DIABETES AND THE EYE
is a very common disease in the United States and is the leading cause
of blindness in adults under the age of 65. In general, there are five
main potential complications with diabetes. They are
1. KIDNEY DISEASE because of degenerated blood vessels.
2. PERIPHERAL NEUROPATHYwith numb spots or shooting pains most often
in the legs, but may be elsewhere as well.
3. INFECTION with an increased frequency and more difficulty getting
rid of infections when they do occur.
4. Acceleratedrate of ARTERIOSCLEROSIS with increased risk of developing
heart disease or stroke and DIABETIC RETINOPATHY.
This brief overview will outline this disorder and explain its
Diabetic retinopathy may affect patients with both Type
1 (juvenile onset)and Type 2 (adult onset) diabetes. The younger diabetics
are usually free of retinopathy for at least the first 5 years after
onset of the diabetic condition. Adults may acquire the retinopathy
at any time after diagnosis is made.
To make a very long story short, diabetic retinopathy is a disease
of the blood vessels in the delicate tissue called the retina. It is
the retina which acts like film in a camera and does the actual sensing
of light inthe eye. These vessels become incompetent and leak fluid
and blood andfail to supply the nutrients necessary for good health
in the retina.
Basically, retinopathy is divided into two forms (1) NON-PROLIFERATIVE(NPDR)
or BACKGROUND RETINOPATHY and (2) PROLIFERATIVE RETINOPATHY (PDR).
NPDR consists of hemorrhages, leaky spots and small dilatations
in the vessel walls.
PDR is all of that plus NEW BLOOD VESSELS. These new vessels
are always abnormal and will leak and bleed if left untreated.About
40% of all diabetics will develop PDR over a 15 year span.
The most common cause of decreased vision with diabetes is NPDR
with swelling in the retina from leaky blood vessels. This is very difficult
to treat, but with focal applications of LASER light to seal these leaks,vision
may be preserved and occasionally improved. PDR poses a very serious
threat to vision as well. Large hemorrhages may obscure visionfor months
at a time. These new abnormal vessels should be treated with LASER therapy.
Retinal detachments may also occur because of traction created
by these new vessels.Other factors may contribute to the progression
of diabetic retinopathy.This list includes HIGH BLOOD PRESSURE, ELEVATED
LEVELS OF SUGAR,CHOLESTEROL and TRIGLYCERIDES in the blood stream. Each
of these factors must be controlled as best possible to assist in the
treatment of the retinopathy.
Regular examinations are critical to early diagnosis and
therapy. We now have more to offer diabetics than ever before. Most
do well, and vision can be preserved in the majority. Help and cooperation
with regular eye examinations are needed in controlling the basic disease.