Eye in Diabetes

Diabetes Mellitus is a very common disease that results in an elevated blood sugar level. It is world wide in its distribution. Diabetes can occur at any age but there is an increasing incidence with increasing age. Those with a more severe form of diabetes need insulin for control of the blood sugar while in more moderate cases, oral medication may be sufficient. Diabetes can affect many organs of the body, including the eye. Diabetic Retinopathy is a major cause of blindness throughout the world.

Diabetic Retinopathy

Diabetes can affect the eye in several ways but its major impact occurs in the retina and is known as Diabetic Retinopathy.

Risk Factors: The longer a person has diabetes, the greater the risk for developing retinopathy. Control of blood sugar also is very important. The better the control of blood sugar, the less likelihood of developing retinopathy. Insulin dependence also is a risk factor. There are many exceptions to these risk factors. In our practice, we have a patient with unstable, insulin dependent diabetes for 60 years and has no retinopathy. On the other hand, diabetic retinopathy may be discovered during an eye examination in a patient not previously known to be diabetic. Other general medical factors, particularly hypertension, may have an adverse affect on the retinopathy.

Diabetic Retinopathy is divided into Nonproliferative and Proliferative stages.

Nonproliferative stage: In this stage, small hemorrhages, microaneurysms (out pouchings of the capillary system), leakage of fluid from the capillary bed and focal areas of decreased blood flow may be seen. If these abnormalities occur in the macular area, visual acuity may be compromised. Nonproliferative Diabetic Retinopathy can come and go and there are many factors involved that we do not completely understand. If the macula (the central area of acute vision) is involved, vision may be significantly compromised. In selected cases, Nonproliferative Diabetic Retinopathy may be treated with laser.

Proliferative Diabetic Retinopathy: In the second stage of retinopathy, new blood vessels develop in focal areas of the retina. New vessels bleed. As these hemorrhages resolve, fibrous tissue (scar) develops. More new vessels grow into the fibrous tissue resulting in another cycle of bleeding. Hemorrhage may occur into the vitreous and sometimes the retina is detached because of traction exerted by the fibrous tissue. Laser therapy may be helpful and, sometimes, if bleeding into the vitreous does not resolve, surgical removal of the vitreous is indicated.

Good control of the blood sugar, blood pressure and regularly scheduled visits to the eye doctor, at least once annually, are very important to insure that vision will not be compromised.