Diabetes and the Eye

• Cataracts, a clouding of the lens in the eye
• Glaucoma, damage to the optic nerve, often due to an increase in the pressure inside the eye or improper blood flow to the nerve
• Diabetic retinopathy:

Diabetic retinopathy can affect patients with both Type 1 (juvenile onset) and Type 2 (adult onset) diabetes.  Younger diabetics are usually free of retinopathy for at least five years after onset of the diabetic condition.  Adults may acquire the retinopathy at any time after diagnosis is made.

In short, diabetic retinopathy is a disease of the blood vessels in the delicate tissue called the retina.  The retina acts like film in a camera and does the actual sensing of light within the eye.  With diabetic retinopathy, retinal vessels become incompetent and leak fluid and blood, thus failing to supply the nutrients necessary for good health in the retina.

Basically, retinopathy is divided into two forms:

• Non-proliferative (NPDR) or Background Retinopathy

NPDR consists of hemorrhages, leaky spots and small dilations in the vessel walls.

• Proliferative Retinopathy (PDR).

PDR is all of the above plus new blood vessels.  These new vessels are always abnormal and will leak and bleed if left untreated.  About 40% of all diabetics will develop PDR over a 15-year span.

The most common cause of decreased vision with diabetes is diabetic macular edema, which occurs when fluid buildup from leaky blood vessels causes the macula, or center of the retina, to swell.  This can cause blurry vision and vision loss.  This is often difficult to treat, but with focal applications of LASER light to seal these leaks, vision may be preserved and occasionally improved.  Sometimes, steroid medications may also be injected into the vitreous of the eye to decrease the swelling in the retina. 

PDR poses a very serious threat to vision as well.  Large hemorrhages may obscure vision for months at a time.  When found, these new abnormal vessels should be treated with LASER therapy.  Retinal detachments can also occur because of traction created by these new vessels.

A number of factors can increase your risk for diabetic retinopathy. This list includes poor blood sugar control over time, high blood pressure, levels of cholesterol and triglycerides in the blood stream, and the other previously mentioned complications of diabetes.  Each of these factors must be controlled as best as possible to assist in the treatment of retinopathy.  Regular examinations are critical for early diagnosis and therapy.  We now have more to offer diabetics that ever before.  Most do well, and vision can be preserved in the majority of patients.