Diabetes can affect different parts of the body, including the eyes. After a number of years, the blood vessels of the retina, which are in the back part of the eye, can become damaged, causing fluid to leak into the macula (also called macular edema), the development of abnormal blood vessels (called neovascularization), bleeding (referred to as a vitreous hemorrhage), and in more severe case, a retinal detachment.
Vision Loss Can Be Prevented
While diabetic retinopathy is one of the leading causes of vision impairment in the world, it can be prevented– through control of diabetes, and regular, careful examinations of the retina. In many cases, if detected early and treated appropriately, vision loss from diabetes can be prevented, and vision loss corrected.
Studies have shown that if a person’s hemoglobin A1C (the blood test that most diabetic patients obtain every four months) remains at or below 7%, then the risk of progressive vision loss from diabetic retinopathy is very low. But even if diabetic retinopathy does occur, many patients can just be carefully observed. In cases where there are sight-threatening changes, however, a number of diagnostic and therapeutic options are available.
Diagnosis of Diabetic Retinopathy
Frequently, especially on the initial visit, a patient may benefit from a fluoroscein angiogram– this is a simple test in the office where a patient receives a small amount of a vegetable-based dye in their vein, and photographs are taken of the retina; this allows your retina specialist to identify many things, including the presence of any significant leakage of fluid (macular edema), development of new blood vessels (neovascularization) or permanent damage of blood flow to the retina (referred to as ischemia).
Another test that is frequently done is an OCT (optical coherence tomography), where a quick scan is taken of the back eye, and gives a very useful indication of the direction of a patient’s retinopathy.
Treatment of Diabetic Retinopathy
If treatment is necessary, a host of options are available, and can be targeted to a patient’s level of retinopathy. Treatments today can involve office-based laser, injection of various medications in the eye, and sometimes retina surgery.
Laser treatment of the retina can be used to treat macular edema, and/or neovascularization; this treatment is usually done with just anesthetic eye drops, and takes a few minutes, with no down-time afterwards.
Injections of the eye are also done in the office, and there are many different choices of medications that can be used; regardless of the drug, injections are administered in the office, usually with just topical anesthetic, or sometimes a small injection of anesthetic just over the white part of the eye.
After an injection, the eye may be a little red for a few days, and the patient may have a little burning sensation for a few hours, which is usually very mild and goes away with just some lubricating drops; antibiotics are usually not necessary, and there are very few, if any, restrictions after the treatment.
If there is significant blood in the eye, known as a vitreous hemorrhage, a patient may benefit from surgery, also known as a vitrectomy; this procedure is usually done in an outpatient setting using light sedation, and some anesthetic around the eye; patients typically go home the same day after surgery with a patch over their eye, which is removed the next day in the office.
Your retina specialist should review with you your extent of diabetic retinopathy, and the various treatment options that are indicated.
Nader Moinfar, M.D., M.P.H., F.A.C.S.
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