurs when the pressure of the eye’s natural fluid builds up without filtering normally through the eye. This damages the optic nerve, which carries signals from the eye to the brain, causing vision loss in many cases. There are several ways to treat glaucoma, all of which aim to lower the pressure on the optic nerve and open up the proper channels for the aqueous humor to flow through. Treatment may include a surgical procedure or the use of certain medications.
Prevention
The best treatment of diabetic retinopathy is prevention of retinopathy. Strict blood glucose control will substantially reduce the risk of vision loss due to diabetes. Regular dilated eye exams are critical for people with diabetes. With better diagnostic testing and treatments, a smaller number of diabetics have serious vision problems. During an eye exam, Dr. Patel dilates the eyes and checks for signs of eye disease. She may also order photographs of the retina or order an optical coherence tomography test (OCT) which creates a three-dimensional view of your retina. If she finds anything of concern, she will begin treatment quickly.
