Dr. David Maberley is the Site Head for Ophthalmology at Vancouver Acute Hospital and Regional Head of Ophthalmology for Vancouver Coastal Health Authority. He is also professor and head of the University of British Columbia’s Department of Ophthalmology and Visual Sciences.
Dr. Maberley is actively involved in clinical medicine, with a great deal of expertise in the medical and surgical management of diabetic retinopathy, macular degeneration, structural macular diseases, retinal detachment, and high myopia.
He is the Medical Director of the UBC/VCHA Inner-City Eye Program and is heading the ophthalmology component of the British Columbia First Nations On-Reserve Diabetes Telemedicine project. His research interests include the epidemiology of ocular disease, clinical trials methodology, and care delivery in marginalized populations.
( Dr. David Maberley, Ophthalmologist, Vancouver, BC ) is in good standing with the College of Physicians and Surgeons.
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.
Local Practitioners: Ophthalmologist
If you have diabetes, your risk of diabetic retinopathy increases based on how well you control your general health.
If you can manage your blood sugars well and keep them well controlled, and manage your A1C levels, if you can keep your blood pressure low and controlled, and if you can manage your serum cholesterol levels, then your risk of developing diabetic retinopathy will be significantly reduced. And that’s an important piece for all patients with diabetes to discuss with their family physicians.
Now assuming that you’re doing the best you can with your systemic control, then you still need to have your eyes examined. And that process would require going to see an ophthalmologist, having dilating drops put in your eyes so the retina can be examined properly.
You would then sit at a high-powered microscope, have your retinas examined, often with a headlamp microscope as well. And depending on what was seen, supplementary testing might be necessary.
Now many times this testing can be performed the same day. That would include such a test as a fluorescein angiogram, where dye is injected into your arm, and photos are taken of the eye. There is a laser photograph test that can be done to look at the thickness of the retina, if we’re worried about leakage of fluid into your central vision area.
And really those are the main tests that we would do to look at your eye in conjunction with the eye exam, to diagnose diabetic retinopathy. Your pupils will be dilated during the process, so bring a pair of sunglasses with you, or having someone drive you and pick you up to take you home is probably a good idea.
Once you’re seen by your ophthalmologist, if testing is required, depending on the facilities available to that individual, there may be an opportunity for performing your tests the same day, and even possibly treatment the same day so that your treatment, if you need it, can be initiated as quickly as possible for your diabetic retinopathy.
If you have questions or further queries about diabetes or diabetic retinopathy, please talk to your family physician or your local ophthalmologist.
Local Practitioners: Ophthalmologist