What does the diagnosis of Diabetes or Diabetic Retinopathy mean exactly? I’ve heard there are different types?
Diabetes affects the small blood vessels in the eye and body. As the small blood vessels and capillaries are damaged they begin to leak fluids and proteins. The tissue in the back of our eye called the retina is full of small blood vessels. As damage occurs to the blood vessels we begin to see hemorrhages, edema, and areas of ischemia in the retina. The less severe form of retinopathy is called nonproliferative diabetic retinopathy and can range from mild to very severe. Once damage is great enough abnormal blood vessels can start grow in the eye. This is called neovascularization and can lead to scar tissue formation, severe hemorrhages, retinal detachments and even blindness. This more severe form is called proliferative diabetic retinopathy.
In what way(s) does a diabetic eye exam differ from a regular eye exam?
A diabetic eye exam is a medical eye exam. During a diabetic eye exam, your eyes will be dilated and extra time and attention is given to examining certain parts of the eye, like the retina. Sometimes additional testing like retinal imaging is performed to further evaluate and diagnose diabetic eye disease.
I understand that Diabetes are common among those over 40 or with weight issues. What causes it? Are there other groups that are at a higher risk?
Type 2 Diabetes is caused when our bodies become resistant to or non-responsive to the effects of insulin. Insulin is released by the pancreas to regulate the level of sugar in our bloodstream. Some of the risk factors for developing diabetes include; obesity, high blood pressure, family history,sedentary lifestyle, high triglycerides and low HDL cholesterol. Certain ethnic groups or races have a higher risk of diabetes, including; African American, Alaska Native, American Indian, Asian American,Hispanic/Latino, Native Hawaiian, or Pacific Islander.
Please describe the typical progression for an individual with Diabetes regarding their eyesight.
If untreated diabetes and diabetic retinopathy will progress and will eventually lead to severe vision loss or blindness. With proper control and treatment many people with diabetes can maintain good eyesight for their whole life.
What happens during a typical Diabetic Eye Exam?
During a diabetic eye exam the patient’s eyes will be dilated so that it is easier to see into the eye and examine the retina. Instruments like a slit lamp and binocular indirect ophthalmoscope are used to carefully examine all structures of the eye. If there is evidence of diabetic eye disease, retinal imaging including OCT and photography is often ordered. Sometimes even if there is no disease those tests are performed to serve as a baseline for future examinations.
What treatment options and/or care is available for this condition?
Initially, if the diabetic retinopathy is mild, treatment to better control the diabetes is recommended. This is typically managed by an internist, or primary care doctor who may prescribe medications, exercise and changes in diet. Once diabetic retinopathy becomes more severe, eye injections, laser treatments and more advanced surgical procedures may be necessary.
What are the risks and side effects associated with these treatments? What if you don’t proceed with treatment?
There are risks associated with all the treatments of diabetic retinopathy, but the risks are quite low.The risks vary depending on the type of treatment being performed. For example, the biggest risk of eye injections is infection. If patients choose to forgo treatment the likelihood of permanent vision impairment and blindness increased dramatically.
Will a change in a patient’s diet, exercise routine, or medication help at all?
Yes, many people can successfully manage their diabetes through diet and exercise or in combination with medications. The goal is to achieve normal/stable blood sugar levels. Any treatment that safely accomplishes this can be very beneficial. Patients who consistently maintain good blood sugar levels are much less likely to have diabetic eye disease and vision impairment.
Regardless of cost or coverage by my insurance, what are some alternative treatments?
All treatments for diabetes should be done in consultation with a licensed physician. There is some evidence that certain nutritional supplements may be beneficial.
Can you recommend a vitamin/mineral program for me that might be helpful or are vitamin supplements specific to each patient?
Along with diet and exercise nutritional supplements can support overall wellness in individuals with diabetes. Certain nutritional supplements may be recommended as a part of an overall diabetic treatment plan. This should be discussed with your physician.