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Diabetes Care

Diabetes can be a devastating disease! In the case of the eye, diabetes creates four distinct problems, either alone or in combination.

First, in an effort to dilute or concentrate blood glucose, an out of control diabetic sustains fluid shifts. Some of the fluid can get into the lens of the eye and create a cataract by causing bubbles to form in the lens. The bubbles scatter light and result in vision impairment.

Second, the cell that acts like the "Maytag Repairman" for the blood vessels is dysfunctional in diabetes. So blood vessel walls don't get the maintenance they need. Leaks can develop, and much like a leaky hose, a lot of leaks result in little or no flow, and the retina loses its blood supply. The body will attempt to rebuild the blood supply but it often does so in a disorganized way, resulting in blood vessel development in areas where they are not desirable. And these vessels leak even worse than the ones they replaced. Laser treatment can often reverse this but only to a degree. Diabetes control is necessary to keep the repair further damage from occurring and to assure the repair is effective.

Third, high blood sugar causes red blood cells to become sticky. The cells clump, forming "rouleaux", which can be large enough to clog small capillaries. This often leads to diabetic optic neuropathy or damage to the optic nerve (the cable that carries all the information the eye collects to the brain). Unfortunately, this cannot be repaired.

Lastly, when the retinal tissue becomes sick enough, it begins to swell. When this swelling occurs in the central vision area of the retina, vision can be distorted. This condition is called Cystoid Macular Edema. The same anti-VEGF medications used to treat macular degeneration can be used in this case, and often good outcomes can result.

A test performed by your family doctor, the Hemoglobin A1C, is very useful to detect trends in diabetes. We try to work with your family doctor so that we see and can follow the A1C results as this will often give us a head's up about your diabetic ocular disease!

Early symptoms of diabetic retinopathy may include:

  • Decreased night vision.
  • Floaters or obscuring vision.
  • Blurry vision.

The condition can typically be diagnosed by an ophthalmologist during an eye exam, long before noticeable vision symptoms occur and when more treatment options are still available.  Thus it is very important for those suffering from diabetes to have regular eye exams, to monitor for diabetic retinopathy and other complications.

Treatment:

Treatments for diabetic retinopathy vary based upon the nature and progression of the condition.  The best way to preserve good vision is to vigilantly control blood-sugar levels, lessening the chance of retinopathy, and impeding its rate of advancement.

Once the disease is in advanced stages, the ophthalmologist may choose a type of laser surgery, called pan-retinal photocoagulation.  This technique burns many tiny dots across the retina, with the aim of sealing off leaky blood vessels and discouraging further blood vessel growth.  This surgery does not cure diabetic retinopathy, but it can help to save remaining vision.

If the vitreous humor has become clouded by blood leakage, there is a chance it may be naturally purged by the eye.  If clouding persists, however, a vitrectomy, a surgical removal of the vitreous humor, may be necessary.  The ophthalmologist replaces it with a saline solution, and the eye naturally replenishes the vitreous fluid over time.  This procedure can restore vision that has been obscured in the vitreous, however, any vision loss due to retinal damage or detachment is not restored.

If you have diabetes or are experiencing any symptoms of diabetic retinopathy, we encourage you to contact us today to schedule a consultation.

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