Diabetes is a serious condition affecting more than 29 million Americans. While someone with diabetes has to see a number of doctors for this condition, it’s important they not forget that an ophthalmologist should be one of them.
Diabetes can lead to permanent eye damage. Patients can develop diabetic retinopathy and are also at higher risk for developing cataracts, glaucoma, eye muscle problems causing double vision, and retinal detachments, CEENTA ophthalmologist Nehali V. "Nikki" Saraiya, MD said.
Diabetic Retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina change, sometimes swelling and leaking fluid or closing off completely, Dr. Saraiya said. Sometimes abnormal new blood vessels grow on the surface of the retina.
There are two types of diabetic retinopathy: nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR is the earliest stage of diabetic retinopathy, when damaged blood vessels in the retina begin to leak extra fluid and small amounts of blood into the eye. Cholesterol or other fats from the blood may also leak into the retina. Also, the leaking fluid can cause a swelling or thickening of the macula, called macular edema. This is the most common cause of vision loss related to diabetes. Macular ischemia is when small blood vessels close and don’t provide adequate oxygen to the macula, causing the patient’s vision to blur.
Many people with diabetes have mild NPDR, which usually does not affect their vision, Dr. Saraiya said. However, if their vision is affected, it is because of macular edema or macular ischemia.
PDR mainly occurs when many blood vessels in the retina close off, preventing enough blood flow. The retina responds by growing new blood vessels in an attempt to supply blood to the area where the original blood vessels closed. However, the new vessels are fragile and can bleed and fill the back portion of the eye with blood. The new blood vessels are also often accompanied by scar tissue that may cause the retina to wrinkle or detach, Dr. Saraiya said.
If the retina wrinkles it can distort vision, and more severe vision loss can occur if the macula or large areas of the retina are detached, Dr. Saraiya said.
"PDR may cause more severe vision loss than NPDR because it can affect both central and peripheral vision," Dr. Saraiya said. With a vitreous hemorrhage, the fragile new blood vessels can bleed into the vitreous – the gel in the center of the eye – preventing light rays from reaching the retina. If it’s a small hemorrhage, the patient may only see a few new, dark floaters, but a large hemorrhage might block out all vision, allowing them to see only light and dark. However, when the blood clears vision may return to its former level unless the macula has been damaged.
If a number of retinal vessels are closed, the new blood vessels may block the normal flow of fluid out of the eye. Pressure builds up in the eye, a particularly severe condition that causes damage to the optic nerve, Dr. Saraiya said.
People with diabetic retinopathy often don’t notice vision changes in the disease’s early stages, but as it progresses it usually causes vision loss that in many cases can’t be reversed. The longer the duration of diabetes, and the more uncontrolled the blood sugar, the more likely patients will suffer long-term damage.
Diabetic patients should get their eyes checked regularly. Once a patient is diagnosed with diabetes, their primary care physician will refer them to an ophthalmologist to have their eyes checked with a dilated eye exam once a year, Dr. Saraiya said. Yearly exams are recommended initially, but if retinopathic changes are noticed, their eye doctor may ask them to come in more frequently. If treatments are needed, they will likely be referred to a retina specialist for laser treatments, injections of medications into the eye, or surgery.
Diabetic eye problems are preventable, though, Dr. Saraiya said. Patients can prevent retinopathy and other related visual loss through tight blood sugar, blood pressure, and cholesterol control. This can be done through a combination of a good diet, regular exercise, and taking medications as directed by their primary care physician.
Dr. Saraiya sees patients in our SouthPark, Matthews, and Pineville offices. To make an appointment with her or one of the ophthalmologists at one of our optical locations across North Carolina, call 704-295-3000.
This blog is for informational purposes only. For specific medical questions, please consult your physician.
CEENTA ophthalmologist Elliot McKee, MD, appeared on WSOC's The Daily Two on November 29, 2023, to discuss eye misalignment, strabismus, and blurry vision.
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