EYE CONDITIONS

DIABETIC EYE DISEASE

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness. Diabetic eye disease may include: cataract - clouding of the lens; glaucoma - increase in fluid pressure inside the eye that leads to optic nerve damage and vision loss; or, Diabetic Retinopathy - damage to the blood vessels in the retina.

Diabetic Retinopathy

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina, the light-sensitive tissue at the back of the eye that is necessary for good vision. If you have diabetic retinopathy, at first you may not notice changes to your vision; but over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

Causes of Diabetic Retinopathy

Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

1. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses.

2. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.

Symptoms of Diabetic Retinopathy

Often there are no symptoms in the early stages of the disease, nor is there any pain. Don't wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year. Blurred vision may occur when the macula swells from leaking fluid. If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision.

If bleeding does occur, you will first see a few spots (specks of blood) "floating" in your vision. If spots occur, you may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep. Sometimes, without treatment, the spots clear and you will see better; however, bleeding can reoccur and cause severely blurred vision. If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. The earlier you receive treatment, the more likely treatment will be effective.

Risk Factors

All people with diabetes - both type 1 and type 2 - are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression. During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

Protecting Against Diabetic Retinopathy

If you have diabetes, get a comprehensive dilated eye exam at least once a year. Remember, proliferative retinopathy and macular edema can develop without symptoms at any stage of diabetic retinopathy and you can still see fine; however, you are still at high risk for vision loss. Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss. If you already have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.

Treatment of Macular Edema

Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula (see image right). These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session, but further treatment may be needed. Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved.

Treatment of Diabetic Retinopathy

During the first three stages of diabetic retinopathy, no treatment is needed unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure and blood cholesterol.

Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink (see image left). Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your peripheral (side) vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision. Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible. If the bleeding is severe, you may need a surgical procedure called a vitrectomy where blood is removed from the center of your eye.

DIABETES AND VISION LOSS

Diabetes is the number one cause of visual impairment and blindness among working-age adults. An estimated 300,000 people in the U.S. have diabetes and vision impairment. Each year, another 37,000 experience severe vision loss due to diabetes. With the onset of vision loss, the person must not only continue their diabetic self-care tasks, but also must now learn to perform these tasks as a visually impaired person.

Independent Diabetic Self-Care for the Visually Impaired

Cleveland Sight Center partners with other agencies – including the Diabetes Association – to provide information and education that is specific to the needs of each individual, as well as to teach indepedent care skills. Cleveland Sight Center specialists teach diabetic self-care skills, including how to measure medicines, how to administer insulin and how to use an audio-adaptive blood glucose monitor. We also teach the skills of daily living, including how to get around safely in the home and outside, how to cook, clean, do laundry and many other routine activities. Cleveland Sight Center is actively involved with national organizations and diabetes associations around the country, joining with them in advocacy efforts.

Adaptive Diabetes Education for the Visually Impaired

Cleveland Sight Center’s diabetes education efforts enable people who have both diabetes and vision loss to perform self-care tasks independently, and plan for additional assistance. Cleveland Sight Center offered the first program in the Cleveland area with specialized services for people with diabetes and visual impairment. Today’s efforts work in partnership with many other community diabetes care resources. To insure continuity of care, Cleveland Sight Center professionals serve as rehabilitation consultants for the primary diabetes care providers.

If you or someone you know is experiencing visual impairment as a result of diabetes and self-care is becoming difficult, contact Cleveland Sight Center's Case Management department at (216) 791-8118.