Diabetic Eye Care

Diabetes is a disease in which the body is unable to produce or properly use insulin. As a result, blood sugar levels become elevated. The sugar is toxic to cells called pericytes that normally live on the smallest blood vessels called capillaries. When pericytes disappear, the walls of these capillaries are weakened, and can form mico-aneurysms. The presence of these on your retinal exam is typically the first sign of diabetic retinopathy. These weakened walls leak fluid, and if located in the most important portion of your retina, may benefit from laser treatment to reduce the swelling. As retinopathy progresses, rupture of the aneurysms followed by scarring and ischemia of those tissues, leads to blood vessel growth and scarring. The presence of abnormal blood vessels is called proliferative diabetic retinopathy. These abnormal vessels can bleed and scar, and eventually to retinal detachment. Treatment at this stage is achieved with injections of anti-neovasular and inflammatory medications, as well as with laser treatment called pan retinal photocoagulation. With this laser treatment, large areas of peripheral and non-essential retina is destroyed, and in doing so, the total production of growth factor by ischemic retina is reduced, and the abnormal vessels can regress. Diabetic retinopathy is now the leading cause of blindness in America, but with timely detection of leakage or blood vessel proliferation, treatment can save vision.

Poorly controlled diabetics also develop cataracts much earlier and are at risk of developing a severe and blinding glaucoma due to abnormal blood vessels growing across the iris and drainage tissues. They may also develop damage to the retina. Unfortunately, damage to this area of the eye may not be reversible. Due to the loss of cells lining the small capillaries in the retina, these vessels become weak and leak blood or fluid. As a result, the retinal tissue does not receive proper nutrition and is subsequently damaged. Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina change. Sometimes these vessels swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.

Diabetic Eye Care

Symptoms

There are often no symptoms in the early stages of diabetic retinopathy and your vision may not be affected until the disease worsens. When the symptoms finally due arise, you may experience:

  • Blurred vision that lasts more than a few days
  • Shadows or missing areas of vision
  • Blurred vision that is not associated with a change in blood sugar
  • Floaters

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Diagnosing Diabetic Retinopathy

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Diabetic retinopathy is best diagnosed with a dilated eye exam. For this exam, eye drops are placed in your eyes that make your pupils open widely for several hours. This allows Dr. Chen to get a better view inside your eye. The drops may cause your close vision to be blurry until they wear off.

During the exam, your he will look for:

  • Test your vision
  • Presence or absence of a cataract
  • Abnormal blood vessels
  • Swelling, blood or fatty deposits in the retina
  • Growth of new blood vessels and scar tissue
  • Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous)
  • Retinal detachment

Optical Coherence tomography

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To determine if macular edema is present, Dr. Chen may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. This device measures and images the thickness of the retina so we may detect macular changes as early in the disease process as possible. Later, OCT exams can be used to monitor how treatment is working.

Treatment

The most effective way to prevent diabetic retinopathy is to keep a tight control of your blood sugar (glucose), blood pressure and cholesterol levels. An effective partnership between you, your primary care physician and Dr. Chen as your ophthalmologist, is critical to ensure that you receive the appropriate eye care and treatment.

Treatment for diabetics involves careful annual dilated ocular examination of the eye and retina. If retinopathy is noted, treatment is based upon the stage of the retinopathy.

Specializing in Cataracts and Eyelid Surgery