DIABETES
As you may know, diabetes mellitus alters the way
your body stores and uses dietary sugar. High blood
sugar levels can arise from an inadequate amount
of insulin (diabetes mellitus type 1) or an insensitivity
of the insulin receptors (diabetes mellitus type
2). In either case, these elevated blood sugar levels
can cause damage to the small blood vessels throughout
your body, including those found in the eye. Damage
to those found in the retina is referred to as diabetic
retinopathy, the most common type of diabetic eye
disease.
DIABETIC RETINOPATHY
Diabetic retinopathy is a leading cause of blindness
in American adults. It can arise in anyone with diabetes
mellitus (type 1 or type 2) but seems to be related
to the length of time one has diabetes and the control
of blood sugar levels. It occurs in two forms: non-proliferative
and proliferative. The non-proliferative, or background ,
retinopathy is an early stage in which damaged blood
vessels can leak blood or fluid into the retina.
This fluid can accumulate leading to swelling and
deposition of exudate in the retina. If the swelling
is central, located at the center of vision-a place
called the macula, a symptomatic blurring of vision
may occur. The more severe type, proliferative diabetic
retinopathy, begins after prolonged oxygen starvation
of the retina. The damaged blood vessels can no longer
carry oxygen and nutrients to the retina, so the
retina forms new blood vessels. These new vessels
are weak and friable (easily broken) and can lead
to devastating eye damage. The vessels may break
and leak blood throughout the eye, they may form
scar tissue in the retina, and they can even result
in retinal detachment. Fortunately, with the advances
in technology early detection can prevent many of
the severe complications of diabetic retinopathy.
SYMPTOMS OF DIABETIC EYE DISEASE
There are often no symptoms of diabetic retinopathy
until significant damage to the retinal blood vessels
has taken place. Symptoms at that time include blurred
vision, loss of vision, new "spots" or floaters (different
from the typical floaters we all get), or shadows.
There is no pain or change in the outward appearance
of the eye. Because of this lack of symptoms early
in the disease, early detection requires an annual
visit to your ophthalmologist.
EARLY DETECTION
It is important to have your eyes examined by an
ophthalmologist at the time of diagnosis of diabetes
and once a year, every year, after that. The ophthalmologist
will dilate your pupils and examine your eyes carefully
for any signs of retinopathy. The earliest stages
of diabetic retinopathy do not usually need treatment
and can respond well to strict blood sugar control.
However, if more significant damage is noted, your
ophthalmologist may suggest treatment.
TREATMENT OF DIABETIC EYE DISEASE
Generally, treatment of diabetic retinopathy means
laser surgery. A strong beam of light is aimed onto
the retina to shrink the abnormal vessels or to seal
the leaking normal blood vessels. Laser surgery has
been shown to reduce the risk of severe vision loss
from diabetic retinopathy by over 60 percent but it
usually cannot restore vision that has been lost. That
is why detection of diabetic retinopathy early is the
best way to prevent vision loss.
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