DIABETES
What
are the types of diabetes?
What is the Retina?
What is Diabetic Retinopathy?
What are the Symptoms?
I'm diabetic and my vision is normal. Why should
I have my eyes checked?
How is Diabetic Retinopathy detected?
How is Diabetic Retinopathy treated?
Dr. Yoken's Patient Handouts
What are the types of diabetes?
Diabetic retinopathy
is the leading cause of new cases of legal blindness among working-age
Americans. Over 16 million American have diabetes. In general, there
are two forms of diabetes. Type 1, previously called juvenile-onset
or insulin dependent diabetes is characterized by a deficiency of
insulin. Type 2, previously called adult-onset or non-insulin dependent
is characterized by insulin resistance. Ninety percent of patients
with diabetes have type 2 diabetes.
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What is the Retina
 |
Normal
Retina: Optic disc,
macula, vessels. |
The
retina is the light sensitive structure that lines the back of our
eyes. When light hits the retina, a signal is formed that is sent
to the brain. Our brain interprets these signals, allowing us to
see. Any damage to the retina impairs our ability to see.
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What is Diabetic Retinopathy?
 |
Diabetic
Retinopathy, with
blood and protein deposits
in the retina. |
The retina is
a very delicate and sensitive structure that is nourished by many
blood vessels. Diabetes can damage these blood vessels. It can cause
some of these blood vessels to leak fluid and create a condition
called Diabetic Macular Edema. This swelling damages the
retina. Diabetes can also cause new blood vessels to grow. This
is called Proliferative Diabetic Retinopathy. These new blood
vessels are very fragile and can break, causing bleeding within
the eye.
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What are the Symptoms?
 |
Diabetic
Retinopathy, with
new blood vessels growing. |
Diabetic retinopathy
often has no early warning signs.
If you develop macular edema, it may blur your vision, making it
hard to do things like read and drive. In some cases, your vision
will fluctuate during the day. As new blood vessels form at the
back of the eye, they can bleed (hemorrhage) and blur vision. Initially
this may not be very severe. You may only notice a few floaters
in your vision. They often go away after a couple of days. It is
also possible to have a much greater leakage of blood. This bleeding
can interfere with your vision. The greater the bleeding, the worse
the vision. In extreme cases, a person will only be able to tell
light from dark in that eye. It may take the blood anywhere from
a few days to many months to clear from the inside of your eye.
In some cases, the blood will not clear. Click
here to find out more about Diabetic Retinopathy.
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I'm diabetic and my vision is normal. Why
should I have my eyes checked?
Once diabetic
retinopathy has progressed to the point where the vision starts
to blur, it is often difficult to prevent vision loss even with
aggressive treatment. If diabetic retinopathy is caught early, before
any visual symptoms have occurred, the success rate of preventing
vision loss with treatment is much greater. In general, diabetics
should have an annual eye exam to check for diabetic retinopathy.
In some cases, the eye doctor may determine that an exam should
be performed more frequently.
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How is Diabetic Retinopathy detected?
Diabetic retinopathy
is detected by a complete eye exam. This includes measurement of
one's visual acuity. Drops are also placed in the eye that make
the pupil larger(dilation). This allows the eye doctor to see more
of the retina and to look for signs of diabetic retinopathy. The
examination of the retina is called ophthalmoscopy. It includes
the use of a special magnifying lens in conjunction with a modified
biomicroscope called a slit lamp. This provides a highly magnified
view of the retina. The physician will also use a special headset
with a bright light and a larger magnifying lens to get a wider
view of the retina. The doctor will carefully look for signs of
diabetic retinopathy such as swelling or the growth of new blood
vessels. Should your doctor suspect that you need treatment for
macular edema, he or she may ask you to have a test called fluorescein
angiography. In this test, a special vegetable dye is injected
into your arm. Pictures are then taken as the dye passes through
the blood vessels in the retina. This test allows your doctor to
find the leaking blood vessels and helps to guide treatment.
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How is Diabetic Retinopathy treated?
There are two
treatments for diabetic retinopathy, laser surgery and vitrectomy.
Laser surgery is performed either in the doctor's office or at the
hospital. Before the surgery, drops are applied to your eye to dilate
the pupils and to numb the eye. Occasionally the doctor will also
need to use a local anesthetic to numb the area behind the eye.
A special contact lens is placed on the surface of the eye to help
guide the laser beam. During the procedure you will see flashes
of light. Once the procedure is finished you can go home, but you
will need someone to drive. Your eye will likely be blurry and a
little scratchy for the rest of the day.
If the laser
treatment is for macular edema, the doctor will be specifically
treating leaking blood vessels in an attempt to seal off the leakage.
The goal of this treatment is not to improve the vision, but to
try and prevent it from getting worse. If the treatment is for proliferative
diabetic retinopathy the doctor will make hundreds of laser
burns in the peripheral portion of the retina to destroy the new
blood vessels. You may loose some of your side vision from this
in order to save your central vision.
 |
| Laser treatment
for Proliferative Diabetic Retinopathy. |
Vitrectomy
is done to remove blood that does not absorb on its own or to remove
excessive scar tissue. The vitreous is a jelly-like substance that
fills the inside of the eye. When a diabetic has a hemorrhage, the
vitreous can fill with blood. A vitrectomy removes the vitreous
and the blood and replaces it with a clear salt solution. Occasionally
scar tissue develops that can pull on the retina and cause a detachment
of the retina. During a vitrectomy, the eye surgeon can carefully
cut away the excessive scar tissue.
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Dr.
Yoken's Printable Handouts
What is the Retina?
Flashes and Floaters
Diabetic Retinopathy
Retinal Tears and
Detachment
Central Serous Retinopathy
(CSR)
Macular Degeneration
Vitamin and Mineral
Supplementation - ARMD
Newest Treatments
for ARMD
Macular Hole
Macular Pucker
Photodynamic Laser
Treatment (PDT) and Visudyne™
Retinal Artery
or Vein Occlusion
Cystoid Macular
Edema
Fluorescein
and Indocyanine Green (ICG) Angiography
Headace, Migraine
and Ocular Migraine
Uveitis
Endophthalmitis
Retained Lens Material
After Cataract Surgery
Monitoring For
Plaquinil-Induced Retinal Toxicity
How to Apply Eyedrops
and Your EyeDrop Schedule
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