Diabetes Medical Clinical Management

Diabetic eye disease refers to a group of eye problems occurring as a complication of the systemic disease Diabetes. All can cause severe vision loss or even blindness. Risk of complications from diabetes increases the longer one has the disease and with poorly controlled sugar levels. Anyone with diabetes is at risk for diabetic eye disease and should have a complete eye exam with dilation every year. Diabetic eye disease may include diabetic retinopathy and glaucoma. Cataracts and glaucoma also affect many people who don’t have diabetes.

What is the most common diabetic eye disease?
Diabetic Retinopathy. This disease is a leading cause of blindness in American adults. Due to increased sugar in the circulation, the blood vessels of the retina swell and leak fluid as seen in the picture on the right. This leads to a swelling of the macular area (the part of the retina that provides sharp, central vision) which leads to vision loss.

Another, more serious complication is neovascularization. The blood vessels in the retina become faulty as a result of the diabetes and do not provide adequate oxygen and nutrients to the surrounding tissues. As a result, new blood vessels begin to grow on the retina. This sounds like an OK adaptation, but these new vessels are not like normal blood vessels. They leak fluid, blood, and lipids, which can greatly disrupt retinal function. This can lead to retinal detachments, more macula edema, and even new blood vessel growth in and around the iris. These complications can lead to severe vision loss and glaucoma.

Who is most likely to get diabetic retinopathy?
Anyone with diabetes is likely to get diabetic retinopathy. The longer one has diabetes, the more likely he or she will get diabetic retinopathy. Nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime. Hence, the importance of a yearly eye exam with Dr. Derryberry.

What are the symptoms of diabetic retinopathy?
Similar to glaucoma, diabetic retinopathy has no symptoms in the early stages. Many people do not bother with eye exams because they feel their vision is fine. This is a big mistake as preventative care is critical, especially in patients who have diabetes, as sight may not change until the disease becomes severe. Once symptoms develop due to swelling in the macula, blurred vision becomes the major complaint. Vision can fluctuate significantly. Symptoms vary greatly, and even in advanced cases of diabetic eye disease, some patients have minimal complaints. However, this does not mean that the disease will not affect sight. Eventually, if uncontrolled, progressive diabetic eye disease will cause severe vision loss. Once again, yearly monitoring and early intervention by Dr. Derryberry is the key.

How is diabetic retinopathy detected?
During an eye exam, our assistants will administer drops that dilate the pupils. This allows Dr. Derryberry a more extensive view of the inside of the eyes, most specifically the retina, to check for signs of diabetic retinopathy. Without dilation, Dr. Derryberry can not completely assess the retina.

Can diabetic retinopathy be treated?
Yes. Dr. Derryberry may suggest laser surgery by a retina specialist in which a strong light beam is aimed onto the retina to shrink and/or seal the abnormal, leaking vessels. This stops the swelling and can control macula edema. Laser surgery reduces the risk of severe vision loss from this type of diabetic retinopathy by 60 percent. However, if vision loss has already become significant, treatment usually only prevents further vision loss and does not restore vision to previous levels. Once again, finding diabetic retinopathy early is the best way to prevent vision loss.

Can diabetic retinopathy be prevented?
Everyone with diabetes will have some degree of diabetic retinopathy, but one’s risk can be greatly reduced by controlling blood sugar levels. Adequate control of glucose slows the onset and progression of retinopathy and lessens the need for laser surgery. Studies show that people who keep their blood sugar levels as close to normal as possible have much less eye, kidney, and nerve disease. See your internist regularly to determine the right sugar level for you based on your age and lifestyle. Once determined, follow your doctor’s recommendations closely to keep blood sugar levels under control.

How common are the other diabetic eye diseases?
Cataracts: Studies show that diabetes patients are twice as likely to get a cataract as a person who does not have the disease. Also, cataracts develop at an earlier age in people with diabetes. Cataracts can usually be treated by surgery.
Glaucoma: Glaucoma may also become a problem. A person with diabetes is nearly twice as likely to get glaucoma as other adults, and as with diabetic retinopathy, the longer one has diabetes, the greater one’s risk of developing glaucoma.Galucoma may be treated with medication or laser. Please refer to our Gaucoma section for more information.

What can one do to protect one’s vision?
Finding and treating diabetic retinopathy early, before it causes vision loss or blindness, is the best way to control diabetic eye disease. So, if you have diabetes, make sure you get an eye examination at least once a year.