Eye disease that is caused by diabetes (diabetic retinopathy) is currently the number one cause of blindness and vision loss. Due to the increased risk in diabetic patients, doctors recommend that people over 30 with diabetes get an ANNUAL eye HEALTH exam. 

Diabetic retinopathy is a condition that causes damage to the retina. Patients that have diabetes often have extended periods of time where their blood sugar is elevated. The high levels of blood sugar damage the retina’s blood vessel walls, which make them susceptible to leaking. When blood or fluids accumulate in the retina and/or macula, it causes vision loss.

If prolonged high blood sugar levels occur, the bleeding and leaking cause the retina to become oxygen-depleted. This causes the abnormal growth of new blood vessels that damage the retina as they grow. This condition is called neovascularization. This blood vessel type is weak and prone to breaking and bleeding.  As these blood vessels proliferate and degenerate, they cause scar tissue to form which can lead to retinal detachment and blindness.
 

Treatment

A healthy diet and exercise regimen is beneficial to your ocular health because if blood sugar remains too high, then diabetic retinopathy can occur. While some of this damage can sometimes resolve once blood sugar is under control, some damage to the retina is irreversible and can cause permanent blindness so it is best to take control of your blood sugar.

It is essential to catch the condition in the earlier stages to reduce the loss of vision. This can also help patients understand the importance of monitoring their blood sugar to prevent diabetic retinopathy. If diabetic retinopathy occurs, treatment options are even more successful when it is caught early. These options include laser pan-retinal photocoagulation, intravitreal steroids, anti-vascular endothelial growth factor (VEGF) treatment and sometimes vitrectomy.

During laser pan-retinal photocoagulation, a surgeon will make small "burns" in the retina around the blood vessels. These small scars create blind spots scattered throughout the retina, leaving healthy areas of the retina in between.  The laser scars reduce the oxygen demand of the retina, slowing the growth of new abnormal blood vessels (neovascularization) that cause more damage to the retina.

Steroids have an anti-inflammatory effect. There are several options for administering steroids, such as intravitreal injection, subtenone injection, and dexamethasone intravitreal implants (DEX).

Anti-VEGF agent injections have shown promising results in slowing the progression of abnormal blood vessel growth (neovascularization).

Vitrectomy is a surgery that removes the vitreous, the fluid/gel in the back of the eye.  When the vitreous becomes clouded with blood that has leaked from the retina it compromises vision.  The vitreous and retina damage can also produce scar tissue that pulls on the retina and needs to be removed. This operation is best performed before the disease has progressed too far. 

Living with Retinopathy

Retinopathy affects every person and even the same pair of eyes differently. A one-size-fits all approach isn’t possible, and it is important to talk Dr. Kubota and your diabetic eye surgeon about which options or treatment plans are right for you.

It’s important to continue to learn about how you can manage diabetes to help keep the progression of diabetic retinopathy at bay. Make sure to use the tools that are available to you. Test your blood glucose often, including two hours after each meal, schedule your regular physician appointments and ANNUAL eye HEALTH exams, and learn to listen to your body. We can often start to detect that something is going wrong when things just don’t feel right.

Managing your diabetes with a complete health plan can lead to an increase in the quality of life and help to stop further vision loss.