Diabetic Eye Disease
What is Diabetic Retinopathy?
If you have diabetes, you are at risk for developing diabetic retinopathy, which can lead to vision loss. Diabetes can cause weakening of the tiny, delicate blood vessels in your retina. If you develop retinopathy, it may cause leakage or closure of capillaries (tiny blood vessels) or growth of new weak capillaries. There are two main types of diabetic retinopathy: nonproliferative retinopathy (blood vessels leak and then close) and proliferative retinopathy (new, weak blood vessels grow, or proliferate).
How is vision affected by diabetic retinopathy?
In the early stages of both types of diabetic retinopathy, you may have little or no vision loss. As the nonproliferative type develops, you may experience moderate to severe vision loss as fluid deposits and swelling occurs. With the proliferative type, abnormal new blood vessels can grow along the surface of the retina and later into the vitreous (fluid inside the eye). If these blood vessels rupture and bleed, they can cloud or blur vision, causing scarring, and retinal detachment which may lead to a further decrease in vision or a total loss of vision.
Diabetic retinopathy can develop rapidly and without immediate warning signs; therefore, it is important to see your ophthalmologist regularly. If you experience cloudy or blurry vision, or black streaks, contact your ophthalmologist for an exam. By seeing your ophthalmologist once a year or more, diabetic retinopathy can be diagnosed and treated early, before your vision is damaged. Controlling your blood sugar and blood pressure, eating healthy, and exercising can also slow the development of diabetic retinopathy.
Treatment Options for Diabetic Retinopathy
Controlling your blood sugar and blood pressure can stop vision loss. Carefully follow the diet your nutritionist has recommended. Take the medicine your diabetes doctor prescribed for you. Sometimes, good sugar control can even bring some of your vision back. Controlling your blood pressure keeps your eye’s blood vessels healthy.
One type of medication is called anti-VEGF medication. These include Avastin, Eylea, and Lucentis. Anti-VEGF medication helps to reduce swelling of the macula, slowing vision loss and perhaps improving vision. This drug is given by injections (shots) in the eye. Steroid medicine is another option to reduce macular swelling. This is also given as injections in the eye. Your doctor will recommend how many medication injections you will need over time.
Laser surgery might be used to help seal off leaking blood vessels. This can reduce swelling of the retina. Laser surgery can also help shrink blood vessels and prevent them from growing again. Sometimes more than one treatment is needed.
If you have advanced PDR, your ophthalmologist may recommend surgery called vitrectomy. Your ophthalmologist removes vitreous gel and blood from leaking vessels in the back of your eye. This allows light rays to focus properly on the retina again. Scar tissue also might be removed from the retina.
Your ophthalmologist can provide more detailed information about the treatment that is best for your diagnosis and explain the benefits and risks of each procedure.
Age-Related Macular Degeneration
What is Age-Related Macular Degeneration?
Macular degeneration is damage or breakdown of the macula. The macula is a small area at the back of the eye that allows us to see fine details clearly. When the macula doesn’t function correctly, we experience blurriness or darkness in the center of our vision. Macular degeneration affects both distance and close vision, and can make some activities – like threading a needle or reading – difficult or impossible.
Although macular degeneration reduces vision in the central part of the retina, it does not affect the eye’s side or peripheral vision. For example, you could see the outline of a clock but not be able to tell what time it is. Macular degeneration alone does not result in total blindness. People continue to have some useful vision and are able to take care of themselves.
What Causes Macular Degeneration?
Many older people develop macular degeneration as part of the body’s natural aging process. The two most common types of age-related macular degeneration are “dry” (atrophic) and “wet” (exudative.)
“Dry” macular degeneration: Most people have dry macular degeneration. It is caused by aging and the thinning of the tissues of the macula. Vision loss is usually gradual.
“Wet” macular degeneration: Wet macular degeneration accounts for about 10% of all cases. It results when abnormal blood vessels form at the back of the eye. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.
What Are the Symptoms of Macular Degeneration?
Macular degeneration can cause different symptoms in different people. The condition may be hardly noticeable in its early stages. Sometimes only one eye loses vision while the other eye continues to see well for many years. When both eyes are affected, the loss of central vision may be noticed more quickly.
The following are some common ways that vision loss is detected:
- Words on a page look blurred
- A dark or empty area appears in the center of vision
- Straight lines look distorted as in the following diagram
How is Macular Degeneration diagnosed?
Many people do not realize that they have a macular problem until blurred vision becomes obvious. Your ophthalmologist can detect early stages of macular degeneration during a medical eye examination that includes the following:
- Viewing the macula with an ophthalmoscope
- A simple vision test where you look at a grid resembling graph paper
- Sometimes special photographs called angiograms are taken to find abnormal blood vessels under the retina. Fluorescent dye is injected into your arm and your eye is photographed as the dye passes through the blood vessels in the back of the eye.
Treatment Options for Age-Related Macular Degeneration
To help treat wet AMD, there are medications called anti-VEGF drugs. Anti-VEGF treatment helps reduce the number of abnormal blood vessels in your retina. It also slows any leaking from blood vessels. This medicine is delivered to your eye through a very slender needle.
Once abnormal blood vessels form, several treatments are available. However, patients do better if we catch the vessels in the early stages of the disease. This is why people with macular degeneration are asked to check their maculas by doing Amsler grid testing separately in each eye every day.
Laser surgery may also be used to treat some types of wet AMD. Your eye surgeon shines a laser light beam on the abnormal blood vessels. This reduces the number of vessels and slows their leaking.
Source: American Academy of Ophthalmology https://www.aao.org/eye-health/diseases/amd-macular-degeneration
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Flashes & Floaters
What are Floaters?
Floaters are little “cobwebs” or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.
In most cases, floaters are part of the natural aging process and simply an annoyance. They can be distracting at first, but eventually tend to “settle” at the bottom of the eye, becoming less bothersome. They usually settle below the line of sight and do not go away completely. Most people have floaters and learn to ignore them; they are usually not noticed until they become numerous or more prominent. Floaters can become apparent when looking at something bright, such as white paper or a blue sky.
What causes Floaters?
Floaters occur when the vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape, slowly shrinks. As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina. These are floaters.
Floaters are more likely to develop as we age and are more common in people who are very nearsighted, have diabetes, or who have had a cataract operation. There are other, more serious causes of floaters, including infection, inflammation (uveitis), hemorrhaging, retinal tears, and injury to the eye.
When are Floaters a problem?
Sometimes a section of the vitreous pulls the fine fibers away from the retina all at once, rather than gradually, causing many new floaters to appear suddenly. This is called a vitreous detachment, which in most cases is not sight-threatening and requires no treatment.
However, a sudden increase in floaters, possibly accompanied by light flashes or peripheral (side) vision loss, could indicate a retinal detachment. A retinal detachment occurs when any part of the retina, the eye’s light-sensitive tissue, is lifted or pulled from its normal position at the back wall of the eye.
A retinal detachment is a serious condition and should always be considered an emergency. If left untreated, it can lead to permanent visual impairment within two or three days or even blindness in the eye. Those who experience a sudden increase in floaters, flashes of light in peripheral vision, or a loss of peripheral vision should have an eye care professional examine their eyes as soon as possible.
Treatment Options for Floaters
For people who have floaters that are simply annoying, no treatment is recommended. On rare occasions, floaters can be so dense and numerous that they significantly affect vision. In these cases, a vitrectomy, a surgical procedure that removes floaters from the vitreous, may be needed.
A vitrectomy removes the vitreous gel, along with its floating debris, from the eye. The vitreous is replaced with a salt solution. Because the vitreous is mostly water, you will not notice any change between the salt solution and the original vitreous.
This operation carries significant risks to sight because of possible complications, which include retinal detachment, retinal tears, and cataract. Most eye surgeons are reluctant to recommend this surgery unless the floaters seriously interfere with vision.
What are flashes?
Flashes can look like flashing lights or lightning streaks in your field of vision. Some people compare them to seeing “stars” after being hit on the head. You might see flashes on and off for weeks, or even months. Flashes happen when the vitreous rubs or pulls on your retina.
As people age, it is common to see flashes occasionally.
When floaters and flashes are serious?
Most floaters and flashes are not a problem. However, there are times when they can be signs of a serious condition. Here is when you should call an ophthalmologist right away:
- you notice a lot of new floaters
- you have a lot of flashes
- a shadow appears in your peripheral (side) vision
- a gray curtain covers part of your vision
These floaters and flashes could be symptoms of a torn or detached retina. This is when the retina pulls away from the back of your eye. This is a serious condition that needs to be treated.
Source: American Academy of Ophthalmology https://www.aao.org/eye-health/diseases/floaters-flashes-treatment
What Is a Detached Retina?
A detached retina is when the retina lifts away from the back of the eye. The retina does not work when it is detached, making vision blurry. A detached retina is a serious problem. An ophthalmologist needs to check it out right away, or you could lose sight in that eye.
How Do You Get a Detached Retina?
As we get older, the vitreous in our eyes starts to shrink and get thinner. As the eye moves, the vitreous moves around on the retina without causing problems. But sometimes the vitreous may stick to the retina and pull hard enough to tear it. When that happens, fluid can pass through the tear and lift (detach) the retina.
Who Is at Risk for a Retinal Detachment?
You are more likely to have a detached retina if you:
- need glasses to see far away (are nearsighted)
- have had cataract, glaucoma, or other eye surgery
- take glaucoma medications that make the pupil small (like pilocarpine)
- had a serious eye injury
- had a retinal tear or detachment in your other eye
- have family members who had retinal detachment
- have weak areas in your retina (seen by an eye doctor during an exam)
Early Signs of a Detached Retina
A detached retina has to be examined by an ophthalmologist right away. Otherwise, you could lose vision in that eye. Call an ophthalmologist immediately if you have any of these symptoms:
- Seeing flashing lights all of a sudden. Some people say this is like seeing stars after being hit in the eye.
- Noticing many new floaters at once. These can look like specks, lines or cobwebs in your field of vision.
- A shadow appearing in your peripheral (side) vision.
- A gray curtain covering part of your field of vision.
Treatment Options for Detached Retina
Surgery is done to repair a detached retina. Here are some types of detached retina surgery:
Your ophthalmologist puts a gas bubble inside your eye. This pushes the retina into place so it can heal properly. Afterwards, you will need to keep your head in a very specific position as your doctor recommends for a few days. This keeps the bubble in the right place. As your eye heals, your body makes fluid that fills the eye. Over time, this fluid replaces the gas bubble.
Your ophthalmologist removes the vitreous pulling on the retina. The vitreous will be replaced with an air, gas, or oil bubble. The bubble pushes the retina into place so it can heal properly. If an oil bubble is used, your ophthalmologist will remove it a few months later. With an air or gas bubble, you cannot fly in an airplane, travel to high altitudes or scuba dive. This is because altitude change causes the gas to expand, increasing eye pressure.
A band of rubber or soft plastic is sewn to the outside of your eyeball. It gently presses the eye inward. This helps the detached retina heal against the eye wall. You will not see the scleral buckle on the eye. It is usually left on the eye permanently.