Diabetic Eye Disease

If left untreated, diabetic eye diseases can cause permanent vision loss – in fact, diabetic retinopathy is the leading cause of blindness among adults in the United States.¹ Symptoms may go unnoticed until irreversible damage has occurred, so all patients with diabetes should have regular eye exams. The eye doctors and retina specialists at CVP Physicians Dayton are experts at recognizing and treating diabetic eye disease.

Diabetic Retinopathy

Diabetic retinopathy develops when high blood sugar levels damage the tiny blood vessels in the retina. Diabetic retinopathy usually affects both eyes. This condition has several stages:

Non-Proliferative Diabetic Retinopathy (NPDR)

NPDR is an early stage of diabetic retinopathy in which blood vessels swell and leak, which can affect the circulation to the retina. Retinal hemorrhages and microaneurysms are common. While treatment may not yet be needed, it does indicate that the eyes need to be closely monitored so any progression can be identified and treated at early stages if necessary.

Diabetic Macular Edema (DME)

Diabetic Macular Edema (DME) is a complication of diabetic retinopathy caused by ongoing damage to the small blood vessels of the retina. This leads to swelling in the central part of the retina, which is called the macula. Blurred vision and wavy lines can be indicators of macular swelling.

Proliferative Diabetic Retinopathy (PDR)

This advanced stage of diabetic retinopathy occurs when circulation to the retina is significantly reduced, leading to abnormal blood vessel growth. These new blood vessels are fragile and often bleed in front of the retina, which is called vitreous hemorrhage. Mild vitreous hemorrhage may cause dark floaters, while more severe vitreous hemorrhage can cause complete loss of vision.

These new blood vessels can also form scar tissue. Scar tissue and the abnormal blood vessels can pull on the retina and lead to a detached retina, which can be a permanently blinding condition that requires surgery. In addition, new blood vessels can form in the front of the eye, causing a type of severe glaucoma called neovascular glaucoma. The PDR stage of diabetic retinopathy is a very serious condition that can lead to permanent central and peripheral vision loss, and at advanced stages, complete blindness. Blurry vision, loss of vision, floaters, pain, or dark missing areas in your vision may be symptoms of PDR.

Symptoms of Diabetic Eye Disease

Diabetes is a chronic health condition that must be managed properly in order to prevent long-term damage to health. Up to 90% of vision loss from diabetic eye disease can be prevented, so it is important to make preventative eye exams part of your diabetes care.²

Contact your eye doctor right away if you experience any of these symptoms:

• Trouble seeing in dim light
• Blind spots
• Blurry vision
• Eye pain
• Black spots (floaters) in your vision
• Flashes of light
• Loss of vision in one or both eyes

Diagnosis of Diabetic Eye Disease

Early diagnosis of diabetic retinopathy is key to successful treatment. Due to the fact that many patients do not experience symptoms in the early stages of diabetic eye disease, yearly comprehensive eye exams are the most critical factor in diagnosis.

At CVP Physicians Dayton, we have the expertise and advanced testing to identify changes in the retina long before you begin to notice symptoms. This provides the opportunity to work with you to protect your vision and prevent any eye conditions from worsening.

Our Retina Physicians & Surgeons are diabetic eye specialists with extensive training in retinal disease, treatment, and surgery. For our diabetic patients, we include additional tests as part of their comprehensive eye exams. These include:

Treatment for Diabetic Eye Disease

If you have diabetes, you need to pay special attention to your vision. While damage caused by diabetic retinopathy cannot typically be reversed, the ophthalmologists at CVP Physicians Dayton offer advanced treatments that can frequently improve vision, help stop disease progression, and prevent further vision loss.

Your diabetic eye disease treatment plan will depend on the stage of your diabetic retinopathy and your overall health. The sooner elevations in blood sugar are brought under control, the easier it is to treat diabetic retinopathy. When your blood sugar stays in a normal range, you can lessen the chance of developing diabetic retinopathy and frequently delay its progression. However, some may progress even if blood sugars are in a normal range. The longer you have diabetes, the greater your risk of diabetic eye disease.

Keeping your blood pressure at healthy levels can also help prevent or limit the progression of diabetic retinopathy. Treatments can be effective at repairing damage and slowing progression. Treatment may be recommended even if vision loss has not occurred. Necessary treatments depend on the nature and severity of your diabetic retinopathy, and can be used alone or in combination. At CVP Physicians Dayton, we use the most advanced treatments available, including:

Injectable Blood Vessel Growth Inhibiting Medications

Also called antibody injections or Anti-VEGF (Vascular endothelial growth) therapy, these medications are injected into the back of the eye to help stop leakage and treat DME. They work to slow the growth of the abnormal blood vessels in your retina to treat PDR. Medications include Avastin^®, LUCENTIS^®, BEOVU^® and EYLEA^®.

Intraocular Steroid Injection

This treatment, which involves injection of corticosteroid medications, may be recommended instead of, or in addition to, Anti-VEGF therapy to help reduce or prevent fluid from leaking into the retina and can be effective in treating DME.³

Laser Treatment (Panretinal Photocoagulation)

In this procedure, commonly called Photocoagulation, a specialized laser beam is focused on the retina. The heat from the laser shrinks the abnormal blood vessels and decreases the growth of new blood vessels. This can also help bond the retina to the back of the eye in order to prevent retinal detachment. A different laser procedure can be performed to help reduce the amount of fluid leaking into your retina in cases of diabetic macular edema.

Vitrectomy

Vitrectomy is a microsurgical procedure performed in an operating room. The purpose is to treat blocked vision by removing the blood that has leaked into the vitreous, which is the clear gel that fills the center of the eye. Vitrectomy may also be performed to repair retinal detachment.

Frequently Asked Questions About Diabetic Eye Disease

Is there a cure for diabetic retinopathy?

No, there is no cure. However, early detection and available treatment options can decrease the risk of progressive vision loss, and serious, life-altering vision impairments. In many patients, treatment can significantly improve vision. You can trust the experts at CVP Physicians Dayton to determine the best treatment option to help you manage diabetic eye disease and protect your vision.

Can I prevent diabetic retinopathy?

While it is not always possible to prevent diabetic eye disease, there are steps you can take to lower your risk and prevent vision loss. These include:

• Yearly comprehensive eye exams
• Monitor and manage blood sugar levels
• Eat healthfully and exercise regularly
• Do not smoke

Does it matter which type of diabetes I have?

Patients with any type of diabetes are at risk for diabetic eye disease. The American Diabetes Association recommends that people diagnosed with Type 2 diabetes start yearly eye exams right away and patients with Type 1 diabetes (sometimes called juvenile diabetes) start yearly eye exams no later than 5 years after diagnosis.⁵

How do I know which diabetic retinopathy treatment is right for me?

At CVP Physicians Dayton, we understand that diabetic eye disease can be worrisome and confusing, and we are dedicated to educating you about treatment options and creating a plan to manage your vision. The most important thing you can do for your eye health is schedule yearly eye exams.

¹ Centers for Disease Control and Prevention (CDC). Common Eye Disorders. Available: https://www.cdc.gov/visionhealth/basics/ced/index.html Accessed May 29, 2020
² American Academy of Ophthalmology. Diabetic Eye Disease. Available: https://www.aao.org/eye-health/diseases/diabetic-eye-disease Accessed May 29, 2020
³ Nurözler Tabakcı B, Ünlü N. Corticosteroid Treatment in Diabetic Macular Edema. Turk J Ophthalmol. 2017;47(3):156‐160. doi:10.4274/tjo.56338
⁴ Mayo Clinic. Diabetic retinopathy. Available: https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611 Accessed May 29, 2020.
⁵ American Diabetes Association. Standards of medical care in diabetes—2016 abridged for primary care providers. Clinical Diabetes. 2016 Jan;34(1)