Retinal and Diabetic Care
How frequently should a patient with diabetes have a retina examination?
A patient with diabetes should have a dilated pupil examination of the retina at the time of diagnosis and a minimum of once a year for life. Some patients with involvement of the retina by diabetes may require more frequent examination as part of the process of providing care for swelling of the retina (macular edema), bleeding into the eye or development of new blood vessels (neovascularization), or in conjunction with laser or surgical treatments for other ocular problems with diabetic retinopathy.
How does diabetes affect the eye?
Diabetes can affect virtually every part of the eye, but involvement of the retina is the most characteristic complication of diabetic eye disease. In non-proliferative or background retinopathy, the center of the retina (macula) may become involved by swelling (edema) from retinal vessels that become altered by diabetes. This macular swelling can cause a visual loss that can usually be stopped by laser treatment. Early macular swelling may not be perceived by the patient, and the importance of routine eye examinations is critical. A second major area of involvement of the retina by diabetes is proliferative retinopathy, i.e., the formation of abnormal new blood vessels (neovascularization) that grow out of the retina into the formerly clear vitreous gel. These vessels will usually bleed into the vitreous, causing any degree of impairment from a few floaters to severe visual loss, or these vessels will undergo traction on the retina resulting in a retinal detachment which can also cause a severe visual loss. In many patients with neovascularization, bleeding and retinal detachment occur together. The treatment of neovascularization is usually by laser if the vessels are detected when the eye clear enough and the retina has not detached. However, patients with severe bleeding or retinal detachment involving the central vision typically require surgery.
Does the development of either form of retinopathy mean that I have done something wrong in the care of my diabetes?
No. Even with excellent control, many patients will still develop retinopathy. Consequently, regular eye examinations are very important.
Will control of my diabetes help slow down the development of retinal problems?
Yes. Good diabetic control produces many benefits, including slowing down the development of retinal complications
How is diabetic retinopathy laser performed?
Laser treatments for either macular swelling or new blood vessels are performed as an outpatient with either topical anesthetic drops or anesthetic injection near the eye as the patient and physician prefer. Treatments may be divided into several sessions over a few weeks, depending on what needs to be treated. Although some patients may want a family member or friend to help them with transportation, most patients can handle the treatments easily and without pain.
What is vitreous surgery for diabetic retinopathy?
Vitreous surgery for diabetic retinopathy is surgery within the eye in order to remove blood, re-attach the retina, or both. Miniaturized instruments such as scissors, lasers, and other devices are introduced into tiny openings in the side of the eye, and the procedure is usually done under local anesthesia, similar to modern cataract surgery. Vitreous surgery for diabetic retinopathy is very complicated, and the prognosis may run a spectrum from optimistic to difficult, and careful consultation is suggested in patients who may be advised to undergo vitreous surgery for diabetic retinopathy.
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