Diabetic retinopathy Eye News

Signs of Diabetic Eye Disease

November is Diabetic Eye Disease Awareness Month, which raises awareness about and supports people who are affected by diabetes and its symptoms. It’s important to know the signs of diabetes and diabetic eye disease, because they often go undetected.

What is Diabetes?

Diabetes is a chronic health condition that affects how your body turns food into energy. There are various types of diabetes, the most common being types 1 and 2.

All types of diabetes are chronic diseases that affect the way your body produces blood sugar, or glucose. Those with type 1 produce little or no insulin, which controls your blood sugar levels. Those with type 2 either don’t produce enough insulin, or their body resists it.

Having too much glucose in the blood long-term can damage small blood vessels in the eyes, leading to various vision problems.

What is Diabetic Eye Disease?

Diabetic eye disease is the leading cause of blindness in people affected by diabetes. According to the CDC, about 90% of vision loss from diabetes can be prevented if detected early.

Diabetic eye disease is a collective term referring to multiple eye problems that can develop due to diabetes, including diabetic retinopathy, macular edema, glaucoma, and cataracts.

Diabetic retinopathy occurs when blood vessels in the retina expand, leak or close off completely. Similarly, macular edema occurs when the small retinal blood vessels begin to leak in, or near, the macula. Glaucoma is a class of diseases, which cause damage to the optic nerve and cataracts cause your lens to become cloudy.

People with diabetes have a higher risk of developing any of these eye diseases. The risk can also increase the longer a person has diabetes, and can lead to permanent vision loss if left untreated. Almost every patient with diabetes will develop some degree of diabetic eye disease, but with early detection and treatment, vision loss can remain minimal. If you’re affected by diabetes, be aware of the following signs of diabetic eye disease:

  • Blurry Vision
  • Floaters
  • Temporary loss of vision
  • Eye aches or pain
  • Watery eyes
  • Headaches

If you experience any of these symptoms you should seek an eye exam immediately. Studies have shown that sixty percent of diabetics do not follow through with recommended eye exams, which can lead to severe complications, like permanent blindness.

How to Protect Your Vision

To protect your eyes from the harmful effects of diabetic eye disease, you should practice healthy eye care by routinely visiting your ophthalmologist and updating your glasses prescription as necessary. Investing in glasses with a proper prescription can relieve you from blurry or foggy vision, and help combat nearsightedness caused by cataracts. If you’re showing signs of diabetic eye disease, your ophthalmologist may recommend more frequent visits and treatment. To better your chances of avoiding this circumstance, avoid harsh UV rays by wearing sunglasses, use eye drops to decrease dryness and irritation, and follow your primary care physician’s diet and exercise guidelines to keep your blood sugar levels at bay.

Randall V. Wong, M.D.
Retina Specialist
Virginia and Washington D.C.

Diabetic retinopathy Uncategorized

Vitreous Hemorrhage in a Patient with Diabetes

This a vitreous hemorrhage.  The patient has a 30+ year history of Type 1 diabetes, has had cataract surgery in both eyes and never had laser or vitreo-retinal surgery for treatment of her diabetic retinopathy.

Essentially, she has been doing very well.  I see her at least twice a year to insure there is no diabetic macular edema and no sign of proliferative diabetic retinopathy.

She has been complaining of a “pixelated” change to the vision of the left eye.  (Honestly, as I told her, I have no idea what “pixelated” means.)

Dilated Eye Examination

Her examination started off normally.  The essential information is as follows;

61 Year Old Female
Bilateral Cataract Surgery
Last Recorded A1C: 8.0
AM Sugar:  90

Vision:  20/20 OD (Right Eye)
20/25 OS (Left Eye)

IOP:  17 OD
20 OS

Every patient gets their pupils dilated so I can examine the retina.  Examination of the retina is paramount in patients with diabetes.

Of significance is that her vision was excellent!

Vitreous Hemorrhage

After dilating her pupils, I was able to diagnose a vitreous hemorrhage.  This is the cause for her “pixelated” vision.  For teaching purposes:

  • This is a photograph of the left retina
  • The scalloped areas are “boat hemorrhages” formed by blood trapped between the retina and the posterior vitreous.  Blood is trapped in a “pocket” between the surface of the retina and the posterior vitreous
  • The top areas are horizontal and “level” due to the effect of gravity – hence,  the “boat”
  • In the larger hemorrhage, notice that the underlying normal retinal blood vessel is hidden – gives you an idea of the actual location of the bleeding

Diagnosis of Proliferative Diabetic Retinopathy

There are many causes of vitreous hemorrhage, but the more likely cause is related to diabetic retinopathy, especially in the absence of a tear in the retina.

While almost every patient with diabetes will develop some early degree of diabetic retinopathy, far fewer develop proliferative diabetic retinopathy.

Proliferative diabetic retinopathy (PDR) is defined as the stage of diabetic retinopathy where abnormal blood vessels, aka “neovascularization,” form somewhere on the retina or elsewhere in the eye.

Neovascular blood vessels are extremely fragile and can bleed easily causing a vitreous hemorrhage.

Sometimes the blood mixes throughout the retina and sometimes, as in this case, the blood remains localized and a nice picture can be obtained.

Vitreous Hemorrhage

In this particular case, my job is to insure that the blood is from the diabetic retinopathy.  As I said above, a retinal tear could also cause a vitreous hemorrhage, so in the absence of a retinal tear or other problem, I can safely observe (i.e. do nothing and simply wait) to see if the hemorrhage resolves on it’s own.  If there were a tear, I would need to treat the tear.

I’ll see this patient back in a few weeks.  The best treatment for this stage of the disease is laser treatment (aka panretinal photocoagulation).

Laser may be attempted in the office if enough of the hemorrhage clears on it’s own.  If not, vitrectomy can remove the blood and laser be performed at the same time.


Diabetic retinopathy Video

What is Diabetic Retinopathy?

Review of Diabetic Retinopathy

Hi!  I’m Randy Wong.  I’m a retina specialist located in Fairfax, Virginia.  Today we are going to talk about Diabetic Retinopathy.  We are going to talk about:

  • Who gets the disease?
  • What the Disease can do
  • How it’s diagnosed?
  • Treatment Plans
Diabetic retinopathy Treatments

Iluvien Treats Diabetic Macular Edema for 3 Years

US ILUVIEN LOGOIluvien is now available in the United States!  Finally receiving FDA approval in late 2014, the injectable sustained release intravitreal implant  is on the market.

Alimera Sciences states that Iluvien (sustained release of fluocinolone) will release its drug for up to 3 years.

Iluvien Treats Diabetic Macular Edema

Diabetic macular edema is the most common vision threatening complication of diabetic retinopathy.  In essence, normal blood vessels of the retina become leaky due to the diabetic retinopathy.

Fluid accumulation in or near the center of the macula is called diabetic macular edema (DME).  This is also known as clinically significant macular edema (CSME) if you are a doctor.

DME often causes blurry vision and in extreme cases can cause legal blindness.

Therapy is aimed at stopping the leakage.  With time, the macular edema may “dry up.”

Treatment options include laser, anti-VEGF (e.g. Avastin, Lucentis, Eylea), intravitreal steroids (Kenalog) or sustained release intravitreal implants (Ozurdex, Iluvien).Size comparison of Iluvien to Pencil Tip | Randall Wong, M.D., Retina Specialist, Fairfax, Virginia

Iluvien is Injected Painlessly

Iluvien is injected directly into the vitreous.  The sustained release system will release fluocinolone for 3 years.  The actual “pellet” is small enough to fit inside a 25 gauge needle.  It is smaller and thinner than a grain of rice.  You may click on the image to enlarge.

By injecting directly into the eye, as with all intravitreal injections, only small amounts of drug are needed to treat the retina.

The steroid will chemically stop the retinal vessels, affected by the diabetic retinopathy, from leaking.

36 month Delivery

While intravitreal drug delivery is not novel, the duration of the product is unique.

Constant treatment for 36 months may have huge practical advantages; namely fewer offices visits and less testing.

The economics of this are intriguing.  The practical consequences are even more staggering.  In short, this could mean far fewer trips to the retina specialist for the patient AND the family.  Fewer office visits translates into fewer examinations and testing.

We’ll see.





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