Sunir Garg, MD, tells Hallie Levine
Diabetic retinopathy, a diabetic eye disease, is one of the leading causes of blindness in the United States. Despite this, nearly 40 percent of people with diabetes do not have annual eye exams. But these screening tests are key because they can prevent vision loss by catching diabetic retinopathy at an earlier, more treatable stage of the disease.
Diabetic retinopathy can lead to permanent vision loss.
Many people are surprised to learn that diabetic retinopathy is the most common cause of vision loss in people with diabetes. Here’s a quick start.
Diabetes is a disease that affects small blood vessels throughout the body, including the fragile blood vessels in the back of the eyes. These blood vessels are like pipes: when they become damaged, they weaken and start to leak. Over time, these tiny blood vessels drip blood and plasma onto your retina. This causes the tissue in the retina to swell, which can lead to cloudy or blurred vision. This can also cause damage, resulting in less oxygen and other nutrients getting to the retina.
Sometimes your body tries to solve the problem by making new blood vessels. But these blood vessels are fragile and can rupture and bleed, or form scar tissue that pulls the retina away from the wall of the eye. All of these conditions can eventually lead to blindness.
You could have diabetic retinopathy and not know it.
The condition often has no symptoms in its early stages, which is why yearly eye exams are so important. As the condition worsens, you may notice the following symptoms:
- blurred vision
- Blurred to clear vision
- Blank or dark areas in the field of vision
- Floaters or dark spots in vision
- poor night vision
- color appears faded
Unfortunately, patients often don’t see an eye specialist until symptoms like floaters or blurred vision appear, and by then the damage has already been done.
There are many things you can do to treat diabetic retinopathy.
When we find signs of diabetic retinopathy during our patients’ routine eye exams, they are often very frightened. They worry that they will lose their eyesight. But most of the time, their disease is mild. We explained that the best way to stop vision loss was to make sure their blood sugar and blood pressure were well controlled. They need to watch their diet carefully and take all medications as prescribed. Often, we show patients pictures of their eyeballs so they can see the damage caused by diabetes. This is usually enough to help them understand why blood sugar and blood pressure control are so important to help their overall health.
But don’t panic if your disease is more serious. The first step is a class of drugs called anti-VEGF. These medications help reduce eye swelling, which can slow vision loss or even improve vision. It is an injection that is injected into your eye at your eye specialist’s office. Laser surgery can also help seal leaky blood vessels, shrink abnormal blood vessels, and reduce retinal swelling. If your condition is very severe, you may need a type of eye surgery called a vitrectomy. An ophthalmologist will remove blood and plasma from your eye and remove scar tissue from your retina. This will also help you see better again.
Regular eye exams are key.
People with diabetes need at least annual comprehensive eye exams by an ophthalmologist, a doctor who specializes in eye diseases. This is true even if your vision is 20/20. Your doctor will give you eye drops to dilate, or widen, your pupils so they can examine the inside of your eyes for diabetic retinopathy and other eye problems.
If you’ve just been diagnosed with diabetes, you’ll need an eye exam right away to make sure there’s nothing wrong with your eyes. After that, they should have annual eye exams — more frequently if they have diabetes-related eye problems, such as diabetic retinopathy.
There are other times in your life when a comprehensive eye exam may be warranted. For example, pregnant women with diabetes need eye exams every trimester because changes in blood pressure and fluid retention may make their diabetes worse.
Interestingly, once your diabetes is well controlled, you also need to have your eyes checked. For some reason, this shift causes diabetic eye disease to worsen in some patients. We don’t know why, other than your body has gotten used to the mess and your eyes don’t know how to deal with the sudden change.
The good news is that most people with diabetes who receive regular eye exams but do go on to develop diabetic retinopathy end up doing well. If we monitor them properly and treat them as they develop, we can maintain good vision for years or even a lifetime in the vast majority of patients. But both physicians and patients must work together to make this happen.
