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DIABETES

RETINAL CONDITIONS & DIABETES

How does Diabetes affect my eyes?

Diabetes affects several structures in the eye, including the retina, macula, lens, the optic nerve and have the potential to cause severe vision loss and blindness

Retinal Conditions related to Diabetes

Diabetic retinopathy are findings affects blood vessels in the light-sensitive tissue called the retina that covers the back of the eye. It is the most common cause of vision disturbance and blindness among working-age adults.

Diabetic macular edema (DME) is a consequence of diabetic retinopathy, in which the macula, the area responsible for your central vision, is swollen.

Cataract is a clouding of the eye’s lens. Adults with diabetes are more likely than those without diabetes to develop cataract earlier in life.

Glaucoma is damage to the eye’s optic nerve, the bundle of nerves that connects the eye to the brain. Some types of glaucoma are associated with elevated pressure inside the eye. In adults, diabetes nearly doubles the risk of glaucoma.

WHAT CAUSES DIABETIC RETINOPATHY

Chronically elevated blood sugar levels from diabetes is associated with damage to the tiny blood vessels in the retina. Diabetes can cause blood vessels in the retina to leak fluid or bleed, distorting vision. In its most advanced stage, new abnormal blood vessels form on the surface of the retina, causing scarring and retinal detachments that lead to loss of retinal cells and ultimately vision loss. Diabetic retinopathy may progress through four stages:

FOUR MAIN STAGES OF DIABETIC RETINOPATHY

Mild nonproliferative retinopathy

Mild nonproliferative retinopathy which are early changes in the course of the disease and consists of small areas of balloon-like swelling in the retina's tiny blood vessels that can cause swelling within the retinal tissue.

Moderate nonproliferative retinopathy

Moderate nonproliferative retinopathy occurs in the middle of the course of the disease. During this stage, blood vessels may rupture, leading to bleeding and increased swelling of the retinal tissue. They may also lose their ability to transport blood.

Severe nonproliferative retinopathy

Severe nonproliferative retinopathy occurs in the later stages of diabetic damage. Many blood vessels are blocked, leading to a reduced blood supply to areas of the retina. These low blood flow areas create growth factors that send the body a SOS signal to the retina to grow new blood vessels, which unfortunately cause more damage.

Proliferative diabetic retinopathy

Proliferative diabetic retinopathy (end-stage disease). At this end-stage level of the disease, growth factors released by the retina trigger the growth of new blood vessels, which form along the inside surface of the retina and into the vitreous gel, the fluid that fills the eye. The new blood vessels are fragile, which makes them more likely to leak and bleed. Accompanying scar tissue can contract and cause retinal detachment—the pulling away of the retina from underlying tissue, like wallpaper peeling away from a wall which can lead to permanent vision loss.

SYMPTOMS & DETECTION

Symptoms of diabetic retinopathy and DME?

The early stages of diabetic retinopathy usually have no symptoms. The disease often progresses unnoticed until it affects vision. Bleeding from abnormal retinal blood vessels can cause the appearance of “floating” spots which sometimes clear on their own. But without prompt treatment, bleeding often recurs, increasing the risk of permanent vision loss. If diabetic macular edema (swelling) occurs, it can cause blurred vision.

TREATMENTS & PREVENTION

Injection Treatment for Diabetic Retinal Swelling

Injection Treatment for Diabetic Retinal Swelling (Spanish)

How DME is treated?

Corticosteroid Injection

Corticosteroids, either injected or implanted into the eye, may be used alone or in combination with other drugs or laser surgery to treat DME. Corticosteroid use in the eye increases the risk of cataract and glaucoma. DME patients who use corticosteroids should be followed for increased pressure in the eye and possible glaucoma.

Anti-VEGF Injection Therapy

These medications are injected into the vitreous gel to block vascular endothelial growth factor (VEGF), which can stimulate abnormal blood vessels to grow and leak fluid. Blocking VEGF can reverse abnormal blood vessel growth and decrease fluid in the retina. Most people require monthly anti-VEGF injections for the first six months on average. Thereafter, injections are needed less often.

Laser Treatment for Diabetic Retinal Swelling

Laser Treatment for Diabetic Retinal Swelling (Spanish)

Focal/grid macular laser surgery

In focal/grid macular laser surgery, a few to hundreds of small laser burns are made to leaking blood vessels in areas of edema around the center of the macula. Laser burns for DME slow the leakage of fluid, reducing swelling in the retina. The procedure is usually completed in one session, but some people may need more than one treatment. Focal/grid laser is sometimes applied before anti-VEGF injections, sometimes on the same day or after an anti- VEGF injection.

Laser Treatment for Diabetic Eye Disease

Laser Treatment for Diabetic Eye Disease (Spanish)

How is proliferative diabetic retinopathy (PDR) treated?

Proliferative diabetic retinopathy can be treated with scatter laser surgery, called panretinal photocoagulation or PRP. Treatment involves making 1,000 to 2,000 tiny laser burns in areas of the retina away from the macula where circulation is poor. These laser burns are intended to cause abnormal blood vessels to shrink. Although treatment may be completed in one session, two or more sessions are sometimes required. While it can preserve central vision, scatter laser surgery may cause some loss of side (peripheral), color, and night vision. Scatter laser surgery works best before new, fragile blood vessels have started to bleed. Recent studies have shown that anti-VEGF treatment is also effective for slowing progression of diabetic retinopathy, including PDR.

Vitrectomy for Diabetic Eye Disease

Vitrectomy for Diabetic Eye Disease (Spanish)

Vitrectomy

A vitrectomy is the surgical removal of the vitreous gel in the center of the eye. The procedure is used to treat severe bleeding into the vitreous, and is performed under local or general anesthesia.
Vitrectomy may be performed as an outpatient procedure or, in rare instances, as an inpatient procedure. After treatment, the eye may be covered with a patch for days to weeks and may be red and sore. Drops may be applied to the eye to reduce inflammation and the risk of infection. If both eyes require vitrectomy, the second eye usually will be treated after the first eye has recovered.