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Preserving Vision with Diabetic Retinopathy Screening and Treatment

June 19, 2018 Michael Moore

 

Diabetic Retinopathy

 

Diabetic retinopathy is one of the many potential complications of diabetes. The early signs of diabetic retinopathy often go unnoticed by patients. For this reason, it is recommended that those living with diabetes schedule yearly eye exams to screen for any changes in eye health.

Unfortunately, many people living with diabetes forgo yearly screenings, even when they notice visual disturbances. Visual disturbances are not only a sign of diabetic retinopathy, but they are also a common symptom of blood sugar fluctuations. For this reason, patients may be tempted to delay retinopathy screening, assuming their visual disturbances are no cause for concern.

 

How Blood Sugar Levels Can Temporarily Affect Vision

When blood sugar levels rise, blood becomes thicker than usual. Thickened blood pulls more fluid from surrounding tissues affecting the eye's ability to focus. High blood sugar can also cause the lens of the eye to swell, creating visual changes, even after meal blurriness.

Low blood sugar can also cause temporary changes in vision, unrelated to the shape of the lens. Since the brain relies on glucose to interpret information, low blood sugar can make it hard for the brain to interpret visual signals.

These visual disturbances are most often temporary. Even blurriness caused by high blood sugar will return to baseline within a few months of stabilized blood sugar levels.

 

High Blood Sugar Levels Can Cause Retinal Damage

Prolonged high blood sugar can cause changes in the blood vessels that nourish the retina. As the walls of the blood vessels weaken, these bulging vessels can leak fluid and blood. Eventually, diabetic retinopathy can cause scarring, the formation of abnormal blood vessels,  and retinal detachment.

 

The Stages of Diabetic Retinopathy

Diabetic retinopathy is preventable, treatable and a leading cause of blindness. It is estimated that up to 80 percent of diabetic patients who have had diabetes for 20 years or more have some level of diabetic retinopathy. 90 percent of new cases could be reduced by proper treatment and monitoring eye health. There are two stages of diabetic retinopathy.

 

Non-Proliferative Diabetic Retinopathy (NPDR)

Non-proliferative diabetic retinopathy is the development of microaneurysms, microscopic bulges of the artery walls. These bulges can burst, causing tiny spots of blood to accumulate in the retina. Microaneurysm typically does not cause any noticeable visual symptoms.

As the disease progresses, it can trigger macular edema (fluid retention) or macular ischemia (lack of blood to the retina) resulting in rapid vision loss.

Early on, diabetic retinopathy may be symptomless or cause only mild visual disturbances. When Symptoms occur, they typically affect both eyes. The only way to detect NDPR is by fundal photography, capturing an image of the back of the eye, and angiography, recording the vascular flow within the eyes by injecting fluorescent dye into the bloodstream.

 

Proliferative Diabetic Retinopathy (PDR)   

Proliferative diabetic retinopathy is the more advanced stage of the disease. At this stage the damaged blood vessels close off, resulting in the formation of new, abnormal blood vessels supplying the retina, neovascularization. These newly formed blood vessels are quite fragile and often bleed into the vitreous, into the clear, jelly-like substance that fills the center of the eye. At this point, slight bleeding may cause the patient to experience dark floaters. This does not cause permanent vision loss. The spots typically clear within weeks or months, but more severe bleeding may block all vision.

The resulting neovascularization of PDR can lead to the formation of scar tissue. Scar tissue can interfere with the normal flow of fluids. Excess fluid causes eye pressure to build (glaucoma), and can damage the nerve that sends visual signals to the brain, the optic nerve.

 

The Importance of Retinopathy Screening For Those Living with Diabetes

Diabetic neuropathy often goes unnoticed until the event of vision loss. That's why it is so important that those living with diabetes get a comprehensive eye exam every year and are evaluated for signs of diabetic neuropathy. As the condition progresses, diabetic patients may notice the following symptoms:

 

  • Small dark spots or "strings" in the field of vision
  • Dark or empty areas
  • Impaired color vision
  • Blurred vision
  • Visual fluctuations
  • Vision loss

 

Diabetic retinopathy, diabetic macular edema, and glaucoma, all have the potential to cause severe vision loss and blindness. In fact, diabetic eye disease is the most common cause of blindness in those who are still of working age.   Early detection and treatment, typically anti-VEGF injections, laser therapy, or the use of corticosteroids, can greatly reduce the risk of vision loss.

Partnering with MedXM allows a medium for you to reach out to all your diabetic patients who have not recently received retinopathy screening. Through MedXM arrangements can be made to examine patients in their home, or advise patients of the locations of testing facilities.

MedXM facilitates the complete circle of care and communication between patients, health plans, and healthcare providers, through our expanded care network. For additional information about our services, contact MedXM today!

 

 Additional Sources:

https://www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy

https://www.webmd.com/diabetes/diabetic-retinopathy#1

https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/diagnosis-treatment/drc-20371617

https://www.diabetes.co.uk/diabetes-complications/retinopathy-screening.html

https://www.diabetesselfmanagement.com/blog/diabetes-and-your-eyes-more-than-retinopathy/

https://www.myvmc.com/diseases/diabetic-eye-disease-non-proliferative-diabetic-retinopathy/

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