Tens of thousands of people lose their vision to diabetes every year, but the good news is that eye problems aren’t inevitable — in fact, most cases of severe vision loss due to diabetes are preventable. In this video, retina specialist Charles Wykoff, MD, PhD, FACS, discusses diabetic retinopathy, the most common eye disease to affect people with diabetes, explaining what the condition is, what steps you can take to reduce your risk of developing it, and what treatments are available if you already have retinopathy.
I am Charles Wykoff, I’m an Ophthalmologist, presently the retinal specialist from Houston Texas. I’m part of the Retina Consultants of Houston.
Diabetes and Eyes
Diabetes is obviously a big player. We live in a world where the prevalence of diabetes and obesity continue to rise. And among the patients with diabetes, the earliest and the most common and organ affected, in other words, the part of the body that’s affected earliest and most commonly is the eyes. So, the eyes is a huge source of problem with patients with diabetes, and yet a huge source of hope because there are really good treatments for diabetic eye diseases.
What is Diabetic Retinopathy?
So, in patients with diabetes, with eye diseases, the most common manifestation of diabetes in the eye is something called Diabetic Retinopathy. The retina is the back of the eye, it’s the part of the eye that senses the light that comes in. It is a highly vascularized tissue, and because of that, diabetes often causes problems in that very delicate tissue. Most patients with Diabetic Retinopathy, don’t have any symptoms at all. They’re just walking around, and they think they’re seeing just fine, when they can have a very severe disease in the back. Now, once a patient notices it, it is like most eye diseases that causes blurry vision, but that is such a vague statement, that its hard to communicate to patients really what that means. You know, some people say they can’t read things as well. Lot of people just think their glasses is out of date, in fact, it is not a glasses problem. You can switch the glasses all day long, and it won’t make any difference, if you have significant vision decreasing diabetic retinopathy.
What is Diabetic Retinopathy Screening?
I’d recommend, that any person that is over the age of ten years of age, get a screening exam and a diagnosis. Certainly, the critical issue for patients in screening for diabetic eye disease, is to make sure they’re engaged with an eye care professional that can examine their eye and identify Diabetic Retinopathy and get them referred to the right resources to manage that disease. And the core examination step there, is the dilated eye exam.
But once someone is diagnosed with diabetes and they get their baseline screening exam, they should be at least annual exams for there forward. Diabetic Retinopathy is a broad spectrum of diseases. There’s really three forms that can cause vision loss. By far, the way the most important and the most common is Diabetic Macular Edema (DME). But to round out the list of what causes vision loss in Diabetic Retinopathy, we should add Proliferative Diabetic Retinopathy (PDR). Which is where abnormal blood vessels grow, and bleed in the back of the eye, which can cause severe vision loss, it can cause blindness as well. And then the third one is really Ischemia, which is a portion of the first two for sure, but its where diabetes causes loss of the normal blood vessels in the back of the eye, and that in itself can cause vision loss, if you loose blood flow to the normal parts of your retina that you need for vision.
How to Prevent Diabetic Retinopathy
Strongly the cornerstone to management is blood sugar, blood pressure control. And if patients are very well controlled, they can still get vision loss or DME and other forms of Diabetic Retinopathy. In that case really, intraocular treatments are the best approach, that have been proven. The controlling blood sugar, controlling blood pressure, controlling cholesterol are critical. The other factors you may want to consider are, smoking. So, smoking is like fuel under fire for many eye diseases, diabetic eye disease included. So, if you can stop smoking, decrease the amount that you smoke. Other factors to be aware of, are things like anemia, renal disease, and there’s some specific kinds of medications that maybe you’re taking orally that exacerbate the swelling of the back of your eye.
What is Treat Diabetic Retinopathy?
If you have either Proliferative Diabetic Retinopathy or DME, are most common vision loss of Diabetic Retinopathy. There are very good treatments for these, the much newer treatments that have now been proven in multiple trials are medications that are injected directly into the back of the patients’ eye, to decrease the swelling and improve the vision. And these medications fall under two categories. By far the most commonly used medications, are medications that block a very specific growth factor called VEGF, or Vascular Endothelial Growth Factor in the back of the eye. Then there is a class of medication known as steroids, which have a more broad effect to decrease inflammation and cause decrease swelling in the back. There are four medications that are FDA approved, treatment of DME, all of which are given by direct injection to the back of the eye. Point to patients, you hear given by direct injection to the back of the eye. And often catches patients off-guard, who haven’t heard of this before. It certainly would me if I haven’t heard about it. Patients look at me and say “Doc, you’re going to put a needle in the back of my eye?”. And the answer to that question is simply yes. And fortunately we’ve done this for so long, as a community, is a field we’ve gotten really good at it. And, the vast majority of patients do not have any pain, they should barely feel it at all.