Approximately 14 million Americans have
diabetes mellitus; but many of them don't know that they are affected.
In addition to causing numerous systemic complications (such as kidney
failure, hypertension, and cardiovascular disease), diabetes is one of
the leading causes of blindness among working-age Americans. In fact,
the risk of blindness to persons with diabetes is 25 times greater
than that of the general population. Many patients with diabetic eye
problems are asymptomatic despite the presence of vision-threatening
disease. If diabetic eye disease is left untreated, it can lead to
serious visual loss. Decreased vision due to diabetes can be caused by
several mechanisms, and treatment for the decreased vision needs to be
tailored to the individual's needs.
Many diabetics notice blurred vision when
their blood sugar is particularly high or low. This blurred vision is
due to changes in the shape of the lens of the eye, and usually
reverse when the blood sugar returns to normal. Diabetics are also
prone to develop cataracts at a younger age than non-diabetics.
Diabetes is a disease that affects not only
the blood sugar levels, but also the blood vessels. Small blood
vessels (capillaries) throughout the retina become damaged or blocked,
resulting in lack of blood supply to small patches of the retina. The
damaged blood vessels also tend to leak, producing swelling within the
retina. This disease of the retinal blood vessels is known as diabetic
retinopathy. Approximately 25% of diabetics have some degree of
diabetic retinopathy.
There are two main categories of diabetic eye disease. The first, background
diabetic retinopathy, (or non-proliferative retinopathy) is the
earlier stage of the disease. This stage is characterized by damage to
small retinal blood vessels, causing them to leak blood or fluid into
the retina. Most visual loss during this stage is due to the fluid
accumulating in the macula, the central area of the retina. This
accumulation of fluid is called macular edema
and can cause temporary or permanent decreased vision. The
second category of diabetic retinopathy is called proliferative
diabetic retinopathy. Proliferative retinopathy is the end result of
closure of many small retinal blood vessels The retinal tissue,
which depends on those vessels for nutrition,
will no longer work properly. The areas of the retina in which the
blood vessels have closed then foster the growth of the abnormal new
blood vessels, called neovascularization. Neovascularization can be
very damaging because it can cause bleeding in the eye, retinal scar
tissue, diabetic retinal detachments, or glaucoma,
any of which can cause decreased vision or blindness.
Diabetic retinopathy can occur in both Type I
diabetics (onset of diabetes prior to age 40) and Type II diabetics
(onset after age 40), although it tends to be more common and more
severe in Type I patients. Because Type II diabetes is often not
diagnosed until the patient has had the disease for many years,
diabetic retinopathy may be present in a Type II patient at the time
diabetes is discovered. In fact, many patients first learn that they
have diabetes when their ophthalmologist finds diabetic retinopathy on
a routine eye exam.
The duration of diabetes is important in
the development of diabetic retinopathy. The longer a patient has had
diabetes, the more likely they are to have diabetic retinopathy.
Diabetic retinopathy does not usually occur for at least three
years after the onset of Type I diabetes. After having diabetes for 15
years, however, about 80% of Type
I diabetics will have some degree of diabetic retinopathy, and 50%
will have proliferative retinopathy.
The diagnosis of diabetic retinopathy is made
based on the appearance of the retina as seen on a dilated retinal
examination. Significant vision-threatening diabetic retinopathy can
be present even if you have no visual symptoms. Retinal photographs
and fluorescein angiography are also used to diagnose and document
progression of diabetic retinopathy. Fluorescein angiography is a
technique which involves injecting a dye (fluorescein) into the veins
and taking a series of photographs of the retina while the dye
circulates through the retinal vessels. This angiography is used to
determine which retinal vessels are leaking, and helps direct laser
treatment more precisely.
The treatment of diabetic retinopathy in any
particular case depends upon multiple factors, including the type and
degree of retinopathy, associated ocular factors such as cataract or
vitreous hemorrhage, and the medical history of the patient. Treatment
options include laser photocoagulation, cryotherapy (freezing), and
vitrectomy surgery (removal of the vitreous gel along with blood, scar
tissue, etc.)
Blindness due to diabetic eye disease is
preventable in most cases. Strategies for preventing diabetic
retinopathy include:
- Careful control of blood sugar levels
through attention to diet, exercise, and medications
- ·
Monitoring for,
and control of,
high blood pressure
- Avoid smoking
- Early detection and treatment of diabetic
retinopathy
If you have diabetes,
you should see an ophthalmologist regularly (approximately every 12
months, or more frequently depending upon the degree of diabetic
retinopathy). Remember, early detection and intervention is the key.
The Country Hills Eye Center Home Page
Dr. Scott C. Richards Main Page
For information regarding the
Country Hills Eye Center phyician
specializing in retinal and diabetic eye diseases
OTHER LINKS OF INTEREST:
ROPARD
- links to resources for parents of visually impaired kids
ComeUnity
- Mailing list for parents of preemies
John
Henry's home page
Ann
Morris Enterprises - Items for sale for visually impaired people
The
American Printing House for the Blind
Kendra's
Story
www.countryhillseyecenter.eyemd.org
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