Diabetics face unique challenges from the day they’re diagnosed, including closely monitoring blood glucose levels and maintaining healthy diets. Routine screening is essential as some problems can sneak up without symptoms. Most often, an eye doctor diagnoses diabetic retinopathy, or damage to the thin light-sensitive nerve layer inside the eye. And frequently the patient is unaware there is a problem. Therefore, an annual eye exam is crucial for diabetics.
Retinopathy Can Affect Anybody
The retina lines the back two-thirds of the eye and transmits visual images to the brain via the optic nerve. When small vessels supplying blood and nutrition to the retina become weakened due to diabetes, the resulting disease is called retinopathy. (Read more about your remarkable retina at Horizon’s Retina services page.)
Hypertension, vascular diseases, smoking, autoimmune disorders and radiation to the eye or brain are all known to cause types of retinopathy. So, healthy weight and diet, exercise and proper sleep (which helps the body regulate inflammation) play a part in avoiding it.
Diabetic retinopathy comes in proliferative and non-proliferative versions. Which version you have depends on the presence (or absence) of abnormal blood vessels and may include macular edema, or a swelling in the central retina. The proliferative kind creates the greatest risk for serious vision loss. A patient who notices blood blocking their vision has almost always already reached that point.
In the earliest stage, an excess of sugar in the blood can damage the inside of blood vessels. These fragile blood vessels leak and break down, choking off capillaries. Ischemia follows and prevents enough oxygen from reaching parts of the retina. If severe, the eye tries to make new blood vessels, but they’re inherently leaky and pro-inflammatory. Without treatment, you risk macular edema. This condition is a swelling of the macula, which supplies much of our central vision and color sense. Consequently, it may endanger your sight.
Detecting and Treating Diabetic Retinopathy
An eye doctor conducting an exam can often see swelling in the retina and micro-aneurysms where blood vessels have leaked. Moreover, they see small dot-blot hemorrhages or white areas called cotton wool spots, which hint at poor blood flow. When that happens, they ask the patient to consult a primary care doctor about diabetes. In addition, they might also recommend a hemoglobin A1c test to identify the need for blood sugar control.
Treatment of damaged eyes usually starts with injections, which are often painless, of anti-VEGF medicines. These antibodies target Vascular Endothelial Growth Factor, an inflammatory mediator that increases the leakiness of cells and promotes swelling and bleeding in the retina. Steroids can also bring down inflammation and decrease the risk of vision loss.
Your doctor may use a laser called PRP (or pan-retinal photocoagulation) to treat ischemic areas. These are areas that don’t get enough blood flow. Sometimes a surgeon has to do a vitrectomy, removing blood from the eye and/or peeling off membranes that cause unwanted traction on the retina and pull it away from the eye. Finally, a surgeon can remove scar tissue buildup and reattach the retina in the proper place. This procedure flattens it back to a more normal configuration.
A Health Care Partnership
Diabetes is a lifelong disease with a lifelong risk of microvascular damage which may worsen over years. Importantly, patients need to establish a partnership to monitor any changes in the condition. This team should include the patient’s primary care doctor, eye doctor and often other specialists. Controlling blood sugar levels remains the key to better health.
Anti-VEGF medicine has been a game-changer for diabetic retinopathy, even reversing some damage to the retina. Sometimes, improving or maintaining one's vision requires frequent visits and treatments. Surgery is typically reserved for advanced disease but has the ability to stabilize the retina. As always, catching the disease early helps patients achieve better vision.
To schedule a consultation at Horizon Eye Care, call 704-365-0555 Monday – Thursday, 8:00 a.m. to 5:00 p.m. and Friday 8:00 a.m. to 3:00 p.m.