Your Eyes and Diabetes

By Brad V. Spagnolo, MD

Baltimore Washington Eye Center

. http://www.bweyecenter.com/

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Your Eyes and Diabetes

Diabetic Retinopathy is a serious complication of diabetes and is actually the most frequent cause of new cases of blindness among adults aged 20-74 years old in the United States. However, with early diagnosis and treatment, progression of the disease and its associated vision loss can at a minimum be slowed, and in many cases vision loss from Diabetic Retinopathy can be prevented.

There are many patients with Diabetes Mellitus who think that the underlying disease is simply an inability to effectively metabolize and process glucose (sugar). Unfortunately, the reality is that the effects of diabetes are considerably more widespread and actually affect many organs and tissues throughout your body. Diabetes is actually a disease of the small blood vessels throughout the body. When diabetes damages these small blood vessels, it will impair the normal circulation of blood in certain organs and tissues. It is quite common for patients with diabetes to experience difficulty with the circulation in their legs, kidneys, heart, brain and eyes-especially the very small blood vessels of the eye found in the Retina. When Diabetes causes damage to the small blood vessels in the retina, it is called Diabetic Retinopathy.

Diabetic Retinopathy tends to appear and progress in Stages as follows

Mild Nonproliferative Retinopathy

Mild Nonproliferative Retinopathy is the earliest stage of Diabetic Retinopathy. It is characterized by the presence of “dot” and “blot” hemorrhages and “microaneurysms” in the Retina. Microaneurysms are areas of balloon-like swelling of the tiny blood vessels in the Retina caused by the weakening of their structure. Mild Nonproliferative Retinopathy can be present without any change in your vision. Mild Nonproliferative Retinopathy usually does not require treatment unless it progresses or is accompanied by Diabetic Macular Edema. If you have Mild Nonproliferative Retinopathy, your doctor will make specific recommendations about how often you will need to be examined.

Moderate

Nonproliferative Retinopathy

Moderate Nonproliferative Retinopathy is the second and slightly more severe stage of Diabetic Retinopathy. During this stage, some of the small blood vessels in the Retina may actually become blocked. The blockage of these tiny blood vessels causes a decrease in the supply of nutrients and oxygen to certain areas of the Retina.

The best way to diagnose blockage of the small blood vessels in the Retina is by having a diagnostic test called an Intravenous Fluorescein Angiogram (IVF). The Intravenous Fluorescein Angiogram is performed right in our office. The IVF is performed by injecting a fluorescent dye into a vein in your arm and then, using a specialized camera, taking a series of photographs of the Retina as the dye circulates throughout the retinal blood vessels. Using the IVF, it is possible to precisely and directly observe the circulation and the integrity of the blood vessels in the Retina so that we can identify any blood vessels that may be blocked.

Severe Nonproliferative Retinopathy

Severe Nonproliferative Retinopathy is the next progression of Diabetic Retinopathy. Severe Nonproliferative Retinopathy is characterized by a significant number of small blood vessels in the Retina becoming blocked. As a greater number of blood vessels become blocked, it results in more areas of the Retina being deprived of nourishment and oxygen. A lack of sufficient oxygen supply to the Retina results in a condition called “Retinal Ischemia”. To attempt to compensate for “Retinal Ischemia”, these areas of the Retina then send signals to the body to stimulate the growth of new blood vessels in order to try and reestablish the supply of oxygen.

Proliferative Retinopathy

Proliferative Retinopathy is a stage of Diabetic Retinopathy that carries a significant risk of vision loss. The Retina responds to a lack of oxygen, or ischemia, by attempting to compensate for the reduced circulation by growing new, but abnormal blood vessels-a process called neovascularization. When Retinal Neovascularization is present, you have progressed into the Stage of Diabetic Retinopathy called Proliferative Retinopathy. At first, it might seem that new blood vessel growth or neovascularization is a desireable event as it will help the Retina obtain greater blood flow and thus more oxygen and nutrients; unfortunately, this is not the case. Retinal Neovascularization is formed from new blood vessels that are extremely fragile and tend to break easily and bleed into the Vitreous. If left untreated, Proliferative Retinopathy will in result in bleeding into the Vitreous that leads to scarring and, ultimately, to retinal detachment with profound vision loss.

Proliferative Retinopathy is treated with either Retinal Laser Photocoagulation Treatment alone or Retinal Laser Photocoagulation Treatment in conjunction with a surgical procedure called a Vitrectomy. During a Vitrectomy, the surgeon will remove the Vitreous that has been filled with blood or scar tissue.

It may be possible for patients to have Proliferative Retinopathy and Retinal Neovascularization and yet still have good vision. Even if Proliferative Retinopathy and Retinal Neovascularization do not appear to be causing any vision loss, it is critical that you be treated as quickly as possible in order to stop the progression and preserve the good vision.

If you have been diagnosed with Diabetes or even if you are just glucose intolerant, you should have a thorough Diabetic Eye Examination.