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Diabetes is the leading cause of blindness in the United States in adults aged 20 to 64. People with diabetes have a higher incidence of cataracts and glaucoma than those without diabetes. In addition, diabetes can cause weakening in the body's blood vessels, including those in the part of the eye called the retina, and result in diabetic retinopathy. Since the retina is the sensitive tissue that receives light and sends it to the brain, this deterioration in the retinal blood vessels can lead to vision loss.
There is a possibility that one may have diabetic retinopathy and not even know it. Diabetic retinopathy can start without symptoms, and even people with 20/20 vision can have diabetic macular edema or new vessel growth that requires laser treatment.
Although no one is certain what causes diabetic retinopathy, high blood sugar levels, high blood pressure, how long one has been diabetic, and genetics may contribute to the development and progression of diabetic retinopathy.
Therefore, keep an eye on blood sugar levels, blood pressure, diet, and start an exercise program to control diabetes and slow its progression and complications. Since diabetic retinopathy can develop and progress without warning, be sure to have regular eye exams in order to catch and treat these conditions early before your vision is permanently damaged.
There are different stages of diabetic retinopathy, and treatment varies accordingly. In the early stage (nonproliferative diabetic retinopathy), there may be retinal hemorrhages, small vessel closure, or tiny bulges of the retinal capillaries. These abnormal blood vessels may leak protein and fluid, causing swelling of the retina, called diabetic macular edema. The Early Treatment of Diabetic Retinopathy Study, sponsored by the National Eye Institute, has shown that early laser treatment in patients with diabetic macular edema can reduce by half the incidence of vision loss and increase the chance for visual improvement.
In the more advanced stage of diabetic retinopathy (proliferative retinopathy), there are weak blood vessels growing in the retina. These new blood vessels are fragile and can bleed easily. They can also cause traction on the retina and result in retinal detachment. The Diabetic Retinopathy Study showed laser treatment can result in regression of the new blood vessels and reduce the incidence of severe vision loss by 60%.
We use intraocular steroid medications to reduce macular edema not responsive to laser. Anti-vascular drugs injected into the eye can also reduce macular leakage and cause regression of new blood vessel growth. Eye Surgeons Associates was the first practice in Iowa to utilize the PASCAL® laser. This technologically advanced laser can deliver up to 25 laser spots at a time resulting in shorter, more comfortable treatments.
In addition to laser treatments, there is an intraocular surgery called vitrectomy. This may be necessary if there is significant bleeding in the eye that does not clear on its own or if there is pulling on the retina that has severely reduced the vision.