It is important for someone who has diabetes to get their eyes checked because diabetic eye problems are a leading cause of blindness. All patients with diabetes, type 1 and type 2, are at risk. High blood sugar levels can damage blood vessels in the retina. The retina is the specialized nerve layer in the back of the eye. It collects light rays and transmits images to the brain allowing us to see.
Types of Diabetic Retinopathy
There are two types of diabetic retinopathy: nonproliferative (or background) and proliferative. Many people with diabetes have the milder nonproliferative form, which may not affect the vision; however, both forms can cause bleeding and swelling of the retina. Often, people with the nonproliferative form have no symptoms.
The more severe proliferative form occurs when new, abnormal blood vessels develop on the surface of the retina, often manifesting with the sudden onset of floaters when the vessels bleed into the vitreous cavity of the eye and obscure your vision. Sometimes scar tissue can develop on the retina, leading to other more serious problems. Macular edema is another cause of visual loss in diabetics. The macula gives us our central vision allowing us to see fine details clearly. Swelling or thickening of the macula from diabetes causes blurred vision.
In most cases, nonproliferative diabetic retinopathy is carefully followed. Proliferative retinopathy is usually treated with laser surgery in the office, often spread over several sessions. More severe cases, especially those involving vitreous hemorrhage, require surgical intervention in the operating room. We now have different options to treat macular edema, such as lasers and injections into the vitreous cavity. Often a combination of treatments is done.
When you come in for a diabetic eye evaluation, your ophthalmologist will dilate your eyes and carefully examine the retina. Diagnostic tests, such as fluorescein angiography and ocular coherence tomography may be needed. More visits may be necessary if problems are present.
Of course, prevention is the best treatment possible. Good blood sugar control will reduce the long term risk of vision loss and diabetic ophthalmic problems. If you have diabetes, be sure to schedule an appointment with your ophthalmologist at least once per year.