Related topics: •  Complications of Diabetes: Foot Ulcers and Infections •  Diabetes Center

One night while watching a play in a dark theater, Paula Lewis saw something terrifying: A fuzzy spot dancing in front of her eyes. She tried to tell herself it was a dustball, but she knew it was really a cloud of blood. Lewis had diabetes, a disease that can damage the blood vessels in the retina. Now one of her vessels had burst, and she worried that blindness wouldn't be far behind.

But Lewis didn't go blind. In fact, her vision is nearly as sharp as ever. Thanks to modern treatments, more and more people like Lewis are keeping their sight. If you have diabetes, you need to know that your vision could be in danger. You also need to know that there's plenty of room for hope.

Diabetes can slowly damage many parts of the body, including the blood vessels that feed the retina, a paper-thin membrane in the back of your eye that collects light. If your blood sugar is too high for too long, the vessels can become fragile and leaky, and new vessels can appear where they don't belong. Doctors call this damage retinopathy, and it's the number-one cause of blindness in American adults.

At first, retinopathy is usually harmless. The vessels may balloon and form pouches, but you probably won't notice any changes in vision. This stage, called non-proliferative retinopathy, often doesn't require treatment. And in most cases, the condition goes into a holding pattern and never gets any worse.

If the damage continues, some vessels may become closed off, and new vessels will grow to take their place. This stage is called proliferative retinopathy. Unfortunately, the new vessels are usually weak and can easily burst. The resulting pools of blood can cloud your vision for days, months, or even years. The retina may also become scarred and detached from its blood vessels.

At any stage of the disease, fluid can leak onto the macula, the ultra-sensitive part of the retina that controls the sharpness and clarity of vision. This can cause swelling of the macula and blurring of vision.

Retinopathy is one of the most common complications of diabetes. Up to 45 percent of people with diabetes and 8 percent of people with pre-diabetes develop retinopathy. The problem is particularly common -- and particularly aggressive -- in people with poorly controlled blood sugar or high blood pressure.

Retinopathy can also strike diabetic women during a pregnancy. Pregnant women with diabetes should have a retinal eye exam early in pregnancy to rule out existing retinopathy. If you already have retinopathy or another disease such as high blood pressure, check with your doctor to see how often you should have your eyes examined during pregnancy.

Often, early retinopathy causes few or no symptoms. And by the time symptoms appear, the retina may already be significantly damaged. Even if you don't have symptoms, you should have your eyes checked by an experienced opthalmologist at least once a year. The specialist can check for retinopathy by dilating the pupil and examining the retina with a machine called an ophthalmoscope. In another common test called a fluorescein angiography or fluorescein dye test, an opthalmologist injects a special dye into your arm. As the dye flows through your blood vessels in your retina into your retina, your opthalmologist will look for any leaking blood vessels. To catch the condition as soon as possible, watch for these signs of trouble:

•Blurry vision

•Double vision

•Pain in one or both eyes

•Spots or floaters

•Fluctuating vision

•Distortion of straight lines

An opthalmologist can also check for glaucoma and cataracts. These conditions are significantly more common in people with diabetes.

Years ago, most diabetics with retinopathy eventually went blind. But thanks to modern treatments, patients with severe retinopathy can reduce their risk of blindness by 95 percent.

The advent of laser surgery was the biggest breakthrough in retinopathy treatment. Lasers can seal off the leaky vessels that cause macular edema, and they can also destroy the abnormal blood vessels that form in proliferative retinopathy. A surgeon will aim the laser at the outer edges of your retina, so you may lose a little peripheral vision. In general, laser surgery won't improve your vision, but it can keep it from getting worse.

If there's a lot of bleeding in your eye, your doctor may need to remove the excess fluid with an operation called a vitrectomy. This operation works best if performed immediately after a vessel bursts. A doctor will make a tiny cut in the white of your eye and insert an instrument that sucks up the bloody fluid and replaces it with a saline solution. Your eye will be irritated, and you'll have to wear a patch for a few days.

The best way to prevent retinopathy is to keep BOTH your blood sugar and your blood pressure under control. Not only will you protect your eyes, you'll also cut your risk of nerve damage, kidney disease, heart disease, and early death. Tight control isn't always easy, but it's within your reach. Work closely with your doctor, take your medications as directed, and make any recommended lifestyle changes. Your sight -- and your life -- may depend on it.

Further Resources

American Diabetes Association

800/342-2383

http://www.diabetes.org

National Eye Institute, part of the National Institutes of Health

http://www.nei.nih.gov

The American Diabetes Association offers a variety of publications with information on retinopathy. One good source of information is the book, The Diabetes Problem Solver.

References

First published January 22, 2001
Last updated February 26, 2008
Copyright © 2001 Consumer Health Interactive

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