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Diabetic Retinopathy
 
What is diabetic eye disease?
Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness.

Diabetic eye disease may include:
 
 
  • Diabetic retinopathy—damage to the blood vessels in the retina.
  • Cataract—clouding of the eye's lens. Cataracts develop at an earlier age in people with diabetes.
  • Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

What is diabetic retinopathy?
Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.


Causes and Risk Factors

How does diabetic retinopathy cause vision loss?
Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

  1. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.
  1. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.

Who is at risk for diabetic retinopathy?
All people with diabetes--both type 1 and type 2--are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy.


What can I do to protect my vision?
If you have diabetes get a comprehensive dilated eye exam at least once a year and remember:
  • Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
  • Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
  • You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.
  • Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.

If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.

The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery.

Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.


How are diabetic retinopathy and macular edema detected?
Diabetic retinopathy and macular edema are detected during a comprehensive eye exam that includes:

  1. Visual acuity test. This eye chart test measures how well you see at various distances.
  2. Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
  3. Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional checks your retina for early signs of the disease, including:
  • Leaking blood vessels.
  • Retinal swelling (macular edema).
  • Pale, fatty deposits on the retina--signs of leaking blood vessels.
  • Damaged nerve tissue.
  • Any changes to the blood vessels.
If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.
 
 
 
 
 
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