Diabetic Eye Disease

Most patients diagnosed with diabetic eye disease who follow their retina specialist recommendations will NOT lose significant vision, thanks to modern medications and vitreoretinal surgical techniques. Timely care, before one experiences visual symptoms, is the ideal time to start treatment.  

Patients often run into trouble when they assume they have no retinal damage since they still see very well and have no vision symptoms. They assume diabetic eye damage will be accompanied by vision symptoms. It is important patients realize diabetic damage often does not affect their vision early on. Often, the best time to treat patients is before they experience any vision symptoms.

Modern diagnostic equipment enables retina specialists to precisely detect the two main types of complications caused by diabetic eye disease, namely diabetic macular swelling (diabetic macular edema) and abnormal new blood vessel growth (neovascularization). Both of these problems respond to drugs delivered by eye injections, which sound terrifying, but are routinely and PAINLESSLY administered in the office. 

Typically, patients will undergo an exam which often includes photographs of the back of the eye (fundus photographs).  These include color photographs and retinal angiography, which gives important information about the health of the retinal blood circulation.  A small needle is used to inject a safe contrast (non-iodine) dye into a vein.  As the injected dye circulates through the patients eye, photographs are taken, which are reviewed by the doctor to determine the degree of retinal damage and whether treatment is needed.  

Another type of test is often referred to as an OCT and it uses light to measure the thickness of the center of the retina in an area known as the macula, which is vital to excellent central vision.  

These tests combined with an exam by the doctor are often used to fully asses the extent of damage caused by diabetes.

Studies have confirmed better blood sugar control over time by the patient will decrease their risk of diabetic eye disease. Often patients are concerned a few days of elevated blood sugars will immediately cause worsening disease. It is true the vision may become blurry when blood sugar is highly elevated due to transient swelling of the lens in the eye. This slight blurring resolves within two weeks once the elevated blood sugar is normalized. The retinal damage occurs from years of elevated blood sugar. Controlling blood sugar, blood pressure, blood lipids (cholesterol and triglycerides) will certainly reduce the risk of diabetic eye disease.

Treatment for diabetic eye disease often involves eye injections to deliver drugs into the eye. These are performed after topical anesthesia is given in the form of eye drops, gels, and/or pledgets placed on the eye. The actual injection takes seconds and is painless. Most patients sense a pressure sensation when the injection is delivered. Immediately afterwards, the surface of the eye is rinsed to remove a marooned-colored cleanser (povodine-iodine) which is used to reduce the risk of an infection inside the eyeball.

The anesthesia wears off after 20 minutes and most patients resume their normal activities of daily living. Some will have some residual burning sensation which can be relieved with more artificial tear drops.  Some patients say the eye remains irritated for several hours afterward.  

Rarely, patients experience severe eye pain often worsened by blinking.  This is often due to a scratch on the cornea of the eye.  This is best relieved by keeping the eye shut the remainder of the day.  If this occurs most patient's pain is resolved upon awakening the following morning. Should the pain persist the following day, one should call their doctor's office to determine if an exam is necessary.

Some patients will develop a bright red spot/area on the white of the eye. This is typically painless but looks quite impressive usually causing others to ask about the "red eye." Rest assured this will not cause any permanent damage to the eye.  It will resolve on its own with a week or two.  This red spot/area is due to the injecting needle slicing a small surface vessel on the eye's surface.  Doctors refer to it as a subconjunctival hemorrhage.

Some patients require laser treatment, which is performed in the office.  One type of laser is done for macular swelling (macular edema).  The other type of laser is done for abnormal blood vessel growth.  Both are typically painless and can be delivered in about 5-15 minutes.  Sometimes different forms of anesthesias are used to reduce any possible pain. Usually, however, this is not needed.

Some patients require a surgery in the operating room called a vitrectomy.  This is usually performed on patients who have not responded very well to the prior treatments described above. Thankfully, modern surgical equipment has made these surgeries usually painless and effective. Sadly, some patients with advanced disease do not respond well to the surgery. They are typically patients who waited too long to see the retina expert.

The good news is modern diagnostic equipment combined with modern treatments have dramatically reduced the likelihood patients with diabetic eye disease will lose their sight as long as diabetic patients start seeing their retina specialist long before they notice worsening changes in their vision. It is recommended that adult diabetic patients see their eye care expert every year in order to detect early diabetic eye disease and to start treatment before vision is ever lost.