Diabetic Retinopathy

MICHAEL COLE, OD Child and Family Eye Care Center

We often see patients in our clinic who have been advised by their primary care doctor to have a diabetic eye examination. Many are not quite sure what that means or why it is necessary. To appreciate the importance of ocular examinations as an integral part of diabetic care, it is helpful to understand how diabetes can affect the eyes.

Diabetes is a condition that affects small blood vessels throughout the body. These tiny tubes supplying oxygen and nutrition to our tissues are damaged over time, causing them to become weaker, leaky, and unable to contain the fluid passing through them. With high blood glucose over long periods of time, the fluid, proteins, and blood cells will eventually start to seep into the areas surrounding the blood vessels. This causes decreased blood flow and prevents proper nutrition and oxygen supply to the regions further downstream from the injury, eventually leading to oxygen deprivation, poor healing, and tissue damage.

The reason that ocular examinations are so important to monitor diabetic status is that the unique anatomy of the eye allows us to view the tiny blood vessels in the retina. This is the only place where we can see blood vessels in their natural state, as they are covered by skin and other tissues elsewhere in the body. These views of the internal eye allow us to observe even small changes that may occur. Try an internet search for “retinal photo,” as well as “diabetic retinopathy,” and see if you can notice the difference in the images.

As we monitor the blood flow in the retina, we can gain insight into the health of the circulatory system in other areas of the body such as the kidneys and nervous system. If a great deal of damage exists in the retina, we can infer that damage has also likely occurred elsewhere. This type of damage is more likely to occur over long periods of time. Individuals with long-standing diabetes (even those well controlled) are more likely to develop diabetic retinopathy than those newly diagnosed.

When retinal tissue becomes deprived of oxygen, it becomes stressed and will eventually permanently lose function. As this process occurs, the neurons send out signals that stimulate new blood vessel growth to supply them with the resources they need. These new blood vessels grow quickly and are poorly formed. The new vasculature is leaky and forms scar tissue among the delicate structures of the eye leading to permanent vision loss. Diabetic retinopathy is unlikely to cause any detectable vision changes until later stages of the disease, and often goes undiagnosed until permanent damage exists. Due to this slow progression of damage, often without noticeable symptoms, it is imperative that those diagnosed with diabetes have a comprehensive eye exam annually, whether they require glasses or not.

In some instances, with very high blood glucose levels, acute vision changes can occur. If glucose levels are high enough, fluid rushes into the lens inside the eye, causing the lens to change shape. This results in a shift in glasses prescription and blurry vision. This often occurs with newly diagnosed individuals before their diabetic status is under control. Usually, when glucose levels return to normal, this transient change in the lens resolves and vision returns to its previous state. While this type of vision disturbance is much more dramatic and noticeable, it is considerably less dangerous when compared with the chronic damage that occurs with diabetic retinopathy.

Diabetic treatment with modern methods is safe and effective. Eye examinations are an important part of that treatment and will result in better long-term care when utilized. Schedule a diabetic ocular examination by contacting our office at 435-363-2980.

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