Consultant Ophthalmologist,
Cataract & Refractive Surgeon

BMedSci BM BS MRCS MRCSEd MRCOpth FRCOphth MMedLaw PgD Cataract & Refractive Surgery

Diabetic Eye Disease

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What's going on?

Unfortunately along with everything else that can be affected by diabetes it can also affect the eye. Even if your diabetes is well controlled you can develop diabetic eye disease. If your diabetes is poorly controlled your eye condition can be serious.

It's all about the blood vessels at the back of the eye. Due to the diabetes these blood vessels weaken. They can leak fluid into the retina and reduce vision or they can pop causing bleeding. These changes don't actually affect your vision straight away but if they worsen they can lead to significant visual loss or even blindness.

Everybody with diabetes should have their eyes checked at least yearly to detect the presence and the severity of any diabetic eye changes.

What will my ophthalmologist see?

By examining the retina we can accurately and comprehensively pick up any eye changes.

What will my ophthalmologist do for me?

If we pick up any changes we can assess their severity and advise you about the optimal follow-up schedule. Often if the condition is mild you can be followed up by your own optician. If the disease is significant we will need to see you regularly (sometimes every two months). We see you to detect any sight threatening changes early. Once the swelling or bleeding gets close to your central area of vision or if new abnormal blood vessels grow we can apply laser treatment to prevent you losing vision.

What can I do?

I'm sure you get this lecture all the time however it is important to reiterate how tight control of your diabetes is vital for your general and eye well being. The better you control your diabetes the less likely your eye disease is to worsen.

Please stop smoking as this can adversely affect your eyes and your vision.

What do I need to know?

If you work hard to control your blood sugars and see us regularly we should be able to work together to preserve your vision as well as possible.

For more precise information about your particular degree of diabetic eye disease please click on the links below:

Background Diabetic Retinopathy

What’s going on?

This is the mildest variant of the disease but can cover a large spectrum of severity. If it is the severe type then we will let you know as we will be worried about your vision. We may even elect to treat you to be on the safe side.

What will my ophthalmologist do for me?

We could see one or two small tiny haemorrhages or we could see lots of them with evidence of fatty leakage from the blood vessels.

What will my ophthalmologist do for me?

Usually we will watch you closely to make sure you don’t develop the other more worrying and potentially sight threatening variants of the disease.

What can I do?

Keep your diabetes well controlled. Make sure your blood pressure control is optimized. Attend regularly for follow-up

What do I need to know?

In the great majority of cases we can preserve your vision so you do not notice any difference. Unfortunately diabetic patients have an increased incidence of cataract.

Proliferative Diabetic Retinopathy

What’s going on?

Due to the diabetes the retinal blood vessels have weakened so much that blood no longer flows down them properly. The retina is starved of oxygen and in an attempt to get a new blood supply new blood vessels begin to form. These new vessels are highly abnormal – they leak and are fragile and can rupture. If they do rupture then the eye can fill with blood dramatically reducing vision. Along with the bleeding they can cause growth of fibrous tissue that tugs on the retina.

What will my ophthalmologist see?

There may be fine new blood vessels at the optic disc or elsewhere within the retina. If the new vessels have already ruptured we may not be able to see any of the back of the eye and we may need to ultrasound the eye.

What will my ophthalmologist do for me?

We can apply laser treatment or sometimes inject a special chemical into the eye. Sometimes we can recommend an operation to have the blood removed from inside the eye.

What can I do?

Once the haemorrhage settles you need to address your diabetic and blood pressure control.

What do I need to know?

This means that you have severe diabetic eye disease. We need to work hard together to make sure that your vision doesn’t get worse.

Maculopathy

What’s going on?

Diabetic changes are affecting the macula, the most important portion of the retina for central vision. If the leakage of fluid and fatty deposits or the haemorrhages reach the very centre of the macula your central vision can go down.

What will my ophthalmologist see?

We will see these diabetic changes within the macula. More importantly we will be able to tell how severe they are and also how close they are to your most important bit of retina.

What will my ophthalmologist do for me?

We will follow you in the clinic to make sure your diabetic damage is not getting worse. If it is and you reach a certain degree of severity (called clinically significant macular oedema) we can treat you with laser or other techniques to preserve your vision.

What can I do?

Control your diabetes, stop smoking and make sure your blood pressure is checked regularly.

What do I need to know?

Treatment is designed to preserve vision and not to improve it. Too much laser treatment can also cause damage in itself so we have to balance risk and benefit.

Clinically Significant Macula Oedema

What’s going on?

You have diabetic changes in the macular, the most important portion of the retina for central vision, and these changes could cause visual loss soon. You need some form of treatment usually in the form of laser. Once vision has been lost, laser treatment is seldom able to restore it – the emphasis is on prevention.

What will my ophthalmologist see?

There are hard and fast rules based upon big research studies which dictate when we should intervene with laser to preserve your vision. When we see these changes we will plan treatment.

What will my ophthalmologist do for me?

We can plan to apply argon laser treatment to the area of leaky retina. This procedure is called a macular grid because a regular grid of laser is applied to the macula. Only mild burns are required to stop the leak, but they do reduce vision in the area where they are applied. This means that there is a careful balance we need to strike between damage and benefit.

What do I need to do?

Optimisation of diabetic and blood pressure control is required.

What do I need to know?

If the condition is left unchecked your vision will inevitably get worse.  Sadly sometimes there is nothing that can be done to preserve vision if the disorder is severe. This is particularly true if the blood vessels to the macula have completely failed due to the diabetes.