Diabetes Living with Diabetes

Save Your Sight: Preventing Vision Loss from Diabetes

Are there early warning signs of diabetic retinopathy?
There can be, but the big problem with the disease is that it's often silent until suddenly major vision loss occurs. People might notice that their vision's getting blurry or a sudden onset of floating spots in their vision. These signs may indicate substantially advanced retinopathy.

Is retinopathy ever a first sign of diabetes?
Yes, in the population-based studies that have been done, a number of people who had diabetic retinopathy had not realized they had diabetes.

How often should people be screened for retinopathy?
Some studies have found that only 41 percent of people with diabetes are getting annual eye exams. It's recommended that everybody with type 2 diabetes, or the adult-onset type of diabetes, be screened annually for diabetic retinopathy and persons with type 1 diabetes should be screened annually, beginning five years after they were diagnosed with diabetes.

What does that eye exam involve?
Generally, a complete eye exam is done, but the key part of the exam is to examine the retina while the pupil is dilated. This involves what is called indirect ophthalmoscopy, which allows me to look through a lens at the retina, so I get a panoramic view of all the different parts of the retina.

It's best to be screened on a regular basis. Clinical experience suggests that there are a number of people who come in too late, or at a point where we're sort of picking up pieces rather than preventing things from going wrong.

How is diabetic retinopathy treated?
Laser treatment for diabetic retinopathy has been the subject of some of the most successful clinical trials ever done in the field of ophthalmology because the risk of progressing to severe vision loss from diabetic retinopathy can be reduced by as much as 90 percent.

There are also a number of promising pharmacologic treatments for diabetic retinopathy in development, although none of them have been approved by the Food and Drug Administration as of yet.

Who is eligible for laser treatment and what does it involve?
Laser treatment is available to people with certain kinds of diabetic retinopathy. If someone develops clinically significant macular edema, or swelling of the retina, they are treated with what's called focal laser treatment or grid laser treatment. This involves making small little burns in the retina that are aimed at leaky blood vessels to prevent them from leaking. If a person develops increased leaking over time or new areas of leakage, there might be a need for subsequent laser treatments.

The advanced stage of retinopathy, or proliferative retinopathy, is treated with another kind of laser, so the demand for blood supply is reduced and the drive to develop the new blood vessels is removed. This usually leads to regression of the disease and often it's not necessary to give further treatments.

Are there side effects of laser treatment?
Laser treatment for people with proliferative disease can cause people to have slightly reduced subjective color vision, maybe more difficulty seeing at night and maybe a loss of about one line on the vision chart. That's compared to 50 percent of people developing visual acuity of 20/800 or worse within a few years if they don't get the treatment. So there's a tremendous tradeoff there.

The laser treatment for clinically significant macular edema has fewer side effects, although people will often describe that there are little spots that are missing or reduced in their vision in one eye or the other.

What is your overall advice to people with diabetes with regard to their eye health?
There are two things they can do to reduce the risk of blindness. The most important thing is to try to prevent diabetic retinopathy from occurring by controlling their blood sugar, controlling hypertension, if it exists, and controlling their blood lipids, such as cholesterol, if they're abnormal. The other thing is to come for the eye exams, which enables the ophthalmologist to provide treatment to prevent severe vision loss.

So both primary prevention and secondary prevention are strongly recommended. The primary prevention can also prevent the numerous other complications of diabetes that can occur, too, such as kidney disease, nerve disease and higher risk of heart problems.

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