While annual and routine eye examinations are important for all individuals, they are especially important for anyone who has diabetes. In fact, one of the key measures in managing a patient with diabetes is ensuring that there has been a dilated eye examination within the past year.
Diabetes can lead to many eye problems – most notably diabetic retinopathy which is a leading cause of blindness in the US. Diabetic changes to the eye can be noted before other body systems begin to have symptoms of damage. An eye doctor will evaluate for diabetic retinopathy and can make recommendations regarding blood sugar control or if there is any treatment indicated for the eyes.
Why Dilation is Important
While having an eye examination in total is important, the most important aspect for a patient with diabetes is having a dilated retinal examination.
The changes from diabetes that can lead to vision loss and blindness can start as small bleeds or clots in the far periphery of the retina.
A dilated eye examination allows the doctor to thoroughly evaluate the health of the retina and check for any signs of diabetic retinopathy.
How Diabetes Affects the Retina
Diabetic retinopathy occurs when the small blood vessels in the retina are weakened and damaged from prolonged elevated blood sugar levels.
When the blood sugar is elevated, the blood vessels begin to store excess sugar in the walls of the blood vessels. Over time, these areas of storage can become weakened and lead to breaks or clots.
Potential changes in the retina can include small hemorrhages or bleeds, areas of ischemia or loss of oxygen supply, and clots in blood vessels that lead to blood backing up into the vessels.
All of these changes can be seen directly with a dilated eye examination and can be assessed using instruments that scan the back of the eye.
Outcomes of Diabetic Retinopathy
There are a variety of different stages of diabetic retinopathy ranging from mild signs that do not impact vision to severe changes that can lead to complete blindness.
In the earliest stages of diabetic retinopathy, there may be scattered hemorrhages or exudates in the retina that indicate small amounts of damage to the blood vessels. These changes will not impact vision and may persist with no relevant issues.
As changes become more impactful, areas of the retina can become ischemic and lose oxygen supply. This can result in permanent vision loss in this area of the retina.
The most severe cases of diabetic retinopathy can cause retinal detachments, vitreous hemorrhages, or vein occlusions, all of which can result in complete vision loss.
Treatment for Diabetic Retinopathy
Depending on the severity of the diabetic retinopathy, treatment may be as simple as continuing to manage blood sugar with medications, diet, and exercise or may involve direct treatments to the eyes.
In mild cases, blood sugar control and management with the primary care provider is typically the only treatment needed.
As symptoms develop and the changes from the retinopathy are more impactful, injections in the eye or laser surgery to the back of the eye may be needed to manage diabetic retinopathy.