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Don’t Let Diabetic Retinopathy Take Your Vision

By Sunir Garg, MD, told to Hallie Levine

Diabetic retinopathy, a type of diabetic eye disease, is a leading cause of blindness in the United States. Despite this, nearly 40% of people with diabetes do not have an annual eye exam. But these screening tests are essential because they can prevent vision loss by detecting diabetic retinopathy in the early, more treatable stages of the disease.

Diabetic retinopathy can lead to permanent vision loss.

Many people are surprised to learn that diabetic retinopathy is the most common cause of vision loss in people with diabetes. Here is a quick introduction.

Diabetes is a disease that affects small blood vessels throughout the body, including the delicate blood vessels at the back of the eye. These blood vessels are like pipes: when damaged, they weaken and begin to leak. Over time, these tiny blood vessels spill blood and plasma onto your retina. This causes the retinal tissue to swell, which results in cloudy or blurry vision. It also causes damage that leads to a decrease in the supply of oxygen and other nutrients to your retina.

Sometimes your body tries to correct the problem by making new blood vessels. But these blood vessels are fragile and can burst and bleed, or form scar tissue that tears your retina away from the wall of your eye. All of these scenarios can ultimately lead to blindness.

You can have diabetic retinopathy and not know it.

The disease often has no symptoms in its early stages, which is why a yearly eye exam is so important. As it gets worse, you may notice symptoms such as:

  • blurred vision
  • Vision that goes from blurry to clear
  • Empty or dark areas in your field of vision
  • Floaters or dark spots in your vision
  • Poor night vision
  • Colors seem faded

Unfortunately, patients often don’t see an eye doctor until they experience symptoms such as floaters or blurred vision, and by then the damage has been done.

You can do a lot to treat diabetic retinopathy.

When we notice signs of diabetic retinopathy during a patient’s routine eye exam, the patient is often very scared. They fear losing their sight. But most of the time, their illness is mild. We explain that the best way to stop vision loss is to make sure their blood sugar and blood pressure are well controlled. They must carefully monitor their diet and take all their medications as prescribed. Often we show patients a picture of their eyeball so they can see the damage caused by their diabetes. That’s usually enough to help them understand why controlling blood sugar and blood pressure is so important to their overall well-being.

But if your disease is more advanced, don’t panic. The first step is a class of drugs called anti-VEGF. These medications help reduce eye swelling, which can slow vision loss and even improve vision. It is given by injection, injected into your eye at your eye doctor’s office. Laser surgery can also help seal leaky blood vessels, shrink abnormal blood vessels, and reduce retinal swelling. If you have a very advanced case, you may need a type of eye surgery known as a vitrectomy. An eye surgeon will remove blood and plasma from your eye and remove scar tissue from your retina. It will also help you see more clearly again.

Regular eye exams are essential.

People with diabetes should have a routine eye exam every year by an ophthalmologist (either an ophthalmologist or an optometrist). This is true even if you otherwise have 20/20 vision. Your doctor will give you drops to dilate or widen your pupils so they can look inside your eyes to check for diabetic retinopathy or other eye problems.

If you’ve just been diagnosed with diabetes, you need an eye exam right away to make sure your eyes are okay. After that, you should have an eye exam every year – more frequently if you have diabetes-related eye problems, such as diabetic retinopathy.

There are also other times in your life when you might need a comprehensive eye exam. Women with diabetes who are pregnant, for example, need an eye exam every trimester because changes in blood pressure and fluid retention can make their diabetes worse.

Interestingly enough, you should also have your eyes checked once your diabetes is well under control. For some reason, this change may lead to worsening diabetic eye disease in some patients. We don’t know why, other than your body has gotten used to things being hot and your eyes don’t know how to deal with this sudden change.

The good news is that most diabetic patients who have regular eye exams and develop diabetic retinopathy end up doing just fine. When we monitor them appropriately and deal with problems as they arise, we can enable the vast majority of patients to see well for years, sometimes even a lifetime. But the doctor and the patient must work together to make it happen.

webmd Gt

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