When you hear the word “diabetes,” you probably think of daily blood tests, insulin injections and sugar restrictions. While those are some of the familiar daily struggles with this disease, there are many other complications associated with diabetes. Did you know that diabetes can cause serious eye problems? Diabetic eye disease has the potential to cause severe vision loss and blindness. November is Diabetic Eye Disease Awareness Month, so Dr. Belmont would like to take this opportunity to describe some of the causes and treatments of this lesser-known complication of diabetes, as well as provide some preventative tips.
Diabetic eye disease is comprised of four eye conditions that affect people with diabetes: diabetic retinopathy, diabetic macular edema (DME), cataracts and glaucoma. Diabetic retinopathy affects the blood vessels in the light-sensitive tissue called the retina. The retina detects light and converts it to signals sent via the optic nerve to the brain. As the retinal blood vessels are damaged, vision is distorted. This is the most common cause of vision loss among people with diabetes.
Diabetic macular edema (DME) is a direct result of diabetic retinopathy. A build-up of fluid from damaged and leaking blood vessels causes swelling in an area of the retina called the macula. The macula is the most sensitive part of the retina and is necessary for the keen, straight-ahead vision that is used for everyday activities like reading or recognizing faces. Approximately 50 percent of people with diabetic retinopathy will eventually develop DME.
Cataract and glaucoma are not direct results of diabetes but a diabetic adult has an increased likelihood of developing these conditions.
Diabetic retinopathy treatment is often delayed until it becomes severe or DME is observed. In cases of severe diabetic retinopathy, laser surgery can be used to shrink abnormal blood vessels. This treatment can preserve central vision but sometimes at the expense of some peripheral, color and night vision.
Once DME occurs, there are several treatments that can be used alone or in combination.
Anti-VEGF injection therapy uses drugs injected into the eye to block production of a specific protein (VEGF). This protein can stimulate the growth of abnormal blood vessels and blocking it can reverse this growth and decrease fluid in the retina, thereby improving vision. Most people undergoing this treatment require monthly injections for the first six months, but after initial treatment, injections are needed less frequently.
In macular laser surgery, leaking blood vessels are singed with a laser to slow the leakage of fluid and reduce swelling in the retina. In many cases one session of treatment is sufficient, but some people may need additional sessions. This surgery is sometimes used in conjunction with anti-VEGF injections or if anti-VEGF injections are not effective.
Corticosteroids can be injected or implanted into the eye to suppress DME. Prolonged use of these drugs increases the risk of cataract and glaucoma so patients using corticosteroids should be closely monitored for these conditions.
Controlling diabetes can prevent or delay vision loss. It is important to take medications as directed, get enough exercise and eat a healthy diet. The beginning stages of diabetic retinopathy often have no symptoms and commonly go unnoticed until vision is affected. Annual comprehensive eye exams are a crucial tool for early detection. Sometimes the vision lost to diabetic retinopathy is irreversible but early detection and treatment can reduce the risk of blindness by 95 percent.
If you have questions or think that you are at risk of developing diabetic eye disease, contact Dr. Sandra Belmont at (212)-486-2020.