What does the diagnosis of diabetes or diabetic retinopathy mean exactly? I’ve heard there are different types?
Diabetic retinopathy is when there is damage in the back of your eyes (retina) due to changes in blood sugar in the well-known systemic condition called diabetes. There are two main types of diabetic retinopathy. The first type is called non-proliferative diabetic retinopathy (NPDR) and it has three levels of grading depending on the severity. The most common sign of NPDR is bleeding in the retina. The second type of diabetic retinopathy is called proliferative diabetic retinopathy (PDR) and it can include the same signs as NPDR but the retina would also show new blood vessels growing. This is the more serious type of diabetic retinopathy and requires treatment as soon as possible.
Another condition that is less well-known but closely related to diabetic retinopathy is clinically significant macular edema (CSME), which is when there is swelling in the central part of your retina called the macula. This condition can significantly decrease your central vision and requires treatment as soon as possible as well.
In what way(s) does a diabetic eye exam differ from a regular eye exam?
Patients with diabetes should be seen by an optometrist at least once a year with a dilated fundus exam. Dilation is done in the exam room with the eye drops that sting and make your pupils extra large for a couple of hours. This procedure is done routinely so that the optometrist can check for signs of diabetes in the retina with an enlarged view. Routine eye exams for every patient will always include checking the health of the eyes but dilation may not be indicated annually.
I understand that diabetes are common among those over 40 or with weight issues. What causes it? Are there other groups that are at a higher risk?
There are two types of diabetes – type 1 diabetes and type 2 diabetes. The exact cause of diabetes is still currently unknown. Type 1 diabetes has a strong genetic component and an earlier onset (young children to adolescents). Type 2 diabetes has a later onset and is more prevalent in people with polycystic ovarian syndrome, obesity, and an inactive lifestyle; however, it also has a small genetic component as well.
Please describe the typical progression for an individual with diabetes regarding their eyesight?
Typically, patients with diabetes will develop non-proliferative diabetic retinopathy (NPDR) first before showing signs of proliferative diabetic retinopathy (PDR) or clinically significant macular edema (CSME), which are more vision debilitating. However, CSME can occur at any stage in diabetic retinopathy.
The chance of finding retinal changes increases significantly after living with diabetes for 5 years. However, many people live with undiagnosed diabetes for many years so eye changes can already be present at the time of diagnosis.
What happens during a typical Diabetic Eye Exam?
As with all routine eye exams, optometrists will check your visual acuities for both distance and near, binocular vision status, and ocular health status. During the ocular health check, it will include a dilated fundus exam, which will check for signs of diabetes inside the eyes.
What treatment options and/or care is available for this condition?
These are the common eye complications from diabetes and their respective treatment:
- A) Non- proliferative Diabetic Retinopathy – There is no treatment for NPDR aside from controlling blood sugars and monitoring for conversion into PDR or signs of CSME.
- B) Proliferative Diabetic Retinopathy: Laser is performed on the retina to stop the new blood vessels from forming. The patient should also better control his/her blood sugars to prevent the condition from recurring or getting worse.
- C) Clinically Significant Macular Edema: Eye injections are performed to decrease the swelling in the retina.
What are the risks and side effects associated with these treatments? What if you don’t proceed with treatment?
The eye surgeon or ophthalmologist will discuss all of the risks, benefits, and side-effects in detail before performing any of the treatment procedures listed above. Depending on the patient’s case history and personal health profile, there are different risks and side-effects that will be considered. Ultimately, blindness can result if treatment is not received in a reasonable time frame.
Will a change in a patient’s diet, exercise routine, or medication help at all?
Yes, in all stages of diabetes, controlling blood sugars by diet, exercise, and medications will help prevent further changes in the vasculature of the retina.
Regardless of cost or coverage by my insurance, what are some alternative treatments?
The only FDA approved treatments for eye complications from diabetes are listed above and are covered by OHIP. New technology and treatment is always being researched; however, the standard of care for the treatment of eye complications from diabetes is what we currently use in Ontario today.
Can you recommend a vitamin/mineral program for me that might be helpful or are vitamin supplements specific to each patient?
There has not been any major clinical studies to show that any vitamins/minerals can help prevent or improve diabetic retinopathy.