Original article courtesy of Vision Aware.
November is Diabetic Eye Disease Awareness Month, which aims to increase awareness of diabetes and diabetic eye disease and encourage people with diabetes to seek treatment for vision problems related to diabetes.
According to Prevent Blindness America, diabetes is the leading cause of new cases of blindness in adults—and all people with diabetes are at risk for vision loss and blindness from diabetic eye disease. African Americans, Native Americans, Alaska Natives, Hispanics, Latinos, and older adults with diabetes are especially at higher risk.
In addition, an emerging body of research in diabetes, vision, and health care indicates that significant differences in the quality and equality of eye care exist throughout the United States, specifically in the African American and Latino communities.
Different Types of Diabetic Eye Disease
The primary vision problem caused by diabetes is diabetic retinopathy and is the leading cause of new cases of blindness and low vision in adults aged 20-65.
What is Diabetic Retinopathy?
- “Retinopathy” is a general term that describes damage to the retina.
- The retina is a thin, light sensitive tissue that the inside surface of the eye. Nerve cells in the retina convert incoming light into electrical impulses. These electrical impulses are carried by the optic nerve to the brain, which interprets them as visual images.
- Diabetic retinopathy occurs when there is damage to the small blood vessels that nourish tissue and nerve cells in the retina.
- “Proliferative” is a general term that means to grow or increase at a rapid rate by producing new tissue or cells. When the term “proliferative” is used in relation to diabetic retinopathy, it describes the growth, or proliferation, of abnormal new blood vessels in the retina. “Non-proliferative” indicates that this process is not yet occurring.
- Proliferative diabetic retinopathy affects approximately 1 in 20 individuals with the disease.
Four Stages of Diabetic Retinopathy
According to the National Eye Institute, diabetic retinopathy has four stages:
- Mild non-proliferative retinopathy: At this early stage, small areas of balloon-like swelling occur in the retina’s tiny blood vessels.
- Moderate non-proliferative retinopathy: As the disease progresses, some blood vessels that nourish the retina become blocked.
- Severe non-proliferative retinopathy: Many more blood vessels become blocked, which disrupts the blood supply that nourishes the retina. The damaged retina then signals the body to produce new blood vessels.
- Proliferative retinopathy: At this advanced stage, signals sent by the retina trigger the development of new blood vessels that grow (or proliferate) in the retina and the vitreous, which is a transparent gel that fills the interior of the eye. Because these new blood vessels are abnormal, they can rupture and bleed, causing hemorrhages in the retina or vitreous. Scar tissue can develop and can tug at the retina, causing further damage or even retinal detachment.
Diabetic retinopathy usually has no early warning signs. It can be detected only through a comprehensive eye examination that looks for early signs of the disease.
Diagnosing Diabetic Eye Disease
A vision screening is a relatively short examination that can indicate the presence of a vision problem, such as diabetic retinopathy, or a potential vision problem. A vision screening cannot diagnose diabetic eye disease; instead, it can indicate that you should make an appointment with an ophthalmologist or optometrist for a more comprehensive dilated eye examination.
Comprehensive Dilated Eye Examination
A comprehensive dilated eye examination generally lasts between 30 and 60 minutes, and is performed by an ophthalmologist or optometrist. The examination will consist of:
An Eye Health Evaluation
- An examination of the external parts of your eyes: the whites of the eyes, the iris, pupil, eyelids and eyelashes.
- A dilated internal eye examination: Special eye drops will dilate, or open, your pupil, which allows the doctor to observe the inner parts of your eye, such as the retina and optic nerve. This can help to detect subtle changes of the optic nerve in persons without any visual symptoms and potentially lead to early detection of disease, including diabetic retinopathy.
- A test of the fluid pressure within your eyes to check for the possibility of glaucoma.
A Refraction, or Visual Acuity Testing
A refraction helps determine the sharpness or clarity of both your near (reading) and distance vision.
This includes testing your vision with different lenses (pictured at right) to determine if your vision can be improved or corrected with regular glasses or contact lenses.
Visual Field Testing
Visual field testing helps determine how much side (or peripheral) vision you have and how much surrounding area you can see. The most common type of visual field test in a comprehensive eye exam is called a confrontation field test, in which the doctor briefly flashes several fingers in each of the four quadrants of your visual field while seated opposite you. In some cases, your doctor may also want to perform a more precise visual field measurement, using a computerized visual field analyzer, such as the Humphrey Field Analyzer (pictured at left).
Your Examination Results
The doctor will be able to determine if the visual problems you are experiencing are normal age-related changes or are disease-related, and if additional testing, referral to another doctor or specialist, or treatments are needed.
Let us know on our Facebook or Instagram about any stories you have, or tell us in the comments below! We’d love to hear from you!