Diabetic Retinopathy & Macular Degeneration
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Lehigh Eye Specialists

Diabetes?

What is Diabetic Retinopathy? What Causes BDR? What are the Symptoms of BDR? Some Other Diabetic Related Eye Conditions How is BDR Diagnosed? How is BDR Treated? Eye exams

Diabetes & Your Eyes Diabetes is one of the leading causes of blindness in adults. About 16 million people are affected by diabetes in the United States, and there are 800,000 new cases every year. There are two main types of diabetes. Type I is referred to as childhood-onset diabetes (insulin dependent) starting before 25yrs of age. Type II is referred to as adult-onset diabetes. With diabetes the body does not use or store sugars properly. Initially you may have such symptoms as increased urination, excessive thirst or dry mouth. Your eyes can also be affected long before any change in vision is noticed. Diabetics need special medical care to control and treat the different complications that can arise such as, diabetic retinopathy. What is Diabetic Retinopathy? Diabetic Retinopathy is a disorder which affects the eye by injuring the tiny blood vessels in the retina. In its earliest stage (known as Background Diabetic Retinopathy or BDR) vision often remains normal. The retina is the layer of nerve fibers at the back of the eye that absorbs light and sends image information to the brain. The retina depends on the nourishment normally supplied by healthy blood vessels, but with BDR these blood vessels weaken causing fluid and blood to leak out into the retina. If BDR is left untreated, over time, the retina will be unable to reabsorb this material causing deposits to form called exudates. In some cases fluid will collect in the macula (center of the retina that gives us our sharp, central and color vision). This collection of fluid is known as macular edema. At this time a person may notice some distortion in their vision or difficulty focusing. As diabetic retinopathy progresses into its later stage, known as Proliferative Diabetic Retinopathy (PDR), blood vessels start to close off completely resulting in a lack of oxygen to the retina. New blood vessels can grow, as a result of insufficient nutrients. These new vessels (known as Neovascularization) have weak walls which can easily bleed resulting in a vitreous hemorrhage. As a result, scar tissue may form. This process causes pulling on the retina (known as traction) which can cause a retinal detachment. If left untreated the retina can become damaged beyond repair. Return to Top What Causes BDR? Many people with long-standing diabetes develop BDR as a complication. Studies have shown that poorly controlled blood sugar levels and having diabetes for a duration of 5 years or more are related to the onset and progression of retinopathy. However, by taking care of yourself through blood sugar control, proper diet, regular exercise, compliance with medications, not smoking, and keeping your blood pressure controlled you become an active participant in your care. Better blood sugar control delays the onset and slows the progression of eye, kidney, and nerve disease. It is also important to keep your regularly scheduled eye exams and other doctor appointments. Return to Top What are the Symptoms of BDR? It is important for patients to realize that there are generally no changes in vision in the early stages of retinopathy, but in its later stages patients may notice the following: Difficulty with reading and focusing on fine print. Fluctuation in vision from day to day. Blurring, distortion, or decrease in vision Return to Top Some Other Diabetic Related Eye Conditions Cataracts caused by poor blood sugar control ("sugar cataracts") Double vision (diplopia) from nerve damage causing the eye to drift or turn Eye infections can also be a problem for the diabetic because of slow healing Blood vessel growth on the iris causing neovascular glaucoma Return to Top How is BDR Diagnosed? Dr. Kazahaya and Aikey can detect early stages of BDR with a dilated medical exam. Your pupils will be dilated to allow the doctor to best see the retinal details. The complete dilated medical exam involves the following: A technician will check your vision Medical history including medications and drops Dilation of pupils with special drops The doctor will examine your eyes Sometimes special photographs (fluorescein angiograms) are taken to view abnormal blood vessels in the retina. During this test a fluorescent dye will be injected into a hand or arm vein and pictures will be taken of your eyes. These pictures will show the circulation in the blood vessels of your retina. This will allow your doctor to see areas of leakage, swelling, blockage, or other trouble areas. When the examination is completed your doctor will review his findings with you. If diabetic changes are found treatment can then be started to slow or even stop the progression of the disease. Early treatment can save your sight! Return to Top How is BDR Treated? The laser is the most common form of treatment for diabetic retinopathy. It is used to seal off or shrink areas of leaking vessels by using short bursts of light precisely aimed at these areas. It can also be used to rid areas of neovascularization. Laser surgery is considered a minor surgical procedure and can be done right here in our office. In some cases the vessels may bleed into the vitreous (gel-like body giving your eye its shape) causing a vitreous hemorrhage. If it does not clear on its own or is not helped following laser treatment, surgery might need to be performed. A vitrectomy will clear the blood filled vitreous from the eye and, if necessary, reattach the retina. The patient will be sent to the hospital for this type of out-patient, microsurgery. Return to Top Eye exams may be recommended as follows: Diabetics diagnosed before age 30, have your first dilated retinal exam within 3-5 years of diagnosis, and then once yearly or every other year as directed by your doctor. Diabetics diagnosed after age 30, have your first dilated retinal exam within a few months of diagnosis, and then once yearly or as directed by your doctor. If you are planning on becoming pregnant, whether you have type 1 or 2 diabetes, have a dilated retinal exam before conception, during the first trimester, and then as directed by your doctor. Glasses checks (refractions) should not be done when blood sugars are unstable or fluctuating because vision will change until sugars are stabilized. It is recommended that blood sugars be stable for at least 1 month. Remember to always see your ophthalmologist if you have any of the following symptoms: Blurred or distorted vision Double vision Flashes of lights or floaters Pain in your eyes or feeling of pressure behind your eyes Trouble reading or losing peripheral vision Return to Top

Maz Kazahaya, MD, FACS

David A. DeRose, MD

Lehigh Eye Specialists 1251 South Cedar Crest Blvd. Suite 307 Allentown, PA 18103 (610) 820-6320 fax:(610) 820-8376

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