Diabetics Need Eye Disease Screening
By BOYD VAZIRI
Diabetic eye disease is often considered a silent stealer of vision because diabetics frequently have no visual symptoms until later stages of the disease.
Patients with diabetes are more likely to develop eye problems such as cataracts (clouding of the lens) and glaucoma (elevated eye pressure and optic nerve damage), but the diseases effect on the retina is the main threat to vision. The effect of diabetes on the eye is called diabetic retinopathy.
Over time, diabetes affects the circulatory system of the retina. The earliest phase of the disease is known as background diabetic retinopathy. In this phase, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages and tiny aneurysms, called microaneurysms. These leaking vessels often lead to swelling or edema in the retina and decreased vision.
The next stage is known as proliferative diabetic retinopathy. In this stage, circulation problems cause areas of the retina to become oxygen-deprived.
New and fragile vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. This is called retinal neovascularization. Unfortunately, these delicate vessels bleed easily.
Blood may leak into the retina and vitreous (the clear jelly in the eye), causing spots or floaters, along with decreased vision. In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment, glaucoma and even blindness.
The effect of diabetic retinopathy on vision varies widely, depending on the stage of the disease. Symptoms include blurred vision (this is often linked to blood-sugar levels or swelling in the retina), floaters and flashes of light, or sudden loss of vision.
The most common scenario, however, is that the retinopathy is asymptomatic and the patient is unaware that damage is occurring to the eye. For this reason, diabetic patients require routine eye examinations so problems can be detected and treated as early as possible.
The diagnosis of diabetic retinopathy is made following a detailed examination of the retina.
Diabetic retinopathy is treated in many ways depending on the stage of the disease and the specific problem that requires attention. The abnormal growth of tiny blood vessels and the associated complication of bleeding is one of the most common problems seen with diabetic eye disease.
Laser surgery, called pan retinal photocoagulation, is usually the treatment of choice for this problem. In this procedure, the surgeon uses laser to destroy oxygen-deprived retinal tissue outside of the patients central vision. The surgery prevents the continued growth of the fragile vessels and seals the leaking ones. The goal of the treatment is to arrest the progression of the disease.
Vitrectomy is another surgery commonly needed for diabetic patients who suffer a vitreous hemorrhage (bleeding in the gel-like substance that fills the center of the eye). During a vitrectomy, the surgeon carefully removes blood and vitreous from the eye, and replaces it with clear salt solution (saline).
Patients with diabetes are at greater risk of developing retinal tears and detachment. Tears are often sealed with laser surgery. Retinal detachment requires surgical treatment to reattach the retina to the back of the eye. The prognosis for visual recovery is dependent on the severity of the detachment.
Diabetics can greatly reduce the possibilities of eye complications by scheduling routine examinations with an ophthalmologist. Many problems can be treated with much greater success when caught early.
The American Academy of Ophthalmology recommends screening for diabetic retinopathy once a year in the absence of diabetic eye disease, and more frequently for those patients with pre-existing diabetic eye disease.
Boyd Vaziri, MD is a practicing ophthalmologist with Digby Eye Associates. For more on this topic, tune in today to Regional Health Talk on WMFR (1230 AM) at 8 a.m. To suggest a column topic, call 878- 6200 or write to info@hprhs.com