Diabetic Eye Exams

November is Diabetic Eye Disease Month.  According to the National Institute of Health 40 to 45% of people with diabetes will develop some form of diabetic retinopathy, although nearly half of them will never know it.*  This is why it is so important to have annual dilated eye exams.  Dilation causes the pupil to enlarge and not constrict when a light is shone in.  This allows the doctor to get a better look at the entire retina, including the optic nerve, macula, and blood vessels which supply nutrients to the retina.  There are two major types of diabetic eye disease: diabetic retinopathy and diabetic macular edema.

Healthy Retinal Image
Healthy Retinal Image

Diabetic Retinopathy
Diabetic Retinopathy  happens when the blood vessels in the retina leak fluid or hemorrhage and in severe cases cause new blood vessel growth.
There are two groups of diabetic retinopathy.  The first one is non-proliferative.  There are three stages from mild to severe.  With non-proliferative diabetic retinopathy (NPDR) there are no new blood vessels growing but the retina can show micro aneurysms or small bleeds within the eye. Sometime NPDR can cause changes in the blood vessels within the macula causing macular edema (read about this below).
The second form of retinopathy is called proliferative diabetic retinopathy (PDR).  This is when new blood vessel growth occurs within the retina.  These fine blood vessels can easily rupture causing hemorrhages within the retina or into the vitreous of the eye. Dangers of PRD include, but are not limited to, retinal detachments and neovascular glaucoma.
Diabetic Macular Edema
Diabetic Macular Edema (DME) occurs when the fluid from inside blood vessels builds up in the macular part of the retina. This is the part of our eye responsible for most of our vision. DME is most likely to occur as diabetic retinopathy progresses but can happen at any stage of the disease.
Treatment
Depending on the diagnosis different treatments are available.  Traditionally PDR has been treated with a type of laser called panretinal photocoagulation (PRP).  The laser burns the blood vessels, in turn causing them to shrink. The side effects of PRP include loss of side, color, and night vision.

Retina treated with PRP
Retina treated with PRP

Newer methods of treatment include injections of anti-VEGF agents. This works by blocking vascular endothelial growth factor (VEGF) and can reverse the blood vessel growth and decrease fluid within the retina.
What You Can Do
1. Work with your primary care doctor to manage your blood sugar levels
2. Schedule annual diabetic dilated eye exam
3. Follow recommendations provided by your healthcare providers

* https://nei.nih.gov/health/diabetic/retinopathy

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