Diabetes and Diabetic Eye Disease

1. I was told I may have a retina problem related to my diabetes. What might this mean?
2. What are the treatment options for my diabetic eye disease?
3. What should I expect with treatment of my diabetic eye problem?
4. How long will it take for my vision to improve?

I was told I may have a retina problem related to my diabetes. What might this mean?

Diabetes affects the eye in the same way that it affects other tissues in the body – by causing slowly progressive damage to the tiny blood vessels called capillaries that supply nutrients and oxygen. These changes are often especially pronounced within the retina. Because such changes are so common in diabetic patients, it is recommended that diabetics undergo an examination of the retina annually. If any changes are noted, your doctor may choose to refer you to a retinal specialist such as our clinic for further evaluation. In general, diabetes causes vision loss in two different ways:

1) Diabetic damage causing leakage of fluid from the retinal blood vessels. This fluid accumulates within the retina and causes the retina to swell, a finding called ‘ diabetic macular edema.’ When enough swelling is present, the vision starts to get blurry. This condition can be treated in the office with laser treatment, injection of medications, or often a combination of both. Sometimes treatment will be recommended even if the patient has not yet experienced and visual symptoms, depending on the amount of swelling present and its location.

2) Diabetic damage to the blood vessels causing poor blood flow (‘ischemia’). Poor blood flow to the central retina can cause poor vision directly, but more commonly problems are caused by the body’s response to the lack of oxygen in this setting. Areas of the retina with reduced blood flow produce a signal which promotes the growth of new blood vessels. This is known as proliferative diabetic retinopathy. However, these new blood vessels cause more problems than they solve. They can cause bleeding within the eye, and if left unchecked can develop into scar tissure which causes the retina to detach and can lead to blindness. This condition is also treated in the office with a combination of laser treatment and injections of medication, although in severe cases traditional surgery is often necessary to preserve vision.

What are the treatment options for my diabetic eye disease?

Often times, retinal findings in diabetes are mild enough that no treatment is needed. However, as discussed above, the presence of retinal swelling or new blood vessel growth often requires treatment to prevent permanent vsion loss, at times even if the patient has noticed no problems with their vision. Usually, treatment can be done the same day in the office with laser treatment and/or injection of medication. In severe cases, traditional hospital-based surgery is needed.

The most important aspect of treating this condition is adequate control of the underlying blood glucose with diet, medication, and/or insulin. We will communicate with your primary care physician to ensure that all necessary efforts are being made from a systemic perspective.

What should I expect with treatment of my diabetic eye problem?

During your evaluation at our clinic, diabetic patients often need to undergo photography of the retina to evaluate the extent of the diabetic damage and to guide treatment. A scan of the retina called an OCT is obtained which helps to show the presence of retinal swelling. Additionally, it is often necessary to perform a retinal angiogram, in which an intravenous dye is used to demonstrate areas of poor blood flow, leakage, blood vessel damage and new vessel growth. If laser treatment is needed, it is well tolerated and not typicaly associated with significant discomfort. If an injection of medication is indicated, this is performed applying drops that numb the surface of the eye so that minimal to no discomfort is experienced.

How long will it take for my vision to improve?

Diabetic eye disease is a difficult condition to treat. In doing so, our main goal is often to prevent further vision loss rather than to restore prior vision. The effect of laser treatments can at times take months to have an effect, and so it is important that patients understand this and have patience with the treatment plan. Typically, both laser treatments and medication injections both need to be repeated multiple times over the span of months in order to have the best response, and during this time frequent monitoring may be necessary.