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The following article was published in Your Health Magazine. Our mission is to empower people to live healthier.
David M. Benderson, MD
Understanding Diabetic Eye Disease
Maryland Eye Associates
. http://marylandeyeassociates.com

Understanding Diabetic Eye Disease

Loss of vision is one of the many dreaded complications of diabetes. Over 5.3 million Americans suffer from diabetes-related retinal disease, or diabetic retinopathy, including an estimated 100,000 Maryland residents. After 20 years of living with diabetes, nearly all type 1 diabetics will have some degree of diabetic retinopathy, as will approximately 60% of type 2 diabetics. Some of these patients will experience significant vision loss.

If you think of the eye as a camera, the retina is the film. This important structure translates images into electrical signals, which are then sent to your brain for processing. High blood sugar levels associated with diabetes damages small blood vessels throughout the body, including the retina. Vision loss may result from leakage of fluid from these damaged blood vessels into the macula (macular edema), which is the area of the retina responsible for your central vision. In advanced diabetic retinopathy, a lack of oxygen leads to the growth of abnormal, fragile blood vessels (proliferative diabetic retinopathy). These unhealthy vessels often bleed into the eye (vitreous hemorrhage), and can also cause extensive damage to the retina, including retinal detachment.

Aside from retinopathy, diabetes can affect the eye in a number of other ways. Elevated blood sugar can result in swelling of the lens, which can temporarily change a patient's glasses prescription, resulting in blurry vision. Once the blood sugar is controlled, the lens swelling resolves. Diabetics are at a higher risk for developing cataracts, or permanent clouding of the lens. Advanced diabetic retinopathy can also cause a devastating form of glaucoma due to growth of unhealthy blood vessels on the iris (neovascular glaucoma).

A multi-pronged approach is necessary to prevent and treat diabetic eye disease. First, it is essential that diabetics work closely with their primary care physician and, in many cases, endocrinologist, to keep their blood sugar under good control. Other health care providers, such as nurse educators and nutritionists serve an essential role in diabetes management. Large studies have shown that tight control of blood sugar reduces the risk of diabetic complications, including retinopathy.

Secondly, diabetics should undergo a complete eye examination, including dilation (in order to view the retina and other structures) on a yearly basis. If a diabetic patient develops diabetic retinopathy, more frequent examination may be necessary. If macular edema or proliferative diabetic retinopathy develop, early diagnosis and treatment is essential to preserving vision. Conversely, if a diabetic patient waits until they have vision loss to visit the doctor, treatment may be less effective.

If diabetic retinopathy develops, a fluorescein angiogram may be necessary to identify and direct treatment of macular edema. This test involves the injection of dye into a vein in the arm, which is then photographed as it travels through the retinal blood vessels, identifying areas of leakage. If macular edema is present, a laser procedure may be necessary to seal off the leaking blood vessels. Proliferative diabetic retinopathy is also treated by an in-office laser procedure to stop the growth of unhealthy blood vessels. More severe damage, including vitreous hemorrhage and retinal detachment may require surgical treatment (vitrectomy).

Ultimately, prevention is the best tool to combat diabetic eye disease. Effective control of blood sugar and blood pressure, maintaining a healthy and balanced lifestyle, and regular follow-up with a primary care physician and ophthalmologist are key elements in avoiding vision loss from diabetes.

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