People with diabetes often develop eye problems. Diabetes is a disease that occurs when the pancreas does not secrete enough insulin (the hormone that regulates the level of blood sugar) or the body is unable to process it properly. Diabetes can affect both adults and children.

Diabetics are more likely than others to develop cataracts and glaucoma, but diabetes’ affect on the retina is the main threat to vision. Most patients develop changes in the retina approximately 20 years after diabetes develops. The effect of diabetes on the eye is called diabetic retinopathy.

Diabetic retinopathy is a leading cause of blindness. Diabetes affects the circulatory system of the retina and usually affects both eyes. Diabetic retinopathy occurs when the diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye.

Symptoms of Diabetic Retinopathy.

Symptoms of diabetic retinopathy may include:

• "Spiders," "cobwebs" or tiny specks floating in your vision
• Dark streaks or a red film that blocks vision
• Vision loss or blurred vision (often linked to blood sugar levels)
• A dark or empty spot in the center of your vision
• Poor night vision
• Difficulty adjusting from bright light to dim light
• Sudden loss of vision

Phases of Diabetic Retinopathy

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. 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 (or ischemic). New fragile vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. These delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous, 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 and glaucoma.

Diabetic patients require routine eye examinations so eye problems can be detected and treated as early as possible. The diagnosis of diabetic retinopathy is made following a detailed examination of the retina with an ophthalmoscope. Many patients with diabetic retinopathy are referred to vitreo-retinal surgeons who specialize in treating this disease.

Treatment of Diabetic Retinopathy

The abnormal growth of tiny blood vessels and the associated complication of bleeding is one of the most common problems treated by vitreo-retinal surgeons. Laser surgery is usually the treatment of choice. The surgeon uses a laser to destroy oxygen-deprived retinal tissue outside of the patient’s central vision. While this creates blind spots in the peripheral vision, it 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 or bleeding in the gel-like substance that fills the center of the eye. During a vitrectomy, the retina surgeon carefully removes blood and vitreous from the eye, and replaces it with clear saline solution. At the same time, the surgeon may also gently cut strands of vitreous attached to the retina that create traction and could lead to retinal detachment or tears.

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.

Treatment for diabetic retinopathy varies depending on the stage of the disease and the specific symptoms. The retinal surgeon relies on several tests to monitor the progression of the disease and to make decisions for the appropriate treatment. Diagnostic tests may include fluorescein angiography, retinal photography, and ultrasound imaging of the eye.

Researchers have found that diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diet and exercise play important roles in the overall health of those with diabetes. Diabetics can also greatly reduce eye complications by scheduling routine examinations by an ophthalmologist.

All people with diabetes--both type 1 and type 2--are at risk. Everyone with diabetes should get a comprehensive dilated eye exam at least once a year. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy.
 

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