Diabetes is one of the most common chronic health conditions in the United States with an estimated 100 million adults currently living with diabetes or pre-diabetes. This metabolic disorder occurs when the body is no longer able to regulate its own blood sugar levels and requires intervention to keep them stable. Diabetes can have serious consequences for our health and our vision. This is because patients who are diabetic can go on to develop a complication that is known as diabetic retinopathy, which can cause permanent vision loss without prompt treatment. It is for this reason that patients who suffer from diabetes need to have regular diabetic eye exams.
Diabetic Retinopathy damages the retina which is found in the back of the eye. The retina has special cells that collect and send light messages through the optic nerve to be processed in the brain which then tell us what we see and how clearly we see it. The retina is nourished by a continuous supply of blood, which is delivered using a network of tiny blood vessels. Over time, having continuously high blood sugar levels, can damage these blood vessels causing blood and other fluids to leak onto the retina. If this happens, scarring may occur which could cause vision loss. Depending on the stage of your diabetes, you may need to be checked 2-3x / year. Often changes in the eye will tell us if your diabetic treatment plan from your physician is effectively controlling your diabetes. It has been shown that damage from diabetes occurs when there are large fluctuations in blood sugar levels. That is why it is recommended to eat smaller meals more often. Diabetic retinopathy (DR) is either non-proliferative or proliferative. Non-proliferative is then subdivided by stages 1 through 4. Stage 1 non-proliferative DR, is characterized with scattered hemorrhages in only parts of the retina, while Stage 4 has bleeding throughout the entire retina. Proliferative diabetic retinopathy is the most severe and patients are at higher risk of permanently losing vision. Diabetic Retinopathy occurs from the body’s response to poor nutrition by growing new, small bloodvessels. This is called neovascularization. These vessels themselves are weak, leaky, and can grow into unwanted areas of the eye causing vision loss from scarring or a retinal detachment. This can all go undetected to the patient as there are no symptoms. Results of an eye exam can alert the patient and their diabetes doctor that they need to maintain better blood sugar control. If during an exam, it is found that the diabetic retinopathy is progressing, proper referral to a retinal specialist is warranted for treatment either by eye injections or laser to prevent further progression. It’s imperative to take wide field retinal scans (Optos) and OCT at least annually to be able to accurately assess any progression from previous visits.
Technically, anyone who suffers from diabetes, whether it be Type 1 or Type 2, could be at risk of developing diabetic retinopathy. However, the condition is more likely in certain situations. These include if:
Minimum yearly eye exams
Optos Wide field imaging and/or dilation
Optical Coherence Tomography (OCT)
Optomap is a simple, non-invasive procedure. In less than ½ second it generates a panoramic, 200 degree, high-resolution, digital, color image of the retina. This image becomes a permanent part of the medical record and enables us to see more of the retina, measure specific aspects of the eye, and magnify some of the finer details, such as very small hemorrhages that can occur in Diabetes that could go undetected with older conventional methods. Most importantly, we can track changes in the eye over time by comparing each year’s optomap. In addition, patients become more involved in their own eye care as we review the images together and discuss the best ways to preserve their vision. An optomap should be performed annually regardless of symptoms, so that we can observe for changes and look for subtle signs of disease progression. Early detection in diabetes and other retinal disease is the most important factor to maintaining good eye health.
This Breakthrough technology provides a non-invasive assessment of structures BENEATHthe surface of the retina allowing a much earlier detection of macualr changes associated with Diabetes and Macular Degeneration. Because the cirrus 6000 OCT takes over 100,000 scans pre second, it provides valuable information regarding the slightest progression of diabetic retinopathy not detected by other tests. Early referral and treatment are essential for preserving vision. Diabetic Macular Edema can now be treated with injections of anti-VEGF agents such as Lucentis. More aggressive treatment is done with a laser.
Healthy Macular OCT Scan
Diabetic Macular Edema
Diabetic retinopathy can be treated before vision loss occurs. Often today, the first line of treatment is injections of an anti-blood vessel growth agent. These eye injections of Avastin, Lucentis, or Eyelea are done under local anesthetic and need to be performed initially on a monthly basis by a retinal specialist. These medications actually target and shrink the bleeding blood vessels. If there is any sensation or discomfort, most are due to anxiety. Some people feel little pressure and experience blurred vision after the injections. Additionally, laser treatment is also successful in slowing the progress of the disease in cases where the injections would no longer be effective. A beam of laser light is directed into the eye to seal the source of leakage and repair the damaged area. While it can improve vision, it cannot reverse scarring of the retina. Extensive laser treatment can constrict one's peripheral vision, and cause difficulty with nighttime vision. Performed as an outpatient basis, most patients are able to resume normal activities shortly afterward. Not all stages of retinopathy require injections or laser surgery. At every stage, however, testing should include measures to ensure that the blood vessels are not leaking blood into the retina. Diabetics are encouraged to have a dilated retinal exam, and/or digital retinal photography at least once a year. We provide both Optos and OCT technologies to ensure the earliest detection of disease and / or progression. Having both these instruments minimizes the need for dilation in many cases.
Retina after extensive laser treatment
Many times, one of the first signs of diabetes is vision fluctuation. You'll get a new pair of glasses, and they only seem to work for a short while, or they don't work at all when you pick them up. If you find that your vision changes suddenly and you are feeling excessively tired, very thirsty, or urinating frequently, this could be an early indicator that you may be diabetic.
Early detection and treatment are the keys to preventing loss of vision. The stability of your sugar levels is most critical in preventing diabetic changes. We recommend small frequent meals at roughly the same time each day. We have seen patients who have had diabetes for 25 years with no eye complications. Conversely, we have seen patients who have had diabetes for 5 years who have significant diabetic eye disease. Most diabetics will develop some form of diabetic retinopathy. That is why constant evaluation is so critical. In the early stages, diabetic retinopathy is unnoticeable. You won't experience pain or blurring or even be aware you have a problem. It's important for your eyes to be examined so that any diabetic changes that need attention can be properly documented by either an Optos, a retinal photo, and scanned with the OCT. Early detection is essential for successful treatment.
Most people don't realize that High Blood Pressure will also show up in your eye and can have a devastating effect on vision. That is why at Skowron Eyecare we routinely take blood pressure as part of the comprehensive Eye Health Examination. Often, an eye doctor is the only healthcare provider a patient sees. The eye can indicate damage to other organs in the body. That's why hypertension is called the "silent killer". Over the years we have detected many cases of high blood pressure through the eye exam and have successfully consulted with the patients’ primary care physicians in efforts to lower it. Hypertension, if left untreated, can be devastating. It is very hard on the organs of the body, especially the heart, and ultimately leads to stroke. Hypertension, much like diabetes, can be controlled and treated, giving individuals the ability to live a long, full, and enriched life
Early HTN eye changes: Blood flow restriction
Same patient 2 years later. Vision lost in half the eye.