Diabetic Eye Disease

What is diabetic eye disease?

Diabetic eye disease can affect many parts of the eye, including the retina, macula, lens, and the optic nerve. At Joseph Eye & Laser Center, we guide you through your options and help you determine the procedure that is customized for your specific needs. Dr. Christopher Joseph, DO, FACS, is an expert in the diagnosis and treatment of diabetic eye disease, as well as cataract and glaucoma surgery.

He pursued an extra year of training by completing a fellowship in Pittsburgh, PA, which specialized in laser cataract surgery and minimally invasive glaucoma surgery (MIGS). Dr. Joseph is also one of the few ophthalmologist in the United States to have been recognized for his excellence by the America College of Surgeons (ACS). In 2018, the ACS nominated Dr. Joseph as a Fellow of the American College of Surgeons (FACS).

Diabetic eye disease is a group of several eye conditions that can affect people with diabetes:

• Diabetic retinopathy affects blood vessels in the light-sensitive tissue called the retina that lines the back of the eye. It is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults.
• Diabetic macular edema (DME) is a consequence of diabetic retinopathy, DME is swelling in an area of the retina called the macula.

Diabetic eye disease also includes cataract and glaucoma:

• Cataract or clouding of the lens of the eye. Adults with diabetes are 2-5 times more likely than those without diabetes to develop cataracts. Cataracts also tend to develop at an earlier age in people with diabetes.
• Glaucoma is a group of diseases that damages the optic nerve of the eye. The bundle of nerve fibers that connects the eye to the brain. Some types of glaucoma are associated with elevated pressure inside the eye. In adults, diabetes nearly doubles the risk of glaucoma.

All forms of diabetic eye disease have the potential to cause severe vision loss and blindness.

Diabetic Retinopathy

What causes diabetic retinopathy?

Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy. The retina detects light and converts it to signals sent through the optic nerve to the brain. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or hemorrhage (bleed), distorting vision. In its most advanced stage, new abnormal blood vessels proliferate (increase in number) on the surface of the retina, which can lead to scarring and cell loss in the retina.

Who is at risk for diabetic retinopathy?

People with all types of diabetes (type 1, type 2, and gestational) are at risk for diabetic retinopathy. Risk increases the longer a person has diabetes. Between 40 and 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy, although only about half are aware of it. Women who develop or have diabetes during pregnancy may have rapid onset or worsening of diabetic retinopathy.

Symptoms and Detection

What are the symptoms of diabetic retinopathy and DME?

The early stages of diabetic retinopathy usually has no symptoms. The disease often progresses unnoticed until it affects vision. Bleeding from abnormal retinal blood vessels can cause the appearance of “floating” spots. These spots sometimes clear on their own. However without prompt treatment, bleeding often recurs, increasing the risk of permanent vision loss. If DME occurs, it can cause blurred vision.

How are diabetic retinopathy and DME detected?

Diabetic retinopathy and DME are detected during a comprehensive dilated eye exam that includes:

1. Visual acuity testing. This eye chart test measures a person’s ability to see at various distances.
2. Tonometry. This test measures pressure inside the eye.
3. Pupil dilation. Drops placed on the eye’s surface dilate (widen) the pupil, allowing a physician to examine the retina and optic nerve.
4. Optical coherence tomography (OCT). This technique is similar to ultrasound but uses light waves instead of sound waves to capture images of tissues inside the body. OCT provides detailed images of tissues that can be penetrated by light, such as the eye.

A comprehensive dilated eye exam allows the doctor to check the retina for:

1. Changes to blood vessels.
2. Leaking blood vessels or warning signs of leaky blood vessels, such as fatty deposits.
3. Swelling of the macula (DME).
4. Changes in the lens.
5. Damage to nerve tissue.

Prevention and Treatment

How can people with diabetes protect their vision?

Vision lost to diabetic retinopathy is sometimes irreversible; however, early detection and treatment can reduce the risk of blindness by 95 percent. Since diabetic retinopathy often lacks early symptoms, people with diabetes should have a comprehensive dilated eye exam at least once a year. People with diabetic retinopathy may need eye exams more frequently. Women with diabetes who become pregnant should have a comprehensive dilated eye exam as soon as possible. Additional exams during pregnancy may be needed.

Only your eye surgeon, can assess whether you have diabetic eye disease, cataract or glaucoma related to your diabetes and determine the necessary treatments or surgeries, for these diseases. These procedures are extremely safe and have a high success rate, however, the use of cutting-edge technology can be difficult to master, so picking the right surgeon is critical. Dr. Joseph is fellowship-trained in minimally invasive glaucoma surgery (MIGS) and laser glaucoma surgery (SLT). As well as, LASER cataract surgery, dropless cataract surgery, and high-tech lens implants (IOLs).

If you would like to learn more about any of our diabetic eye disease evaluations, cataract or MIGS procedures, contact the trusted experts at Joseph Eye & Laser Center today at (330) 619-3155.