What is diabetes?

Diabetes is a disease resulting from a variable interaction of hereditary and environmental factors. It results in abnormal insulin secretion and elevated blood glucose levels that cause a variety of organ complications including kidney disease, eye disease, nerve disease, and blood vessel disease. Symptoms of diabetes include excessive thirst, appetite, and urination. Approximately 8 million people in the USA have diabetes.

Diabetes falls into three groups. Type 1, also called juvenile onset diabetes, typically occurs between age 11 and 13. It is unusual for an individual to have Type 1 after age 40. People with Type 1 require treatment with insulin. Type 2 typically occurs in people over 40. Obesity is a factor in 80%-90% of people with Type 2. Individuals with Type 2 diabetes are treated by diet modification, oral medication, and sometimes insulin. The third group of diabetes occurs secondarily to other conditions such as pancreatic disease, endocrine gland disease, and certain drug induced forms.

How does diabetes affect the eye?

Diabetes affects many parts of the eye. Diabetes can cause physiologic alterations in the human lens leading to fluctuations in vision and cataract formation. It can also cause sudden onset of double vision and decreased corneal sensitivity. Diabetes is a risk factor for glaucoma as well as various vascular obstructions in the eyes. The most serious and potentially blinding eye condition associated with diabetes is diabetic retinopathy. The diagnosis of diabetic eye disease is made by optometric physicians during a complete eye examination.

What is retinopathy?

Persistently elevated blood glucose levels in an individual causes damage to the tiny blood vessels in the retina. Unhealthy vessels allow leakage of blood and fluid into the retina, which can permanently damage retinal tissue. The irreversible damage caused by diabetic retinopathy leads to permanent vision loss. Failure to adequately control blood glucose will promote the growth of new blood vessels in the retina and iris. New blood vessels, called neovascularization, can cause severe bleeding, scar tissue formation, and retinal detachment and glaucoma. If diabetic retinopathy is untreated, blindness can result.

Is vision loss from diabetes preventable?

Yes. Early diagnosis and aggressive treatment to control blood glucose levels are very important in slowing the progression of diabetic retinopathy and preventing vision loss. Yearly dilated eye examinations by an optometric physician are necessary for all individuals with diabetes. Although the damage from diabetic retinopathy is often irreversible, medical and surgical intervention will stabilize the damaging effects of diabetic retinopathy. Optometric physicians diagnose the presence of diabetic retinopathy, evaluate the severity, and make direct referrals to diabetologists and retinologists for laser treatment when necessary.

What is the treatment for diabetic retinopathy?

In early stages, controlling blood glucose levels will slow the development of retinopathy. As retinopathy progresses, blood and fluids leak out of small blood vessels and accumulate in the central retina of the eyes. Laser treatments to the areas of leakage help stop further leakage. As retinopathy progresses, new blood vessels form inside the eye. Extensive laser treatments and even surgery may be necessary to prevent new blood vessel formation from causing blindness.

What are the risk factors for developing retinopathy?

Several factors increase the risk of developing retinopathy including high blood pressure, carotid artery disease, and pregnancy. The prevalence of retinopathy in the diabetic population increases with age. Diabetic retinopathy rarely occurs in children under 10 years of age. However after having diabetes for 20 years, nearly 99% of those with Type 1 diabetes and 60% of those with Type 2 have some degree of retinopathy.

Is diabetic eye disease preventable?

Early diagnosis and treatment are essential in stabilizing diabetic eye disease. Regular physical examinations and self discipline in following instructions about diet, exercise and medication are of utmost importance. Frequent dilated eye examinations by an optometric physician is essential in preventing vision loss.