Diabetic Retinopathy (Eye Damage)
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For anyone with either type 1 or type 2 diabetes, eye care is an important priority. By keeping your blood glucose level close to normal, you can lower your risk for some of the long-term effects of diabetes and preserve your eyesight. An eye specialist monitors changes in your eyes, especially those changes associated with diabetes. He or she then determines what those changes mean and how they should be treated. For example, changes in the tiny blood vessels that supply your retina—the part of the eye that detects light and thus visual images—could be an early sign of diabetic retinopathy. Left untreated, diabetic retinopathy can lead to blindness.
Although your diabetes care provider will look at your eyes during the course of your yearly physical examination, you also need to have them more thoroughly examined by a trained eye specialist. Your eyes need to be dilated for this exam. If you are 10 years of age or older and have type 1 diabetes, you should have a comprehensive examination 3 to 5 years after you are diagnosed with diabetes and yearly thereafter. If you are an adult with type 2 diabetes, you should have a comprehensive eye and visual exam conducted by an eye doctor when you are diagnosed and every year thereafter—even if your vision is fine. Also, if you notice any changes in your vision or you are planning a pregnancy, you should be examined.
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There are steps you can take to avoid eye problems if you have diabetes:
- First and most important, keep your blood sugar levels under tight control. In the Diabetes Control and Complications Trial, people on standard diabetes treatment got retinopathy four times as often as people who kept their blood sugar levels close to normal. In people who already had retinopathy, the condition progressed in the tight-control group only half as often. These impressive results show that you have a lot of control over what happens to your eyes. Also, high blood sugar levels may make your vision temporarily blurry.
- Second, bring high blood pressure under control. High blood pressure can make eye problems worse.
- Third, quit smoking.
- Fourth, see your eye care professional at least once a year for a dilated eye exam. Having your regular doctor look at your eyes is not enough. Nor is having your eyeglass prescription tested by an optician. Only optometrists and ophthalmologists can detect the signs of retinopathy. Only ophthalmologists can treat retinopathy.
- Fifth, see your eye care professional if:
- Your vision becomes blurry
- You have trouble reading signs or books
- You see double
- One or both of your eyes hurt
- Your eyes get red and stay that way
- You feel pressure in your eye
- You see spots or floaters
- Straight lines do not look straight
- You can't see things at the side as you used to
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Photocoagulation is a treatment for diabetic retinopathy (diabetic eye disease). A strong beam of light (laser) is used to seal off bleeding blood vessels in the eye and to burn away extra blood vessels that should not have grown there.
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The best way to diagnose diabetic retinopathy in the eye is through a full dilated eye examination by an ophthalmologist. Watch this video to learn more from Dr. Manvi Maker about how diabetic retinopathy is diagnosed.
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The eye examination consists of multiple parts, many of which are quantifiable. When vision is tested, it is useful for documenting eye health status and any changes. Vision is usually tested,one eye at a time, for distance and for near. Often it is done without glasses (prescription) and then repeated with glasses. If a patient doesn't have glasses or has reduced vision, a pin?hole device can be used as an estimate of the best potential visual acuity. The next step in an eye exam is utilizing lenses in order to establish best?corrected visual acuity. For instance, you cannot really decide how bad a cataract is without knowing the individual best correction.
The external eye exam consists of the evaluating pupil reactions, eye muscle movements, lids, and color of the iris. The next part of the exam employs a microscopic instrument called slit lamp. By varying the size beam and the magnification, the eye doctor can stereoscopically view the insides of the eye and diagnose almost all ocular conditions. This is why individuals need to see an ophthalmologist or optometrist in order to diagnose any serious eye problem. The intraocular pressure is measured at this time; this is an important test as part of the evaluation of glaucoma. Primary care doctors and emergency room physicians are usually able to recognize and treat pink eye and other common eye conditions but are unable to get a good look inside the eye without more testing.
Usually the final part of the eye exam is an evaluation of the retina with either a hand held or head mounted light and lenses. Many systemic conditions, such as diabetes or hypertension, which can affect the eye can be identified through a slit lamp and retina exam. There are other tests that are useful to measure and manage eye disease such as the following: visual fields,color vision, prism measurements of eye deviations, tear tests for dry eyes, and checker board grids for macular degeneration.
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Diabetic retinopathy can appear in three forms, macular edema, background retinopathy (BDR), and proliferative diabetic retinopathy (PDR). Macular edema is swelling in the center of the retina without involvement of the periphery. BDR is leakage of blood vessels around the macula and the optic nerve in an irregular scattered fashion. It tends to be slow but may be a forerunner of either macular edema or proliferative changes.
PDR is characterized by sprout of new blood vessels growing from the surface of the retina or optic nerve directly into the fluid vitreous cavity. This new blood vessel formation is called neovascularization and can also grow from areas in the peripheral retina. The consequences are the same; the blood vessels grow along with scar tissue, which may contract and pull off the retina (retinal detachment). Therefore PDR is the most serious diabetic complication in the eye.
PDR is associated with:
- Increased severity of disease
- Increased duration of disease
- Elevated HbA1c
- Protein in the urine
- Men
- Increased diastolic blood pressure (the lower number)
- Family history
Blurred vision may not be recognized immediately but if the fragile new blood vessels bleed, blurred vision is sudden. And if the retina becomes torn and pulled off, a curtain comes down across the vision. Therefore, annual dilated eye exams are imperative for diabetics so that complications such as BDR and PDR can be detected early. The standard treatment for PDR without bleeding is pan retinal photocoagulation (PRP) laser. The basis for making a concentric series of small laser burns all around the periphery of the retina is to kill off enough cells to extinguish the low oxygen supply to them. By removing the low oxygen stimulus surprisingly these new blood vessels disappear and even background changes may fade. The laser light is absorbed by either the pigment under the retina or the blood cells in the blood vessels enabling the focal scar to occur. The peripheral location of the scars does not affect central vision but does reduce the peripheral visual field and night vision (adaptation to the dark). Given the choice of progressive deterioration in vision and destruction of the retina, PRP has much more benefit than risk. The treatments may be done in one or several sessions and are approximately 55% immediately successful. In many instances, the success rate is much higher when performed by
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Diabetes can result in retinopathy or changes in the blood vessels of the retina, the light-sensitive tissue at the back of the eye. The blood vessels may swell and leak fluid and/or new blood vessels grow on the retina surface, disrupting vision. Often there are no initial symptoms.
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All people with diabetes-both type 1 and type 2-are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she is to get diabetic retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.
During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.
This answer is based on source information from the National Institute of Diabetes and Digestive and Kidney Diseases.
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Unfortunately, diabetic retinopathy -- an eye disease caused by damage to blood vessels of the retina (the innermost layer of the eye) -- has no early warning signs. The best way to protect yourself is to understand your risk and receive vision testing as necessary. Anyone with diabetes -- either type 1 or type 2 -- should get a comprehensive dilated eye exam at least once a year.
Comprehensive eye exams can detect macular edema and diabetic retinopathy in the earliest stages. If the problem is treated quickly enough, it is possible to prevent severe vision loss and blindness. A regular eye exam includes various procedures to detect early problems: a vision acuity test to identify problems with vision, tonometry, a glaucoma screening test, to measure pressure inside the eye, and a dilated eye exam to reveal damage to the retina and optic nerve. Ocular imaging, both with and without dye, may also be necessary.