Diabetic Retinopathy

with Dr. Raphael Rosenbaum

Diabetic Retinopathy


What is diabetic eye disease?

Diabetic eye disease refers to a constellation of eye problems that may develop as a complication from poorly controlled or undiagnosed diabetes mellitus.  If neglected diabetic eye disease can lead to permanent visual loss.

Diabetic eye disease can lead to the formation of; diabetic retinopathy,  premature cataract formation, and glaucoma.  All of these can lead to devastating visual loss.

What is diabetic retinopathy?

Diabetic retinopathy is a leading causes of blindness in American adults and is the most common form of diabetic eye disease.

It is known that elevated blood sugar in patients with diabetes leads to blood vessel damage throughout the body and to the Retina in particular.  As a result patients with diabetic retinopathy, have been found to have abnormal leaky blood vessels and often go on to grow abnormal fragile blood vessels.

Patients with early onset or mild diabetic retinopathy may not notice changes to their vision. With time however, diabetic retinopathy is guaranteed to lead to bilateral vision loss.  If you or a family member has diabetes please make an appointment to see us at Eye Surgeons of NYC.

What are the stages of diabetic retinopathy?

Diabetic retinopathy has four stages, mild nonproliferative retinopathy, moderate nonproliferative retinopathy, severe nonproliferative retinopathy, and proliferative retinopathy.  These are determined based on fundus exam findings.  There are times when you doctor at Eye Surgeons of NYC may need to perform fluorescein angiography or OCT scanning to further evaluate and classify your diabetic retinopathy.

How does diabetic retinopathy cause vision loss?

There are two main ways that elevated blood sugar in diabetes can lead to visual loss.  Abnormal blood vessels can grow.  Due to the fragile nature of these vessels they often leak and bleed causing blurriness and distortion of vision.  Alternatively incompetent damaged blood vessels can leak into the macula, the part of the retina that is used for sharp crisp center vision. This leads to macula swelling also referred to as macular edema.

Who is at risk for diabetic retinopathy?

All people with diabetes Type I or Type II insulin dependent or non-insulin dependent are at risk to develop diabetic retinopathy. As a result anyone with diabetes should get an annual comprehensive eye exam.  Approximately half of the patients when diagnosed with diabetes already have some stage of diabetic retinopathy. If you have diabetic retinopathy, fortunately the doctors at Eye Surgeons of NYC can recommend treatment to help prevent its progression.

What can I do to protect my vision?

The most important thing you can do is get an annual comprehensive eye exam with a Retinal specialist.  Screening exams are crucial in patients with Diabetes as often the disease can be asymptomatic despite the presence of retinal damage.

The Diabetes Control and Complications Trial (DCCT), a study that looked at thousands of patients with diabetes showed that better control of blood sugar levels delayed the development and slowed the progression of diabetic retinopathy. Other studies also showed that controlling ones blood pressure and cholesterol can reduce the risk of vision loss.

Does diabetic retinopathy have any symptoms?

Often the disease is asymptomatic.  Blurred and obscured vision may occur from macular edema or from bleeding inside your eye.

What are the symptoms of proliferative retinopathy if bleeding occurs?

At first, you might see a few specks of blood, or floaters in your vision. If this occurs please see your doctor at Eye Surgeons of NYC as soon as possible.  As you may benefit from treatment before more serious bleeding occurs.

Sometimes the bleeding will stop on its own. However if proliferative diabetic retinopathy is left untreated it can lead to severe vision loss and even blindness.

How are diabetic retinopathy and macular edema detected?

Diabetic retinopathy and macular edema are screened for at your annual comprehensive eye exam.  The physicians at Eye Surgeons of NYC check your retina for the earliest signs of disease, including; the presence of leaky or abnormal blood vessels, the presence of retinal exudate or areas of retinal ischemia, as well as any damage to the nerve tissues of the retina.  If there is suspicion of diabetic retinopathy your doctor may recommend getting a fluorescein angiogram and an OCT scan.  These tests are used to detect leakage from blood vessels and early accumulation of  intra-retinal or sub-retinal fluid.

How is diabetic retinopathy treated?

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

Proliferative retinopathy is treated with panretinal photocoagulation or scatter laser therapy.  Panretinal photocoagulation works by shrinking abnormal blood vessels. However if the bleeding is severe, you may need  to undergo retinal surgery to remove the blood in your eye.

It is important to keep in mind that with laser therapy and appropriate follow-up the risk of blindness can be reduced by 90 percent. However,treatment for diabetic retinopathy often can’t restore vision that has already been lost. That is why prevention is key and appropriated follow up with your doctor is crucial.

How is a macular edema treated?

Recent studies have shown that Macular Edema is best treated with intra-ocular injections of anti-VEGF therapy and or concomitant focal laser therapy.  This protocol decreases the amount of fluid in the retina.  It is important to understand that focal laser therapy stabilizes vision and reduces the risk of vision loss by about 50 percent but rarely improves your current level of vision.

It is important to keep in mind that with laser therapy and appropriate follow-up the risk of blindness can be reduced by 90 percent. However,treatment for diabetic retinopathy often can’t restore vision that has already been lost. That is why prevention is key and appropriated follow up with your doctor is crucial.

What is a Pars Plana Vitrectomy?

If you have a lot of blood that accumulates and does not clear from the vitreous gel, the center of your eye your doctor may recommend a pars plana vitrectomy to remove the blood and restore your vision.  During a pars plana vitrectomy a small instrument like a roto-rootor is used to remove the vitreous gel  and blood that is obscuring your vision. As the vitreous is removed it is replaced with a balanced salt solution. A pars plana vitrectomy is typically performed in an outpatient setting with the patient going home after the surgery with there eye patched.

What can I do if I already have lost some vision from diabetic retinopathy?

If you have lost some sight from diabetic retinopathy, don’t be afraid to use your eyes. Normal use of your eyes will not cause further damage to your vision.  If you have lost some sight from diabetic retinopathy, ask your doctor at Eye Surgeons of NYC about low vision services and devices that may help you make the most of your remaining vision.