Diabetic Eye Disease
The Moore Eye Institute began with a primary mission to help diabetics keep and treat their vision, and improve their lives. Diabetics have a greater risk of developing retinopathy, an eye disease causing blurry, distorted vision and, in severe cases, blindness. Diabetics also have a higher risk of developing cataracts and glaucoma.
- The Moore Eye Institute has pioneered the way with a “whole person” approach to diabetes care.
- Dr. Ginsburg is one of the few American ophthalmologists who is also a Certified Diabetes Educator
- The American Diabetes Association Executive Director has congratulated Moore for their extensive diabetes education programs.
- The OCT/SLO Moore introduced to Pennsylvania allows for the most precise measurement of the retina when treating diabetic macular edema.
Watch a video on diabetic retinopathy (NP)
What is diabetes?
Diabetes mellitus is a condition that, due to a lack of insulin, prevents the body from coping normally with sugar and other carbohydrates in the diet. Diabetes can start in childhood, but often begins later in life. It can cause complications affecting many different parts of the body, the eye being one of them. There are two different types of diabetes mellitus:
|Type 1 Diabetes||Type2 Diabetes|
How Diabetes May Affect the Eye
Temporary blurring may occur as one of the first symptoms of diabetes, may also occur when diabetes is not well controlled. It is due to a swelling of the lens of the eye and will clear without treatment after the diabetes is controlled.
A cataract is a clouding of the lens of the eye causing the vision to become blurred or dim because light cannot pass to the back of the eye. This is a very common eye condition that develops as people age, but diabetics may develop the condition at an earlier age. The treatment for cataracts involves an operation to remove the cloudy lens, which is replaced by a plastic lens. This helps the eye to again focus properly.
The most serious eye condition associated with diabetes is Diabetic Retinopathy. This involves the retina, and the network of blood vessels lying within. Diabetic retinopathy is usually graded according to the severity. The condition has three main stages.Background Diabetic Retinopathy – Least Severe
- Very common in long-term diabetics
- Vision is normal with no threat to sight
- Blood vessels in the retina are only mildly affected, bulging slightly or lightly leaking
- The macula area of the retina remains unaffected
Maculopathy – Moderate Severity
- The main cause of loss of vision
- The macula area becomes affected and central vision gradually worsens
- Patients find it difficult to recognize people's faces in the distance or see details such as small print
- Peripheral vision remains
Proliferative Diabetic Retinopathy – Most Severe & Rare
- When the retinal blood vessels become blocked, new blood vessels form in the eye that rarely affect vision
- The new blood vessels are weak and grow on the surface of the retina and into the vitreous gel
- These blood vessels may bleed and cause scar tissue to form in the eye which pulls and distorts the retina
- Retinal detachment occurs when the retina is pulled from position
- Visual loss is often sudden and severe
- Without treatment, total loss of vision may occur
- With treatment, sight-threatening diabetic problems can be prevented if caught early; however, laser treatment will not restore vision already lost.
Treatment of Diabetic Retinopathy
If given early enough, laser treatment can manage most sight-threatening conditions. The laser can be focused with extreme precision so that the blood vessels leaking fluid into the retina can be sealed. This treatment does not cause discomfort.
More extensive laser treatment may need to be carried out if the condition is proliferative and requires the removal of the new blood vessels. The treatment is normally carried out in an outpatient clinic. The eye is numbed, and the patient is asked to move their eyes in certain directions throughout the treatment. This treatment may cause some mild discomfort.
Possible Side Effects of Laser Treatments
- The laser for sealing blood vessels laser is very bright, causing a temporary reduction of sight.
- Patients lose a little central vision or small black spots in your vision.
- It is common to lose some peripheral vision, which may affect ability to drive. Patients receiving laser treatment for diabetic retinopathy are required to inform the Motor Vehicle Authority.
- Night and color vision may also be affected.
If the eye condition causes retinal detachment and scar tissue, or if the vitreous becomes cloudy due to recurrent bleeding, a vitrectomy operation may be performed. This procedure is highly specialized and involves the vitreous being removed and replaced with a clear solution.
Reducing the Risk of Vision Loss from Diabetes
Maintaining excellent diabetic control and normal blood pressures are the two main ways to prevent visual loss from diabetes. Your diabetic clinic, GP or hospital can monitor your blood pressure at your regular visits. High blood pressure can also be eased by lifestyle changes and medication.
Annual Eye Exams!
Blindness due to diabetes is preventable, but an early diagnosis is crucial. This can only be detected by a detailed examination of the eye. Therefore, regular, annual eye examinations are extremely important. Do not wait until vision has deteriorated to have an eye exam and eye examinations are free for diabetics. Your family doctor, diabetologist or optometrist can examine your eyes for diabetic retinopathy. If a problem is found you will be referred to a consultant ophthalmologist.
How the eye works - A cross section of the eye
Your eye has a lens and an aperture (opening) at the front known as the pupil, which adjust to bring objects into focus on the retina at the back of the eye. The retina is made up of a delicate tissue that is sensitive to light, rather like the film in a camera. It also contains a fine network of small blood vessels.
At the center of the retina is the macula, which is a small area about the size of a pinhead. This is the most highly specialized part of the retina and is vital because it allows you to see fine detail for activities such as reading and writing and also to recognize colors. The other parts of the retina give you side vision (peripheral vision). Filling the space in front of the retina is a clear jelly-like substance called the vitreous gel.
Coping with Partial Vision Loss
Patients seeking to maximize their remaining vision should ask their doctors about low vision aids. They should also register as partially sighted or blind through an eye specialist. This opens the door to expert help and financial benefits.