Diabetic Eye Exams and Retinopathy Treatment

Diabetic retinopathy occurs when diabetes damages the small blood vessels inside the retina. It is the leading cause of blindness among working-age adults and one of the most common complications of diabetes.

There are four distinct stages of diabetic retinopathy. They are:

• Mild nonproliferative retinopathy – microaneurysms develop in the tiny blood vessels of the retina
• Moderate nonproliferative retinopathy – blood vessels to the retina become blocked
• Severe nonproliferative retinopathy – the blood supply to the retina is blocked
• Proliferative retinopathy – New blood vessels, to replace the blocked blood vessels, grow alongside the retina

During any stage of diabetic retinopathy a condition known as macular edema can develop. Macular edema is the buildup of fluid in the macula, the light-sensitive part of the retina that allows us to see objects with great detail. As the macula swells vision becomes blurred. About half of the people with proliferative retinopathy are diagnosed with macular edema.

Early stages of diabetic retinopathy usually do not show symptoms. Treatment is not always required. Patients need to monitor their blood sugar level to prevent the disease from progressing. If the disease does progress, prompt treatment will be necessary to preserve your vision.

Patients who develop diabetic retinopathy may not notice any changes to their vision at first. In its earliest stages, this condition causes tiny areas of swelling in the small blood vessels of the retina.

Symptoms of diabetic retinopathy may include the following:

• Vision that may be blurry or doubled
• Flashing lights
• Blank spots
• Dark floaters or spots in the vision
• Pain or pressure in either or both eyes
• Problems with peripheral vision
• Severe vision loss or blindness

After a thorough medical examination of the eyes, some of the following diagnostic tests will be conducted to confirm diagnosis:

• Visual acuity test
• Dilated eye examination
• Tonometry test
• Retinal exam
• Fluorescein angiogram

Other than controlling blood pressure, blood cholesterol and the levels of blood sugar, treatment is not needed during the first three stages of diabetic retinopathy. The fourth stage, proliferative retinopathy is treated with a laser surgery procedure known as scatter laser treatment. During the procedure the abnormal blood vessels are ablated causing them to shrink. This procedure works best once the blood vessels begin to bleed. Severe blood vessel bleeding may need to surgically corrected with a vitrectomy procedure to remove the blood from the eye.

Treatment of retinal swelling from diabetes can sometimes necessitate injections of anti-Vascular Endothelial Growth Factor (anti-VEGF) medications into the vitreous of the eye.

Patients with diabetes need to have an annual comprehensive dilated eye exam. The length of time a patient has diabetes will determine the likelihood of developing diabetic retinopathy. Over 40 percent of patients in the United States, diagnosed with diabetes, have a form of diabetic retinopathy.

The risks of developing diabetic eye disease can be minimized by:

• Monitoring changes in vision
• Keeping A1C levels under 7%
• Monitoring and managing blood pressure levels
• Eating a healthy diet
• Participating in a regular exercise routine
• Monitoring and managing cholesterol levels