Diabetic Eye Disease

Diabetic Retinopathy before OCT

Diabetic Retinopathy OCT

Diabetic eye disease refers to a group of eye problems that people with diabetes may experience as a complication of diabetes.

Diabetic eye disease may include:

  • Diabetic Retinopathy: damage to the blood vessels in the retina.
  • Cataract: clouding of the eye’s lens. Cataracts develop at an earlier age in people with diabetes.
  • Glaucoma: increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.

What is Diabetic Retinopathy?

Diabetic Retinopathy is damage to the retina caused by complications of both type 1 and type 2 diabetes mellitus, which can eventually lead to blindness if not treated properly. It affects up to 80% of people who have had diabetes for 10 years or more. Over time, diabetes affects the blood supply of the retina.
These tiny blood vessels at the back of the eye are very vulnerable to poor blood sugar control. This can damage the blood vessels and cause swelling of the retina or progress further to severe bleeding in the eye.

The stages of diabetic retinopathy are:

  • Mild Nonproliferative DR: In this initial stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels. At this stage, most people do not notice any change in their vision.
  • Moderate Nonproliferative DR: Some blood vessels that nourish the retina become increasingly blocked.
  • Severe Nonproliferative DR: Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These oxygen-deprived areas of the retina send signals to the body to grow new blood vessels for nourishment.
  • Proliferative DR: Fragile, new blood vessels then grow along the retina and in the clear, gel-like vitreous humour that fills inside the eye. These new blood vessels can bleed, cloud vision, and destroy the retina.

Diabetic Macular Edema (DME)

Some people develop a condition called Diabetic Macular Edema (DME). It occurs when the damaged blood vessels leak fluid and fatty deposits into the macula area, the central part of the retina. The fluid makes the macula swell and become water-logged, which blurs vision.

What are the symptoms?

Often, there are no symptoms in the early stage of the disease. However, it can present as:

  • Blurred vision
  • Floaters or black spots in the vision
  • Sudden loss of vision
  • Distortion or crookedness of central vision

How is it diagnosed?

A comprehensive eye examination will be performed and may include tests such as retinal photography, OCT scan, B scan ultrasound and Fluorescein Angiography (FFA) to allow observation of retinal changes, swelling and/or leakage.

What are the available treatments?

Treatment of diabetic retinopathy involves 2 main areas:

Systemic (body) Treatment: It is important that people who have diabetic retinopathy make sure their blood sugar levels, blood pressure and cholesterol are under control.  Working together with the family doctor, diabetes specialist and dietitian can improve people’s diabetes which in turn can improve diabetic retinopathy.

Eye Treatments: There are currently a few major treatments which are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90% chance of keeping their vision when they get treatment before the retina is severely damaged.

  • Laser: to shrink the abnormal blood vessels and reduce swelling of the retina. Thermal laser surgery can work by cauterising or photo-coagulating abnormal leaky blood vessels and to dry up fluid swelling in the macula. Multispot Micropulse Yellow Laser surgery can be as effective in reducing retinal swelling with less long term scarring especially around the macula
  • Intravitreal Steroid (Triamcinolone/ Dexamethasone) injection: to decrease macular edema and stabilise vision. Intravitreal triamcinolone is an anti-inflammatory agent and has a potent effect on reducing the swelling that occurs with diabetic retinopathy. The effect of injection may be transient, can last up to a few months and repeated injections are sometimes necessary for maintaining better vision..
  • Intravitreal Bevacizumab Injection: to reduce swelling of the retina in the macular area (Diabetic Macular Edema) and shrink abnormal blood vessels.
  • Vitrectomy Surgery: performed when there is a lot of blood in the vitreous cavity or tractional retinal detachment where diabetic retinopathy pulls off the retina. It involves removing the cloudy vitreous and replacing it with a saline (salt water) solution.

From October 1, 2015, a new treatment for diabetic eye disease will be available on the PBS (Pharmaceutical Benefits Scheme). Aflibercept is a type of injection in the eye to treat swelling of the macula part of the retina (diabetic macular edema) which can cause blindness or vision loss if left untreated. This joins another new eye injection Ranibizumab which has recently been available on the PBS since July 1 2015.

From November 1 2016, a new, sustained-release eye implant, Dexamethasone, will become available on the Pharmaceutical Benefits Scheme (PBS) for the treatment of Diabetic Macular Edema (DME).

Please discuss with our retina specialists who will be able to determine if these treatments are appropriate for you.