Facts about Diabetec Eye Disease

There are approximately 16 million Americans who have either Type I (juvenile onset) or Type II (adult onset) diabetes. All are at risk of developing sight-threatening eye diseases that are common complications of diabetes. Although early detection and timely treatment can substantially reduce the risk of severe visual loss or blindness from diabetic eye disease, many people at risk are not having their eyes examined regularly to detect these problems before they impair vision.

What is diabetic eye disease?

Diabetic eye disease refers to a group of sight-threatening eye problems that people with diabetes may develop as a complication of the disease. They include:

• Diabetic retinopathy — damages the blood vessels in the retina, the light-sensitive tissue at the back of the eye that translates light into electrical impulses that the brain interprets as vision.
• Cataract — is an opacity of the eye’s crystalline lens that results in blurring of normal vision. People with diabetes are twice as likely to develop a cataract as someone who is not diabetic. These diabetic cataracts tend to develop at an earlier age, around late middle age.
• Glaucoma — This disease occurs when increased fluid pressure in the eye leads to progressive optic nerve damage. People with diabetes are nearly twice as likely to develop glaucoma as other adults.

What is the most common diabetic eye disease?

Diabetic retinopathy: About half of the Nation’s estimated 16 million people with diabetes have at least early signs of diabetic retinopathy. Of this group, about 700,000 have serious retinal disease, with approximately 65,000 Americans progressing each year to proliferative retinopathy, the disease’s most sight-threatening stage. Annually, as many as 25,000 people go blind from the disorder, making it a leading cause of blindness among working-age Americans.

Although anyone with diabetes can develop diabetic retinopathy, research shows two important risk factors: (1) type of diabetes, and (2) duration of disease. People with Type I diabetes are generally more likely to develop diabetic retinopathy than Type II patients. In fact, virtually all people who have had Type I diabetes for 15 years or more have some degree of diabetic retinopathy. Among people with Type II diabetes, duration of disease is also an important risk factor. Insulin-dependent Type II patients who have had diabetes for five to ten years have about a 2 percent incidence of proliferative retinopathy. This rate increases to more than 50 percent in insulin-dependent Type II patients who have had diabetes for more than 20 years.

What causes diabetic retinopathy?

Diabetic retinopathy is a complex disease. Although scientists understand much about the disease’s natural history, they are still unclear about its specific pathological causes. There are three metabolic and hematologic changes involved in the early stages of diabetic retinopathy:

• Hyperglycemia is a chronic increase in normal blood-glucose levels that may gradually alter cell metabolism in the retinal blood vessels.
• Blood platelet abnormalities: Diabetes-related biochemical changes may make circulating blood platelets abnormally sticky.
• Blood vessel narrowing: Hematologic changes may cause the retinal blood vessels to constrict.

These abnormalities may cause certain cells to die inside the retinal blood vessels. This leads to altered blood flow, increased blood vessel permeability, and the growth of certain blood vessel components. As a result, microaneurysms are formed and may bulge from the weak blood vessel walls, and may leak blood onto the central retina, or macula. This causes an early sight impairing swelling of this area called macular edema.

The disease enters its proliferative stage when new blood vessels begin to grow into the retina and optic nerve to increase blood flow to these tissues. These new blood vessels are fragile and often leak blood and protein into the vitreous and retina, further causing visual impairment.

As the disease progresses, the new blood vessels may also grow into the vitreous and cause it to detach gradually from the back of the eye. As the vitreous pulls away, it may detach the retina as well, causing sever visual loss or blindness.

What are the symptoms of diabetic retinopathy?

There are no early symptoms for most people with diabetic retinopathy. There is no pain, no blurred vision, and no ocular inflammation. However, some people in the early and advanced stages of diabetic retinopathy may notice a change in their central and/or color vision. The loss of central vision results from macular edema, which can often be effectively treated.

How is diabetic eye disease detected?

Since diabetic eye disease often has no early symptoms, it is detected during a comprehensive eye examination through dilated pupils. Dilation consists of Dr. Kevin Anderson placing medicated eye drops into the eye to enlarge the pupil. By doing so, Dr. Anderson can better examine the back of the eye for early signs of disease, such as microaneurysms, before noticeable vision loss occurs. If Dr. Anderson detects diabetic retinopathy early, he can then monitor the patient’s condition, correspond with your primary physician, document the changes with digital imaging, and determine the best time to treat the problem, should it progress to that point. The National Eye Institute recommends that people with diabetes undergo a comprehensive eye examination through dilated pupils at least once a year.

How is diabetic retinopathy treated?

A laser procedure, called photocoagulation, is now being used successfully to treat proliferative retinopathy. It is performed by aiming a narrow, high-energy beam of light through the pupil and onto the retina. The beam of light is used to make hundreds of small burns over the retinal surface that destroys the growing blood vessels. This laser procedure is also used to treat macular edema. In this procedure, the laser is aimed directly onto the leaking blood vessels in the macula. This beam of light then seals the blood vessels to stop their sight-impairing leakage.

Current treatment guidelines are so successful that even people with proliferative retinopathy have a 90 percent chance of maintaining their vision. Current treatment guidelines call for:

• Regular eye examinations through dilated pupils
• Timely laser procedures
• When needed, vitrectomy, a surgical procedure that clears hemorrhaged blood that can cloud vision from inside the eye.

With the proper yearly maintenance of dilated eye examinations, Dr. Anderson will be able to detect any early signs of diabetic retinopathy, monitor and refer to a retinal diabetic specialist for a laser procedure.

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