WHAT IS DIABETES?
Diabetes is a common disease in the United States, and diabetic eye disease is the most common cause of blindness in the US. Regular eye examinations are important in diabetes because diabetic eye disease and the vision loss caused by it are completely preventable.
In diabetes, high sugar levels in the blood damage blood vessels throughout the entire body. Damage to blood vessels in the kidneys can cause kidney failure requiring dialysis. Damage to blood vessels in nerves can cause neuropathy. Your eye also has many blood vessels in it, and diabetes can also damage those blood vessels. In particular, high blood glucose levels cause damage to the blood vessels in the retina of the eye. The retina lines the back of your eye like wallpaper, and is like the film in a camera—it detects the light entering your eye and turns it into pictures for your brain to see.
When the retina’s blood vessels are damaged, the retina stops working properly, and sight can be lost. After being exposed to high sugar levels for a long time, the blood vessels in the retina develop some weak spots. These weak spots often pooch out like bubbles along the blood vessels, and these are called micro aneurysms. Sometimes the micro aneurysms rupture, and blood spills into the retina to form small dot hemorrhages. Your retina will eventually clear the blood away, but some debris is often left behind—these clumps of debris are called hard exudates. Altogether, these changes—micro aneurysms, dot hemorrhages, and hard exudates—are called background diabetic eye disease. Most people with diabetes get these small changes in their eyes after having diabetes for 10 years or more.
Cataracts can also develop as a result of diabetes. Diabetic Cataracts tend to progress more quickly and at a younger age than typical age-related cataracts. These will give symptoms such as glare, light sensitivity, hazy/cloudy vision, and difficulty with night driving.
HOW DOES DIABETES DEVELOP?
Background diabetic eye disease does not usually cause significant vision loss unless the swelling occurs in the very center part of the retina, called the macula. If you have swelling here, it is called diabetic macular swelling (or diabetic macular edema), and it is a common cause of vision loss among diabetic patients.
Background diabetic retinopathy is a sign that your retina’s blood vessels are sick. If enough of the blood vessels rupture, the retina may not receive enough blood to keep it healthy. In this case, the retina will try to grow new blood vessels to replace the sick ones. Unfortunately, these new blood vessels usually grow in the wrong places. They are fragile, and they break easily, sometimes spilling enough blood to fill up the eye. When these new blood vessels begin to grow, it is called proliferative diabetic eye disease.
Proliferative diabetic eye disease is less common than background diabetic eye disease, but is much more likely to take away some or all of your vision. If it is caught early—before your vision is damaged—proliferative diabetic eye disease can be treated with eye injections or laser therapy to save your vision. Once the vision is lost, it is very hard to get it back.
Diabetic Cataracts can be treated with cataract surgery. If no other diabetic complications are affecting the vision, in many cases sight can be fully restored with cataract surgery.
WHAT ARE SOME SIDE EFFECTS?
Background and early proliferative diabetic retinopathy have no symptoms. The only way to know if you have these changes—and need eye injections or laser therapy to save your sight— is to visit your eye doctor regularly. People with diabetes should have a medical eye exam at least once a year to make sure they do not have early damage that threatens their vision.
WHAT TESTS ARE PERFORMED IN A DIABETIC EYE EXAM?
A diabetic eye examination will include a refraction (measuring the prescription of your eyes), ocular examination, dilation of the eyes, and a full retinal exam. It is highly recommended to also include Optomap Retinal Imaging as part of your exam. There are a few insurance plans that will help cover the cost of an Optomap image as a screening tool, but most will not unless there is a medical diagnosis that requires it. It is a minimal cost that allows our doctors to even more thoroughly examine the retina for diabetic complications and will photodocument your retina for future comparison should your eye health change.
At the conclusion of your examination, we will send your results to your managing primary care provider and/or endocrinologist to ensure the best continuity of care.