AdvantageRx: Diabetes: Your Eyes

Why Your Eyes Require Special Attention

No one knows exactly how diabetes causes damage to the eyes, but there's no doubt about this fact: people with diabetes are at an increased risk of visual impairment, and even blindness. The longer a person has had diabetes, the greater the risk.

Fortunately, we are living in a time when major medical progress makes it possible to prevent, reduce or repair damage to the eyes caused by diabetes. This brochure will tell you about the latest developments in detecting and treating diabetic eye problems. You will also see that, as with all of the complications of diabetes, self-care and regular medical checkups are the cornerstone of prevention, but not a guarantee.

Remember:

Looking at Diabetic Retinopathy
Diabetic retinopathy is the most common eye condition related to diabetes--and the most serious.

It occurs when the retina, a thin, light-sensitive tissue that lines the back of the eye and transmits visual images to the brain via the optic nerve, is damaged by the deterioration of small blood vessels that supply the retina with vital oxygen and nutrients. The extent and nature of diabetic retinopathy varies from person to person.

Background Retinopathy (Non-Proliferative Retinopathy)
Background retinopathy is the earliest stage of the disease, and the mildest form. At this stage, retinal capillaries become clogged and swollen, forming balloon-like sacs that leak fluids into the retina and cause swelling. For the vast majority of people with diabetes (80 percent), retinopathy never progresses beyond the background stage--many won't notice any change at all in their vision.

Macular Edema (Diabetic Maculopathy)
In some cases, however, the leaking fluid from the capillaries will pool in the most sensitive part of the retina--the macula. The macula is in the center of the retina and is responsible both for the fine vision used in reading, and for color vision. People with macular edema may experience any or all of the following:

Proliferative Retinopathy
This is the most advanced form of diabetic retinopathy which can and does cause blindness. In proliferative retinopathy, new blood vessels begin to sprout on the retina or the optic nerve. This is called neovascularization. The new blood vessels are fragile, and hemorrhage easily. The blood which spills from the weakened vessels may prevent light from hitting the retina, abruptly blocking vision. Scar tissue that forms near the retina may tug on the retina, detaching it from its normal position at the back of the eye. When the retina becomes detached, a person experiences severe loss of vision, or even blindness.

In the early stages of retinopathy, there may be no symptoms to indicate its presence. For any person with diabetes, annual eye examinations by an ophthalmologist are absolutely essential. If retinopathy is detected, more frequent checkups may be necessary.

Report Any Changes in Vision to Your Doctor
Although the following symptoms do not necessarily indicate diabetic retinopathy, they should nevertheless be reported promptly to your doctor:

While no single symptom confirms the presence of retinopathy, your doctor is the best one to evaluate its significance.

Treatments for Diabetic Retinopathy
Since the early 1970's, tremendous strides have been made in the treatment of diabetic retinopathy. The most important breakthrough was the discovery that lasers can reduce the risk of visual loss caused by retinopathy.

Laser Photocoagulation
This form of treatment has been proven to reduce the change of severe visual loss by 60 percent in people with retinopathy.

How it Works--Laser photocoagulation is a form of microsurgery in which a powerful laser beam is aimed at many spots in the retina. It seals hemorrhages in the eye that are caused by neovascularization (new blood vessels), and prevents further development of new blood vessels.

When It Is Used--Although laser treatment is usually used to treat proliferative retinopathy, many ophthalmologists now believe that lasers can be used in prevention as well. Treatment is given in the preproliferative retinopathy usually include three sessions per eye.

What is involved--Usually laser treatment is performed in the doctor's office and normally does not require hospitalization. The patient sits in a chair and is given a drop of anesthetic in the eye to be treated. Once the surgeon has identified the exact spots where treatment is needed, he uses a foot pedal to direct the laser beam at the retina. The patient sees a brief flash of light. This process is repeated many times. Treatment usually lasts less than half an hour, and initial treatments for proliferative retionpathy usually include three sessions per eye.

Vitrectomy
Despite the success of laser photocoagulation, some people with diabetic retinopathy suffer vitreous hemorrhages, massive bleeding into the vitreous--the normally clear gel that fills the center of the eye. When the vitreous is clouded by blood and scar tissue, blindness may result. Today, new surgical techniques have made it possible to remove blood and scar tissue from that part of the eye through a process called vitrectomy. This surgery clears up the vitreous and makes the area transparent again so that light can get through to the retina. Vitrectomy is a complex microsurgical procedure requiring general anesthesia and a two hour operation. Following vitrectomy, many patients have improved vision--some even see well enough to read or drive again.

Self-Care--How to Protect Your Eyesight
Retinopathy is a real and serious potential complication to every person who has diabetes. To ensure everything possible is being done to prevent eye damage, follow these guidelines:

Control Blood Sugar Levels
People who have difficulty controlling blood glucose levels are at an increased risk of experiencing eye problems. So test blood sugar frequently, and make sure your diabetes management plan is designed for maximum control.

Another Reason Not to Smoke
Diabetes is particularly damaging to small blood vessels. Smoking, which constricts blood vessels, increases circulatory problems which may make diabetic eye disease more severe.

Beware of High Blood Pressure
High blood pressure also contributes to diabetic eye damage by increasing stress on already fragile blood vessels in the eyes. Be sure to have your blood pressure checked frequently.

Pregnancy and Eye Care
Pregnancy is known to be a factor in the development of diabetic eye complications. Pregnant women with diabetes should therefore pay particular attention to monitoring their vision--and schedule more frequent visits to the ophthalmologist.

Have Your Eyes Checked Each Year
Make sure your doctor or ophthalmologist thoroughly examines your eyes at least once a year. Remember, changes can happen in your eyes without any noticeable symptoms. Early detection makes a big difference in preventing progressive damage.

Cataracts
A common problem for older people is cataracts. Cataracts, the clouding of the lens of the eye, interferes with vision by blocking the passage of light rays to the back of the eye. This occures more often--and at an earlier age--in people with diabetes. In addition, diabetics experience complications from cataract surgery more often than non-diabetic patients.