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How does diabetes affect the eye?
Patients with diabetes are at an increased risk of developing eye diseases that can lead to vision loss and blindness, such as diabetic retinopathy, cataracts, and glaucoma. In fact, diabetic retinopathy is the leading cause of blindness in the United States. South Texas has a higher incidence of diabetes than most parts of the country. This means here in San Antonio we have more diabetic retinopathy too.
Diabetic eye conditions often develop without any noticeable vision loss or pain, so significant damage may already have occurred to the eye by the time patients notice any symptoms. For this reason, it is important for diabetic patients to have their eyes examined at least once a year. Early detection of eye disease can help prevent permanent damage.
Diabetic-related eye problems develop from high blood sugar levels, which can cause damage to blood vessels in the eye. More than 40 percent of patients with diabetes will develop some form of eye disease in their lifetime. The risk of developing eye problems can be reduced through regular eye exams and by keeping blood sugar levels under control through a healthy diet and regular exercise.
Causes of Diabetic Eye Conditions
Diabetic eye conditions develop in the retina as a result of microvascular abnormalities. The tiny blood vessels within the retina develop microaneurysms and begin to leak blood. As new blood vessels develop to replace the blood vessels that are no longer viable, they also leak blood and can cause hemorrhages and permanent damage to the retina.
While diabetics struggle with a high sugar count in the blood along with insufficient insulin production, it is actually the lack of oxygen in the blood that causes eye problems and leads to vision loss.
Diagnosis of Diabetic Eye Conditions
Diabetic eye conditions can be detected through a comprehensive eye exam. A comprehensive eye exam involves a visual acuity test to measure vision at various distances, and a dilated eye exam to examine the structures of the eye for any signs of disease. During this test, your doctor can examine the retina and optic nerve with a special magnifying lens. Tonometry may also be performed during a comprehensive eye exam to measure the pressure inside the eye with a special instrument. Eye Associates of South Texas has many state-of-the-art diagnostic tools to diagnose and follow the treatment of diabetic retinal disease. We have spectral domain OCT in most of our locations San Antonio Medical Center, San Antonio North Central, Seguin, New Braunfels, Castroville, and Hondo. We also have Flash ERG, Pattern ERG, and VEP at key locations. Color Fundus Photography and Fluorescein Angiography may aid in the early detection of macular ischemia (loss of blood supply).
Eye exams should be performed at least once a year or as soon as any potential problems are detected in order to ensure the early detection of any serious conditions. Early detection is the strongest protection against diabetic eye diseases.
Diabetic Retinopathy
Diabetic retinopathy is the most common type of diabetic eye disease and the leading cause of blindness in the United States. This condition is caused by blood vessel changes within the retina that lead to swelling and leaking of fluid. It can also cause the growth of abnormal new blood vessels on the surface of the retina. There are four stages of diabetic retinopathy that begin with the occurrence of microaneurysms and eventually lead to the presence of abnormal blood vessels on the surface of the retina that can easily leak fluid and cause severe vision loss and even blindness.
The fluid can also leak into the center of the macula and cause swelling and blurred vision, a condition known as macular edema. The risk of developing macular edema increases as diabetic retinopathy progresses.
Treatment of Diabetic Eye Conditions
Treatment for early stages of diabetic retinopathy and other conditions usually focuses on maintaining levels of blood sugar, blood pressure, and blood cholesterol, in order to prevent any permanent damage from occurring. For more advanced stages of the condition, laser surgery is often effective in shrinking the abnormal blood vessels through more than 1,000 laser burns in the area of the retina. This procedure, known as scatter laser treatment, usually requires two or more sessions in order to fully remove the blood vessels.
Panretinal Photocoagulation
Panretinal photocoagulation, also known as PRP or scatter laser treatment, is a minimally invasive laser procedure used to seal or destroy leaking blood vessels on the retina. This method of treatment is effective in shrinking and preventing the growth of new blood vessels around the retina. Panretinal photocoagulation may reduce the occurrence of vitreous bleeding or retinal distortion in those patients with proliferative diabetic retinopathy, an advanced stage of diabetic eye disease.
Focal Photocoagulation
Retinal laser photocoagulation is a minimally invasive procedure used to seal or destroy leaking blood vessels in the retina that lead to serious retinal conditions such as diabetic retinopathy and macular edema. This procedure can also seal retinal tears and destroy abnormal tissue found in the back of the eye.
Laser treatments can be performed in your doctor’s office. Anesthetic eye drops will be used to minimize pain during the procedure. Patients may experience blurry vision for the remainder of the day and should rest at home. It is important for patients to realize that these procedures cannot cure diabetic eye conditions, but rather help reduce vision loss and slow the progression for patients with more advanced cases. We have Argon lasers in our San Antonio and Seguin Offices.
Anti-VEGF for the Diabetic Eye
Vascular endothelial growth factor, or VEGF, is a protein that causes abnormal blood vessels to grow within the eye. If they leak, it can be very damaging to the structures of the eye. This is a common problem in diabetes patients, since blood vessels in the eye may become obstructed because of high glucose levels. The eye attempts to compensate by producing more VEGF in an attempt to supply a sufficient amount of oxygen to the eye’s tissues.
There are now treatments available, however, that can slow VEGF production and decrease the leaking of the blood vessels. Administered as an injection into the eye, anti-VEGF treatment can help to prevent and sometimes even reverse vision loss in patients. The Ophthalmologists and retina specialists of Eye Associates of South Texas can inject these medications in-office at all our offices including San Antonio, Seguin, New Braunfels, Luling, Lockhart, Gonzales, Castroville, and Hondo.