The effect of diabetes on the retina is called diabetic retinopathy. Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of sugar in the blood. Diabetes’ effect on the retina is the main threat to vision, even though it may cause problems such as cataracts and glaucoma to develop. Diabetic changes in the retina begin to occur after approximately 10 years, but can occur much earlier. These changes are called diabetic retinopathy.
Diabetes damages the circulatory system of the retina at the back of the eye. Tiny blood vessels called capillaries become weak and may leak fluid into the retina resulting in two major medical problems: swelling, diabetic macular edema; and abnormal blood vessel growth, retinal neovascularization. If the edema extends to be close to the center of the macula, significant loss of vision may result. Retinal new blood vessels are delicate and hemorrhage easily, allowing blood to leak into the vitreous, causing spots or floaters and decreased vision.
Diabetic patients need to have eye examinations on a regular basis to detect eye problems and treat them as early as possible. The patient’s internist and endocrinologist will work closely with the eye care provider and retinal specialist. Diabetes is a chronic disorder and therefore requires regular follow-up for the entire life of the persons afflicted. A component of the follow-up is regular retinal exams and treatment when necessary to prevent vision loss before it occurs.
Treatment is determined by the stage of the disease and specific problem involved. The retina specialist may use several tests to monitor the problem and make decisions for appropriate treatment such as fluorescein angiogram, which involves injection of a special dye into the patient’s arm. The dye passes through the blood vessels into the retina. The retina physician can then see the leaking blood vessels and take steps to perform laser to seal the vessels and stop the leakage.
OCT is an exciting technology allowing NRI physicians to map the specific areas of retinal swelling to help determine which leaking retinal vessels are causing the most damage to the retina. Vitrectomy, the removal of the gel inside the eye, may be used to eliminate the blood accumulation and scar tissue that can develop in order to restore sight. Medications such as anti-VEGF (Avastin®) and steroids can be injected inside the eye to help reduce retinal swelling and improve vision.
To protect vision, the diabetic patient is urged to have routine, dilated eye exams at least once a year, and often more frequently, as well as to maintain good control of blood sugar levels. The onset and progression of retinopathy is lessened by good control of blood sugars. NRI physicians and surgeons, who are internationally recognized leaders in the diagnosis and treatment of diabetic retinopathy, will devise a plan of treatment especially formulated for each patient to try to prevent, arrest or reverse this sight threatening disorder.