Diabetic Retinopathy - Mesa, Arizona.

Diabetic Eye Disease - Early Detection Is Seriously Vital.

Diabetes affects nearly 14 million Americans. If you have diabetes, it is important to learn as much as you can about the effect this can have on your vision. With proper knowledge and today's improved methods of diagnosis and treatment, you may have a substantially reduced risk of developing serious diabetic eye disease. We invite you to make an appointment and learn more: 480-981-6111.

Diabetes can cause blindness. More than 8000 diabetic patients in the US become blind every year. Eye disease in the form of diabetic retinopathy is the leading cause of blindness in patients aged 20 - 64 years. Early detection, along with improved lifestyle, is your best protection against permanent vision loss. By maintaining strict control of your blood sugar and scheduling regular eye exams, you can significantly affect the long term quality of your vision.

Diabetic retinopathy affects the retina and optic nerve.

What is Diabetic Retinopathy?

If you have diabetes mellitus, your body does not regulate blood sugar levels properly. High blood-sugar levels can cause damage to blood vessels throughout your body, but especially vulnerable are the blood vessels in the nerve layer at the back of the eye, called the retina, which senses light and helps to send images to the brain. Damage caused by diabetes to the retinal vessels is referred to as diabetic retinopathy.

Types of Diabetic Retinopathy.

Diabetic retinopathy can be broadly categorized into two types: non-proliferative (NPDR) and proliferative (PDR). Diabetic retinopathy is a progressive process. In general, there is a progression from non-proliferative to the more severe proliferative diabetic retinopathy, but this is not inevitable.

Non-Proliferative Diabetic Retinopathy

Non-Proliferative Diabetic Retinopathy (NPDR), commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form hard deposits called "exudates". Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is the result of macular edema and/or macular ischemia.

Diabetic Macular Edema

One of the earliest effects of diabetes is fluid leaking from retinal blood vessels. This leaking causes a swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is the most common cause of visual loss in diabetes. Vision loss may be mild to severe, but even in worst cases, peripheral vision continues to function. Any diagnosis of macular edema is an indication that breakdown of the retinal blood vessels from diabetes is starting to occur and requires careful monitoring.

Diabetic Macular Ischemia

Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly.

Proliferative Diabetic Retinopathy (PDR) may cause more severe vision loss than NPDR because it affects both central and peripheral vision.

As diabetic retinopathy begins to progress, the retinal blood vessels continue to weaken and begin to narrow and close. As the blood vessels close, they can no longer carry oxygen to the retinal tissue. Once deprived of sufficient oxygen and nutrients to maintain normal health and functioning, the retina responds by attempting to compensate by growing abnormal new vessels blood vessels - a process called neovascularization. The condition whereby retinal neovascularization exists is called proliferative diabetic retinopathy.

While new blood vessel growth or neovascularization might seem like a beneficial event, these new blood vessels are extremely fragile and tend to break easy and hemorrhage. If left untreated, proliferative diabetic retinopathy will in fact result in hemorrhage that leads to scarring and ultimately to retinal detachment with profound vision loss. Proliferative diabetic retinopathy is treated with either laser treatment or laser treatment in conjunction with a surgical procedure called a vitrectomy. The retinal surgeon will perform a vitrectomy in order to remove the vitreous that has become filled with blood or scar tissue.

Sometimes it may be possible for patients to have proliferative diabetic retinopathy and neovascularization and yet still have good vision. It is critical that in order to maintain that good vision the neovascularization be treated as quickly as possible even if it does appear to be causing any vision loss.

Diagnosis and Diabetic Eye Exams

A comprehensive medical eye examination, which includes a dilated retinal examination, is essential to detect changes inside your eye. The ophthalmologists at East Valley Ophthalmology can often diagnose and treat serious retinopahty before you are aware of any vision problems. Your ophthalmologist will dilate your pupil and look inside fo the eye with special equipment and lenses. Ancillary tests may be required depending on the severity of retinopathy discovered. These include color fundus photography, fluorescein angiography, and ultrasonography.

Unfortunately, because visual loss is often a late symptom of advanced retinopathy, many patients remain undiagnosed and are examined only after the optimal time for treatment has passed. Much of the complications can be prevented if the retinopathy is detected early enough for treatment. The optimal time for treatment is before you experience visual symptoms.

Patients with diabetes must be diligent and attentive to their eye care throughout their lives. The American Diabetic Association (ADA) recommends yearly eye examinations for all diabetic patients to detect blood vessel leakage and the presence of diabetic retinopathy in its earliest stages. While “screening photographs”, even through a dilated pupil may be of some use, it is not a substitute for a comprehensive diabetic eye examination by an ophthalmologist.

Diabetic patients may also be more prone to other significant eye problems such as glaucoma and cataracts and thus a comprehensive eye examination is a necessity. Depending on the severity and progression of diabetic retinopathy, it might be necessary to have an Intravenous Fluorescein Angiogram (IVF) on a regular basis in order to observe and record any changes to the retinal circulation. In general, most insurance carriers endorse and pay for regular annual diabetic eye exams with Intravenous Fluorescein Angiography as often as needed in order to help patients preserve vision. High quality diabetic eye care is an important event for all diabetic patients.

Treatment of Diabetic Retinopathy:

Laser Treatments for Diabetic Retinopathy

Vitrectomy for Diabetic Retinopathy

1) Drops are administered to dilate your pupils and numb your eyes.

2) In some cases, the area behind your eye may be numbed by injection as well to prevent any discomfort.

3) A special lens is placed onto your eye.

4) The lights in the office are dimmed. As you sit facing the laser, you may see flashes of light and notice a painless pinching sensation.

5) Your pupils will remain dilated for a few hours, so you will need to wear dark wraparound sunglasses afterwards and arrange for someone to drive you home.

Laser treatments are available for:

Studies on Laser Treatments for Diabetic Eye Disease

Three major clinical trials have conclusively demonstrated the value of argon laser photocoagulation surgery in reducing the rate of severe visual loss in patients with advanced diabetic retinopathy as well as in earlier stages of the disease and for the treatment of macular edema. Earlier surgery for severe proliferative retinopathy and vitreous hemorrhage has also been recommended.

The aforementioned clinical trials have shown that individuals who are treated appropriately are more likely to have better visual outcomes than those who are not. Panretinal scatter photocoagulation using the Argon laser reduces the rate of severe visual loss by over 50%. In this outpatient procedure laser light is directed into the eye through a special contact lens held on the eye while the patient sits at a slit lamp. Between 1000 and 2000 burns a fraction of a millimeter in size are evenly placed across the entire peripheral retina. This destruction of retinal tissue causes the proliferating vessels to disappear by a poorly understood mechanism.

Laser treatment of clinically significant macular edema also reduces the rate of subsequent visual loss substantially. In this case the leaking microaneurysms are treated directly with the argon laser to seal them and allow the edema to be resorbed preventing further vision loss. Vitrectomy and retinal detachment surgery may become necessary in cases of persistent, non-clearing vitreous hemorrhage and for traction retinal detachment due to scarring.

1) Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision.

2) Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.

3) Vitrectomy is often done under local anesthesia, which means that you will be awake during the operation. Tiny incisions are made in the sclera, or white of the eye. Then, small instruments are placed into the eye that remove the vitreous and replace it with the salt solution.

4) Your eye will be red and sensitive. You may be able to return home soon afterwards, or you may be asked to stay in the hospital overnight. An eye patch is required thereafter, for a few days or weeks to protect the eye, as well as medicated eye drops to protect against infection.

Ideal Treatment for Diabetic Retinopathy

The ideal treatment fo diabetic retinopathy is to prevent the development of the disease as much as possible, as  it is possible to maintain vision and prevent severe vision loss for many patients. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy. If high blood pressure and kidney problems are present, they need to be treated.

The eye specialists of East Valley Ophthalmology perform advanced technology diagnostic testing and treatment, as well as taking the time necessary to provide each patient with information needed to fully understand their condition and to achieve their best possible visual outcome.

If you would like further information, please call our office at:

480-981-6111

East Valley Ophthalmology

Eye Doctors - Mesa, Arizona

If you or a family member or friend have not had a recent routine eye examination, have a specific eye condition that needs addressing, or are looking for an eye specialist or professional eye consultant please take a moment to Request an Appointment.