Patient with diabetes should have a dilated eye exam at least once a year. Dilation means using drops to make the pupil bigger so your eye doctor can better examine the back of the eye called the retina.

Diabetic retinopathy develops after prolonged high levels of sugar in the blood. High sugar levels begin to damage the blood vessels in the retina. As the blood vessels become deprived of oxygen and nutrients, a cascade of problems occur which can eventually lead to blindness.

• Microaneurysms: damaged blood vessels develop bulges which leak blood and fluid

• Macular edema: the most central part of our vision called them macula accumulates the leakage of blood or fluid. This swelling results in blurred or distorted vision

• Proliferative retinopathy: in response to damage, the retina attempts to make new blood vessels by releasing a growth factor known as VEGF. However, these new blood vessels are abnormal, fragile and continue to bleed. Bleeding can occur at the level of the retina, below the retina, or go into the vitreous. Floaters, sudden vision loss, even retinal detachment are possible as a result of these abnormal vessels

• Retinal ischemia: decreased flow of blood means decreased availability of oxygen which can further encourage the release of VEGF

Management

The best management is prevention! Keeping tight control of sugar levels with diet, exercise, medication and regular checkups, including measuring blood sugar home and at the doctors, are critical.

Your eye doctor will ask about morning fasted blood glucose levels, A1C (which is the 3 month average of circulating blood sugar levels), length of disease, and medications at your visit.

Duration of disease matters – the longer someone has diabetes, the greater the risk of developing diabetic retinopathy.

With mild to moderate changes, your eye doctor will monitor you about every 6 months.

With more severe changes, or if we notice signs of proliferative diabetic retinopathy where abnormal vessels are growing and leaking, more intensive measures are required.

• Laser: an in-office procedure to destroy the growth of abnormal blood vessels or close off leaking vessels
• Injections: an in-office procedure where a medication that stops the creation of new blood vessels is injected into the eye