Diabetes Eye Health

Diabetes can harm your eyes. It can damage the small blood vessels in your retina, which is the back part of your eye. This condition is called diabetic retinopathy. Diabetes also increases your risk of having glaucoma, cataracts, and other eye problems.

Local Ophthalmologists

HealthChoicesFirst practitioner

Dr. David Ehmann

Ophthalmologist
Philadelphia, Pennsylvania
HealthChoicesFirst practitioner

Dr. Adnan Pirbhai

Ophthalmologist
Fort Erie, ON
HealthChoicesFirst practitioner

Dr. Patricia Teal

Ophthalmologist
Fort Erie, ON

Diagnosing Diabetic Retinopathy - How It's Done

Diabetic retinopathy is diagnosed by looking into the eyes. The eye is the only structure in which a doctor can look with a microscope with a magnification into the microscopic blood vessels in your body, without having to do things like a biopsy.

In the office you will have optical coherence tomography, which is a scan of the eye and can show all kinds of problems, such as swelling of the retina; optical coherence and geography, which allows the shape and location of blood vessels to be identified and look for places where blood vessels are missing or new blood vessels are growing.

You can have photography to compare what is currently happening and be able to compare it to what has happened in the past inside the eye, to see if there’s any progression. You can have fluoresceine and geography, which is injection of a dye inside the arm, and looking at the blood flow in the back of the eye.

With these techniques it is possible to identify the amount of disease, where the problem points are and make a treatment plan for treating the diabetic retinopathy.

Interestingly, inside the eye, you can look at these microscopic blood vessels by a simple examination. It is possible because of this that you can be diagnosed with diabetes just by somebody looking in your eye. And the other problem is that if you have diabetic eye disease in the blood vessels, you probably have diseases in other organs in your body that you may not yet be aware of.

For more information, talk to your eye doctor, who can explain both the treatments and the options for diagnosing the degree of disease that you have.

Presenter: Dr. Amit Gupta, Ophthalmologist, Scarborough, ON

Local Practitioners: Ophthalmologist

Quiz: Do You Understand Diabetic Retinopathy?

Test your knowledge by answering the following questions:

Questions
True
False
1

There are two types of diabetic retinopathy.

Explanation:
There are two types of diabetic retinopathy: early diabetic retinopathy and advanced diabetic retinopathy.
2

Diabetic retinopathy usually affects one eye.

Explanation:
Diabetic retinopathy usually affects both eyes, and anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy.
3

Diabetic retinopathy can be caused by poor blood control management.

Explanation:
Diabetic retinopathy can be caused by poor blood control management. Excess sugar in your blood can lead to a blockage of the blood vessels leading to the retina, cutting off the blood supply.
4

Effectively managing your serum cholesterol levels can help prevent diabetic retinopathy.

Explanation:
If you can manage your blood sugars and A1C levels, keep your blood pressure low and controlled and manage your serum cholesterol levels, your risk of developing diabetic retinopathy will be significantly reduced
5

Steroid injections are not a treatment for diabetic retinopathy.

Explanation:
Diabetic retinopathy treatment includes anti-VEGF medication, steroid injections, vitrectomy to remove vitreous gel and blood from leaking vessels or laser surgery to seal off leaking blood vessels.
(Answer all questions to activate)

What is Diabetic Retinopathy and its Causes

Diabetic retinopathy is the second leading cause of vision loss in North America, but it’s the leading cause of vision loss in people of working age.

So it has major implications in terms of health economics and impact on society. It develops with a diagnosis of diabetes, and tends to occur 10 to 15 years after a patient is diagnosed with diabetes.

Type 1 diabetes is diabetes that tends to occur as people are younger, and it tends to be the insulin-treated form of diabetes. And really when that disease begins, we can start counting because we have a very precise diagnosis to when Type 1 diabetes begins.

With Type 2 diabetes, which tends to occur in elderly people, in obese people and people with vascular disease, that can often grumble along for years before a diagnosis is actually made.

And so when a diagnosis of Type 2 diabetes is made, a patient may already have five or six years of diabetes in their system, and their risk of developing eye disease from diabetes could be very frequently, very quickly developing after that.

And we often see people coming in with diabetic retinopathy who haven’t even been diagnosed with diabetes yet. So in the context of Type 2 diabetes, it is important for people who are diagnosed with that to have an eye exam very early on in the course of their disease management.

Now diabetes affects the eye primarily in two ways. Diabetes causes high blood sugar levels in the body. Those sugars, when they’re broken down, can damage the blood vessels, and they damage the blood vessels in the eye.

Most frequently, the blood vessels start to leak, and we get fluid leaking into the macula or the central part of your retina, and that causes blurring of vision and can cause loss of vision.

That’s called diabetic macular edema. The second problem that can occur is the blood vessels in the back of your eye can start to break down in a way that the retinal tissue loses blood supply and tries to grow its own blood vessels to compensate.

Now those compensatory vessels are a problem because they’re fragile and they don’t grow properly, and they can form scar tissue and they can bleed and they can cause traction and pulling on your retina, and can even lead to retinal detachment or an eye full of blood. So we’re obviously very concerned about diabetic retinopathy. The biggest problem is, is that most people’s vision is very, very good until the disease is already rampant in their eyes. And so early detection and prevention is very important for this condition. This condition only occurs if you have diabetes.

But if you have more questions, please talk to your family doctor about a diagnosis of diabetes, if you’re concerned about that. And if you’re concerned about diabetic retinopathy, a referral to your local ophthalmologist would likely be a good idea. We tend to recommend yearly examinations for patients with diabetes for their eyes.

Presenter: Dr. David Maberley, Ophthalmologist, Vancouver, BC

Local Practitioners: Ophthalmologist

Local Ophthalmologists

HealthChoicesFirst practitioner

Dr. David Ehmann

Ophthalmologist
Philadelphia, Pennsylvania
HealthChoicesFirst practitioner

Dr. Adnan Pirbhai

Ophthalmologist
Fort Erie, ON

What is Advanced (Proliferative) Diabetic Retinopathy and Pars Plana Vitrectomy?

Diabetic patients may experience two forms of retinopathy. One is called background, the other proliferative. Background retinopathy has changes in the retina that include swelling of the retina, or diabetic macular edema.

Proliferative diabetic retinopathy may have growth of blood vessels, which can bleed in the eye, or pull on the retina and detach the retina. Diabetic retinopathy that’s called proliferative, where there’s bleeding or pulling on the retina, may require the consultation with a vitreoretinal surgeon.

Advanced diabetic retinopathy or proliferative diabetic retinopathy can be associated with hemorrhage and traction on the retina. If these situations cannot be controlled with injections of drugs such as anti-VEGF medication or laser photocoagulation, they may require an intervention called pars plana vitrectomy.

Your ophthalmologist or retina specialist may send you for an opinion of a vitreoretinal surgeon to determine whether your disease state has reached a point that you would benefit from pars plana vitrectomy to maintain or stabilize your vision in diabetic retinopathy.

Pars plana vitrectomy is typically performed under a local – but sometimes under general anesthesia. The surgeon will enter the eye with a cutting device to remove the blood, and sometimes with a cutting device or scissors, to remove traction that is pulling on your retina.

The recovery from diabetic vitrectomy is longer than vitrectomies for other conditions. Diabetics are operated on because there’s blood or traction in their eye. Even after the operation, there may be recurrent bleeding, which can last days to weeks, and the need for restricted head position.

One should not expect a rapid improvement of vision after diabetic vitrectomy. The goal of this operation is to improve the prognosis in the long run, and to stabilize diabetic retinopathy. It is not usually an immediate recovery of central or peripheral vision.

The improvements in the technology for pars plana vitrectomy in patients who have diabetic retinopathy have offered better outcomes. That said, the ultimate improvement of vision will rely and depend upon the underlying state of the diabetic retinopathy. So that is if a patient has significant poor circulation, the vitrectomy will improve part of their vision but not everything.

Your doctor will be the best person to determine how much vision improvement can be gained by pars plana vitrectomy in your case. By following the suggestions of your surgeon, and maintaining particular head position in the aftermath of pars plana vitrectomy, you can improve the chances of improving your vision after a diabetic vitrectomy.

If you have had bleeding in your eye, or your doctor has noted progressive growth of blood vessels and traction, you may be best served by having the opinion of a vitreoretinal surgeon to determine whether or not your condition has reached the point of requiring pars plana vitrectomy.

Presenter: Dr. Michael Kapusta, Ophthalmologist, Montreal, QC

Local Practitioners: Ophthalmologist

Dr. Amit Gupta, MD, FACS, Ophthalmologist, goes over the various different tools available to help diagnose diabetic retinopathy.

Dr. Michael Kapusta, MD, FRSCS, Ophthalmologist, talks about advanced (proliferative) diabetic retinopathy and pars plana vitrectomy as a treatment option.

Dr. Amit Gupta, MD, FACS, Ophthalmologist, talks about the steps involved and potential side effects when getting an intravitreal injection.

Intravitreal Injections - The Procedure

The intravitreal injection procedure consists of freezing the eye and sterilizing the eye—those are the first steps. Your doctor may put in your eye a lit speculum that holds the lids open. After some time they will inject the eye with medication that is required, remove the speculum, they may rinse the eye, and the procedure itself is over.

After the procedure is done, you will feel that the eye is frozen, the lids will feel a little bit heavy, these are all common things after the procedure and are expected. When the freezing wears off, you may have a feeling of sand or grit in the eye, which will fade with time. There may be a red blotch on the white part of the eye, that too will fade with time and get better. You might get a few floaters, a little round ball floating around that looks like it’s on the bottom of your vision. That again goes away in a day or two.

So these are common side effects that occur with a procedure, by the next morning most of these are gone. The red blotch may last for many days, but you will see it gradually changing colour and fading.

All these side effects are not harmful. The red part on your eye—the red blotch on your eye, the biggest problem with it is everyone stops you and asks you “Oh my God, what happened to you?” But it doesn’t affect your vision, and it doesn’t cause any permanent damage; it’s like getting a bruise when you have blood drawn. It doesn’t look good, the difference here is that it’s on the eye so everyone notices that you have it. Aside from that it’s not a problem.

For more information, talk to your eye doctor, who can explain these effects and what to expect.

Presenter: Dr. Amit Gupta, Ophthalmologist, Scarborough, ON

Local Practitioners: Ophthalmologist

Local Optometrists

Dr. Christian Nanini

Dr. Christian Nanini

Optometrist
Welland, ON
Dr. Laurie Capogna

Dr. Laurie Capogna

OD
Optometrist
Niagara Falls, ON

Eye Health: Diabetic Retinopathy

Dr. David Mitchell, OD, discusses how diabetes affects the eyes.

Diabetes is a multi-organ disease and from the eye standpoint it’s the leading cause of blindness.

We use our digital scanning ophthalmoscope to photograph the retina on each visit to look for early signs of leakage or hemorrhage.

If those signs are there our patient will be referred to an ophthalmologist to get that sealed up, in order to protect their vision, and from there they’ll be seeing their GP or endocrinologist to further look into the signs of the diabetes.

Presenter: Dr. David Mitchell, Optometrist, Vancouver, BC

Local Practitioners: Optometrist

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