If you have diabetes mellitus, your body
does not use and store glucose properly.
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The eye doctors and Houston retina specialists at The Eye Clinic of Texas provide examination, diagnosis and treatment of diabetic eye problems and disease, including diabetic retinopathy, with laser treatment and Lucentis® injections. Diabetic Retinopathy is the most frequent cause of new cases of blindness among adults aged 20-74 years old. However, with early diagnosis and treatment, progression of the disease and its associated vision loss can at a minimum be slowed, and in many cases vision loss from diabetic retinopathy can be prevented.
There are many patients with Diabetes Mellitus who think that the underlying disease is simply an inability to effectively metabolize and process glucose. Unfortunately, the reality is that the effects of diabetes are considerably more widespread and actually effect many organs and tissues throughout your body. Diabetes is actually a disease of the small blood vessels throughout the body. When diabetes damages these small blood vessels it will impair the normal circulation of blood in certain organs and tissues. It is quite common for patients with diabetes to experience difficulty with the circulation in their legs, kidneys, heart, brain and eyes-especially the very tiny blood vessels of the eye found in the retina. When diabetes causes damage to the small blood vessels in the retina, it is called diabetic retinopathy.
Stages of Diabetic Retinopathy
Mild Nonproliferative Retinopathy
Mild Nonproliferative Retinopathy is the earliest stage of diabetic retinopathy. It is characterized by the presence of "dot" and "blotch" hemorrhages and "microanuerysms" in the retina during your eye examination. Microanuerysms are areas of balloon like swelling of the tiny blood vessels in the retina caused by the weakening of their structure. Mild Nonproliferative Retinopathy can be present without any change in your vision. Mild Nonproliferative Retinopathy usually does not require treatment unless it progresses or if is accompanied by Diabetic Macular Edema. If you have Mild Nonproliferative Retinopathy, the eye doctors at The Eye Clinic of Texas will make specific recommendations about how often you will need to be reexamined.
Moderate Nonproliferative Retinopathy
Moderate Nonproliferative Retinopathy is the second and slightly more severe stage of diabetic retinopathy. During this stage, some of the small blood vessels in the retina may actually become blocked. The blockage of these tiny blood vessels causes a decrease in the supply of nutrients and oxygen to certain areas of the retina. The best way to diagnose blockage of the small blood vessels in the retina is by having a diagnostic test called an intravenous Fluorescein Angiogram (FA).
Severe Nonproliferative Retinopathy
Severe Nonproliferative Retinopathy is the next progression of diabetic retinopathy. Severe Nonproliferative Retinopathy is characterized by a significant number of small blood vessels in the retina becoming blocked. As a greater number of blood vessels become blocked, it results in more areas of the retina being deprived of nourishment and oxygen. A lack of sufficient oxygen supply to the retina results in a condition called "Retinal Ischemia". To attempt to compensate for "Retinal Ischemia", these areas of the retina then send signals to the body to stimulate the growth of new blood vessels in order to try and reestablish the supply of oxygen.
Proliferative Retinopathy is a stage of diabetic retinopathy that carries a significant risk of vision loss. The retina responds to a lack of oxygen, or ischemia, by attempting to compensate for the reduced circulation by growing new, but abnormal blood vessels-a process called neovascularization. When Retinal Neovascularization is present, you have progressed into the stage of diabetic retinopathy called Proliferative Retinopathy. At first, it might seem that new blood vessel growth or neovascularization is a desirable event as it will help the retina obtain greater blood flow and thus more oxygen and nutrients. However this is not the case at all. Retinal Neovascularization is formed from new blood vessels that are extremely fragile and tend to break easily and hemorrhage into the Vitreous. If left untreated, Proliferative Retinopathy will in result in hemorrhaging into the vitreous that leads to scarring and ultimately to retinal detachment with profound vision loss.
Depending on the stage of Diabetic Retinopathy, the potential for and the amount of vision loss, it is possible to treat, stabilize and often reverse the effects of the disease. Treatment of Diabetic Retinopathy can entail the use retinal laser photocoagulation treatment as well as intravitreal injections of Vascular Endothelial Growth Factor (VEGF) Inhibitor drugs or other drugs. However, successful management of diabetic eye problems requires early diagnosis and treatment.
Diabetic Macular Edema
Normally, the small blood vessels in the retina do not leak. One of the early effects of diabetes is to cause the blood vessels in the retina to begin to leak by weakening the inner lining of the blood vessels so that they become porous. Leakage from the retinal blood vessels may cause the center of the retina, the Macula, to actually swell, a condition called Diabetic Macular Edema. Diabetic Macular Edema can occur in any stage of Diabetic Retinopathy.
The Macula is responsible for central vision, and thus Diabetic Macular Edema can result in vision loss of varying severity. The most effective and accurate ways to observe and diagnose Diabetic Macular Edema are to perform a careful dilated examination usually accompanied with a Fluorescein Angiogram (FA) and an Ocular Coherence Tomography (OCT). Using the Fluorescein Angiogram, it will be possible to precisely and directly observe the severity and location of “leaky” blood vessels. By using OCT, it is possible to detect very slight thickness changes in the macula that may indicate the presence of leakage. It is important that leaking blood vessels be found as early as possible so that they can be most effectively sealed with Retinal Laser Photocoagulation Treatment and VEGF Inhibitor Injections. In most cases, early laser treatment will reduce the swelling and prevent further vision loss, but will not restore vision that has already been compromised.
It is also possible to have Diabetic Macular Edema and not have vision loss. Any diagnosis of Diabetic Macular Edema is an indication that breakdown of the retinal blood vessels from diabetes is beginning and requires careful monitoring. In the discussion about your stage of diabetic retinopathy, The Eye Clinic of Texas eye doctors and houston retina specialists will also make specific recommendations about how often you will need to return for eye examinations and the need for additional photographs, Fluorescein Angiograms or OCT Studies. Please be sure to keep these appointments, as they are critical in helping you maintain your eye health and vision.
Treatment of Diabetic Retinopathy
It is critical for all patients with diabetes to have regular eye exams since with early and aggressive treatment of Diabetic Retinopathy it is often possible to maintain vision and prevent severe vision loss.
The National Institutes of Health and the National Eye Institute have funded a number of large scale, multi-center, controlled studies that have produced clinical care guidelines for Diabetic Retinopathy used our physicians.
Early Treatment Diabetic Retinopathy Study (ETDRS)
Diabetes Control and Complications Trial (DCCT)
Diabetic Retinopathy Study (DRS)
Diabetic Retinopathy Vitrectomy Study (DRVS)
We use the results of these studies to guide patients in the treatment of Diabetic Retinopathy since with early treatment it is possible for patients with Diabetic Retinopathy to have only half the likelihood of losing vision as compared to those patients who fail to receive early treatment.
About Diabetic Laser Treatment
Nonproliferative Retinopathy & Laser Treatment
During the early stages of Mild Nonproliferative Retinopathy, Moderate Nonproliferative Retinopathy and the beginning of Severe Nonproliferative Retinopathy, it is not likely that you will need Laser Treatment, unless you
have Diabetic Macular Edema.
However, in order to prevent the progression of Diabetic Retinopathy it is quite important to maintain good overall health. First, tight control of blood sugar levels is key for protecting the health of the small blood vessels. Patients should work to reduce any and all risk factors for vascular disease including controlling their blood pressure, not smoking, reducing dietary fat consumption to lower cholesterol and triglycerides and exercising regularly.
Proliferative Retinopathy & Laser Treatment
Proliferative Retinopathy is treated with a Retinal Laser Photocoagulation procedure called “Scatter Laser Treatment” or “Pan Retinal Photocoagulation”. The goal of Scatter Laser Treatment is to shrink abnormal blood vessels. Your doctor will place approximately 1,000 to 2,000 laser spots in areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Since Scatter Laser Treatment requires a large number of laser spots, it is often necessary to use two or more sessions to complete the laser treatment.
Sometimes patients who have had Scatter Laser Photocoagulation will experience some loss of their side or peripheral vision, some loss of night vision and a decrease in color vision. However, Scatter Laser Treatment is necessary to preserve the rest of your vision and stop the progression of the disease.
When Scatter Laser Treatment is unsuccessful in stopping the progression of the proliferative retinopathy, when a vitreous hemorrhage occurs and does not clear on its own, or when a retinal detachment develops, then a vitrectomy is often helpful. A vitrectomy involves inserting instruments into the eye, and removing the vitreous gel, any blood present in the vitreous cavity, and removing the scar tissue that has grown on the surface of the retina.
Diabetic Macular Edema & Laser Treatment
Diabetic Macular Edema is best treated with one of two types of Retinal Laser Photocoagulation procedures called Focal Laser Treatment and Grid Laser Treatment. Focal Laser treatment is used to close leaking micro aneurysms in a limited area and Grid Laser treatment is used to treat a more diffuse swelling in the macula.
With either type of Laser Treatment for Macular Edema, your doctor will place laser spots in the areas of retinal leakage surrounding the macula. These spots act to slow the leakage of fluid and reduce the amount of fluid in the retina. It is usually possible to complete these Laser Treatments in one session, however depending on the results additional treatment may be necessary. You may need to have Laser Treatment for Macular Edema more than once to control the leaking fluid. If you have Macular Edema in both eyes and require laser surgery, generally only one eye will be treated at a time. Laser treatment of Diabetic Macular Edema works to stabilize vision. In fact, Laser Treatment may reduce the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it may be improved. It is important to restate that this treatment is performed to keep vision form further declining, but does not usually result in improvement in vision already lost. This is why it is so crucial to have regular eye examinations as the goal is to diagnose vision-threatening disease before vision is compromised.
Diabetic Retinopathy is a common eye disease that affects a large number of patients with Diabetes Mellitus. With early detection and treatment, vision loss from Diabetic Retinopathy can be prevented.
If you or someone you know has diabetes or any signs of elevated blood sugar they should be sure to have regular eye exams at The Eye Clinic of Texas by calling 800-423-3737.