Dr. Michael Behforouz
As featured in
"Best of 2011"
Diabetes is a disease that affects blood vessels throughout the body, particularly vessels in the kidneys and eyes. When the blood vessels in the eyes are affected, this is called diabetic retinopathy.
The retina is in the back of the eye. It detects images and transmits them to the brain. Major blood vessels lie on the front portion of the retina. When these blood vessels are damaged due to diabetes, they may leak fluid or blood and grow scar tissue. This leakage affects the ability of the retina to detect and transmit images.
During the early stages of diabetic retinopathy, vision is typically not affected. However, when retinopathy becomes advanced, old blood vessels leak or new blood vessels grow in the retina. The new vessels are the body’s attempt to overcome and replace the vessels that have been damaged by diabetes. However, these new vessels are not normal. They may bleed and cause the vision to become hazy, occasionally resulting in a complete loss of vision. The growth of abnormal blood vessels on the iris of the eye can lead to glaucoma. The new vessels also may damage the retina by forming scar tissue and pulling the retina away from its proper location. This is called a retinal detachment and can lead to blindness if left untreated.
There are usually no symptoms in the early stages of diabetic retinopathy.
In later stages, symptoms can include:
Diabetes: Everyone who has diabetes is at risk for developing diabetic retinopathy, but not everyone develops it. Uncontrolled and fluctuating blood sugars increase the risk.
You can reduce your risk of losing vision from diabetic retinopathy by:
There are usually no symptoms in the early stages of diabetic retinopathy. Vision may not change until the disease becomes severe. An exam is often the only way to diagnose changes in the vessels of your eyes. This is why regular examinations for people with diabetes are extremely important.
Your eye doctor will likely perform a macular OCT to determine if the retina is swollen. This laser scanner gives extremely detailed information about the anatomy of the retina.
Your eye doctor also may perform a test called fluorescein angiography. During the test, an organic orange-red dye called fluorescein will be injected into a vein in your arm. The dye will travel through your body to the blood vessels in your retina. Your doctor will use a special camera with a green filter to flash a blue light into your eye and take multiple photographs. The pictures will be analyzed to identify any damage to the lining of the retina or abnormal blood vessels.
Diabetic retinopathy does not usually impair sight until the development of retinal swelling or bleeding. In either of these cases, laser therapy can be performed to give you the best chance of maintaining your vision. In the most severe cases, pan-retinal photocoagulation is performed. During this procedure, a laser is used to destroy all of the dead areas of retina where blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to decrease or disappear. In some cases, surgery is needed to remove the blood and abnormal blood vessels that cannot be treated by laser.
Diabetes can also predispose your body to form cataracts. Cataracts can be treated with surgery if they cause a problem with vision. These problems include difficulty reading and driving at night.
The management of diabetes and the ocular manifestations of diabetes are best handled by a team approach. The coordination of care between a primary care physician, a specialist such as an ophthalmologist, and you the patient is the single most important step in preventing vision loss from diabetic eye disease. At Center for Sight we strive to keep you and you primary care physician involved in the treatment of your diabetic eye problems.
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