Diabetes is one of the most common chronic health conditions in the United States with an estimated 100 million adults currently living with diabetes or pre-diabetes. This metabolic disorder occurs when the body is no longer able to regulate its own blood sugar levels and requires intervention to keep them stable. Diabetes can have serious consequences for our health and our vision. This is because patients who are diabetic can go on to develop a complication that is known as diabetic retinopathy, which can cause permanent vision loss without prompt treatment. It is for this reason that patients who suffer from diabetes need to have regular diabetic eye exams.

DIABETIC RETINOPATHY

Diabetic Retinopathy damages the retina which is found in the back of the eye. The retina has special cells that collect and send light messages through the optic nerve to be processed in the brain which then tell us what we see and how clearly we see it. The retina is nourished by a continuous supply of blood, which is delivered using a network of tiny blood vessels. Over time, having continuously high blood sugar levels, can damage these blood vessels causing blood and other fluids to leak onto the retina. If this happens, scarring may occur which could cause vision loss. Depending on the stage of your diabetes, you may need to be checked 2-3x / year. Often changes in the eye will tell us if your diabetic treatment plan from your physician is effectively controlling your diabetes. It has been shown that damage from diabetes occurs when there are large fluctuations in blood sugar levels. That is why it is recommended to eat smaller meals more often. Diabetic retinopathy (DR) is either non-proliferative or proliferative. Non-proliferative is then subdivided by stages 1 through 4. Stage 1 non-proliferative DR, is characterized with scattered hemorrhages in only parts of the retina, while Stage 4 has bleeding throughout the entire retina. Proliferative diabetic retinopathy is the most severe and patients are at higher risk of permanently losing vision. Diabetic Retinopathy occurs from the body’s response to poor nutrition by growing new, small bloodvessels. This is called neovascularization. These vessels themselves are weak, leaky, and can grow into unwanted areas of the eye causing vision loss from scarring or a retinal detachment. This can all go undetected to the patient as there are no symptoms. Results of an eye exam can alert the patient and their diabetes doctor that they need to maintain better blood sugar control. If during an exam, it is found that the diabetic retinopathy is progressing, proper referral to a retinal specialist is warranted for treatment either by eye injections or laser to prevent further progression. It’s imperative to take wide field retinal scans (Optos) and OCT at least annually to be able to accurately assess any progression from previous visits.

Am I at risk of diabetic retinopathy?

Technically, anyone who suffers from diabetes, whether it be Type 1 or Type 2, could be at risk of developing diabetic retinopathy. However, the condition is more likely in certain situations. These include if:

• your blood sugar levels are uncontrolled or poorly controlled
• you have a long history of diabetes
• you have high blood pressure (hypertension)
• you suffer from high cholesterol
• you are pregnant

DIAGNOSING AND MONITORING DIABETES

The following protocol must be followed to properly monitor for diabetic retinopathy:

• Minimum yearly eye exams

• Optos Wide field imaging and/or dilation

• Optical Coherence Tomography (OCT)

Optomap is a simple, non-invasive procedure. In less than ½ second it generates a panoramic, 200 degree, high-resolution, digital, color image of the retina. This image becomes a permanent part of the medical record and enables us to see more of the retina, measure specific aspects of the eye, and magnify some of the finer details, such as very small hemorrhages that can occur in Diabetes that could go undetected with older conventional methods. Most importantly, we can track changes in the eye over time by comparing each year’s optomap. In addition, patients become more involved in their own eye care as we review the images together and discuss the best ways to preserve their vision. An optomap should be performed annually regardless of symptoms, so that we can observe for changes and look for subtle signs of disease progression. Early detection in diabetes and other retinal disease is the most important factor to maintaining good eye health.