Diabetic Retinopathy

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Diabetes has reached epic proportions in the United States. Some 26 million Americans over the age of 20 have diabetes—and another 79 million are at risk of developing it, according to a 2011 report from the American Diabetes Association. The numbers are even more dramatic as people age: almost 11 million adults age 65 and older have diabetes, representing almost a quarter of the over-65 population.

Diabetes Affects More Than Your Eyes

Diabetes occurs when the pancreas is no longer able to secrete enough insulin for our body to transfer the glucose, metabolized from the food we eat, from the blood stream into the cells throughout the body where it is used for fuel. As a result, diabetics tend to have very high levels of blood sugar circulating throughout the body. If not properly controlled, with injections of insulin or through medications, over time this elevated blood sugar can damage small blood vessels throughout the body, including those in the eyes, kidneys and peripheral nerves of the feet.

Diabetes is a Leading Cause of Blindness

When the blood vessels in the back of the eyes are affected, a person is said to have diabetic retinal disease, or diabetic retinopathy. Approximately 1 million adults have diabetic retinopathy, making it the leading cause of visual impairment and blindness among those ages 20 to 74.

Here’s what happens: Elevated blood sugar levels cause the small blood vessels in the retina to weaken and become porous, which can make them leak blood and fluid into the eye. This may cause blurriness and can also cause swelling, or edema. If the swelling involves the macula—which is in the center of the retina and is responsible for high-definition vision—vision can worsen dramatically. Macular edema is present in up to 40 percent of patients with moderate diabetic retinopathy.

Uncontrolled blood sugar can also cause the small vessels in the back of the eye to become blocked, so that parts of the retina do not receive enough oxygen. This is called ischemia, and triggers the formation of new, abnormal blood vessels that try to compensate for the lack of oxygen. These abnormal blood vessels are fragile and prone to bleeding into the inner cavity of the eye, with devastating visual consequences. Scar tissue also can form along with the new fragile vessels, causing the retina to detach from the back of the eye. If not surgically repaired promptly, this can lead to permanent loss of vision.

Treatment for Diabetic Retinopathy

The gold standard of treatment for patients with diabetic retinopathy is laser photocoagulation. A procedure called scatter or panretinal photocoagulation involves the application of hundreds of microscopic laser spots to the outer regions of the retina. This causes the abnormal blood vessels to shrink and reduces the risk of bleeding and retinal detachment. When macular edema is present, the laser is used to seal the leaking blood vessels. Two landmark clinical trials sponsored by the National Eye Institute have demonstrated the benefits of laser photocoagulation for new blood vessels and macular edema.

New Treatments for Retinal Disease

In 2010, a new form of treatment emerged for adults with diabetic retinopathy. The same medications that are used to treat leaking blood vessels in patients with age-related macular degeneration—Avastin and Lucentis—are also powerfully effective in reducing the leakage from blood vessels damaged by diabetes. These medications have given our patients with reduced vision the best chance for visual improvement. They also appear to stop further progression of diabetic retinopathy. If the data stands the test of time, this could be a game-changer. Imagine receiving two or three injections of medicine each year and virtually eliminating the risk of losing one’s sight.

Of course, the best way to avoid diabetic retinopathy is through prevention. Studies show that if you have diabetes, you can reduce your risk of developing diabetic retinopathy by about 25 percent by exercising moderately, avoiding smoking, and intensely controlling your blood sugar, blood pressure and cholesterol.

If you’ve been diagnosed with diabetes, you should receive a dilated retinal exam every year. Up to 90 percent of all cases of diabetic blindness can be prevented with early diagnosis and timely treatment.

For an appointment, please call the office of retinal specialist Joseph “Jack” Timmes, Jr., M.D., at 703-560-7797.

 

***This post is for information purposes only. This posting does not offer medical advice, so nothing in it should be construed as medical advice. The information on this blog/post is only offered for informational purposes. You shouldn’t act or rely on anything in this blog or posting or use it as a substitute for medical advice from a licensed professional. The content of this posting may quickly become outdated, especially due to the nature of the topics covered, which are constantly evolving. The materials and information on this posting/blog are not guaranteed to be correct, complete, or timely. Nothing in this posting/blog and nothing you or I do creates a doctor-patient relationship between you and the blog; between you and me; or between you and Joseph J. Timmes, Jr., M.D., F.A.C.S. or NovaRetina.com. Even if you try to contact me through the blog or post a comment on the blog you are still not creating a doctor-patient relationship. Although, I am a doctor, I’m not YOUR doctor until and unless there is a written agreement specifically providing for a doctor-patient relationship.***
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