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Diabetic Retinopathy
H o w D i a b e t e s A f f e c t s t h e S t r u c t u r e s o f t h e E y e
Image Credit: Brittany Richardson, CRA, OCT-C, COA
Flaum Eye Institute, Rochester, NY
Sarah Michaels, COA
Melissa Field, COA
Diagnostic Imaging at
Flaum Eye Institute, URMC
Credit: LensCrafters.ca
AnatomyT h e e y e c o n s i s t s o f s e v e r a l s t r u c t u r e s t h a t m a k e i t f u n c t i o n w e l l f o r u s t o s e e c l e a r l y . T h e e y e r e c e i v e s l i g h t t h r o u g h t h e p u p i l . T h e l e n s f o c u s e s t h e l i g h t o n t h e r e t i n a w h i c h p r o d u c e s s i g n a l s t o t h e b r a i n t o b e p e r c e i v e d a s i m a g e s .
Sclera
IrisPupil
Image Credit: Heather Carmello, CRA, OCT-C, COA
Flaum Eye Institute, Rochester, NY
The Lens
The lens is responsible for focusing light rays onto the retina. The lens is transparent, and can be replaced if necessary. As we age, and especially with diabetes, our lens loses it's transparency and becomes more opaque. This results in cataracts. Cataracts form more quickly in patients with uncontrolled diabetes. In cataract surgery an artificial implant is used to replace our natural lens.
Lens
Light rays
If you look through the
pupil this is what you see…
…the retina!
The Retina
T h e r e t i n a i s t h e l a y e r o f n e r v e c e l l s l i n i n g t h e b a c k w a l l i n s i d e t h e e y e . T h i s l a y e r s e n s e s l i g h t a n d s e n d s s i g n a l s t o t h e b r a i n . T h e m a c u l a c o n t a i n s l i g h t s e n s i n g c e l l s t h a t p r o d u c e o u r s h a r p e s t p o i n t o f v i s i o n . A r t e r i e s a n d v e i n s s u p p l y b l o o d , o x y g e n , a n d o t h e r n u t r i e n t s t o t h e r e t i n a .
Image Credit: Brittany Bateman, COA, OCT-C, CRA
Flaum Eye Institute, Rochester, NY
Macula
The Optic Nerve also referred to as the optic disc
A b u n d l e o f m o r e t h a n a m i l l i o n n e r v e f i b e r s t h a t c a r r i e s s i g n a l s f r o m t h e r e t i n a t o t h e b r a i n . Y o u r b r a i n p r o c e s s e s i m a g e s f r o m t h e r e t i n a i n t o i m a g e s t h a t w e s e e . D a m a g e t o t h e o p t i c n e r v e c a n c a u s e b l i n d n e s s . G l a u c o m a i s o n e o f t h e m o s t c o m m o n e y e c o n d i t i o n s r e l a t e d t o o p t i c n e r v e d a m a g e . G l a u c o m a i s m o r e c o m m o n i n p a t i e n t s w i t h d i a b e t e s .
Image Credit: Sarah Michaels, COA
Flaum Eye Institute, Rochester, NY
Diabetesand how it relates to eye health
Diabetic retinopathy is the leading cause of
blindness in the working age population
“ You have diabetes when there
is too much sugar in your blood
Diabetes is a metabolic problem that leads to high sugar or hyperglycemia in
the blood vessels and body tissue.
Diabetes worsens when you have unhealthy habits. For example, if you eat too much sugar and salt or if
you do not exercise.
WHY?Blood Sugar Blood Pressure Cholesterol
“
When Diabetes Affects the Eye…
• Increase in floaters
• Blurred vision
• Changing vision from blurred to clear
• Poor night vision
• Darkened or black areas in vision
“
In this patient we see the swelling (figure 1) that
occurs as a result of uncontrolled diabetes. The
spacing or dark areas show us that fluid is gathering
in the retina. Vision is compromised and can
fluctuate daily.
This is a normal retina. There should be no
spaces between the layers. The top most layer
should maintain a smooth contour with a small
dip in the center where the fovea (the area that
controls the sharpest vision) is.
Figure 1
Layers of the Ret inaAn OCT (optical coherence tomography) is an image of the layers of the macula. This is
a non-invasive imaging test. OCT uses light waves to take cross-section pictures of your
retina. Think of this as an ultrasound but using light waves instead of sound waves.
Stages Of Diabetic Retinopathy
• Early stage
• Tiny blood vessels leak
• Swelling of the macula (edema)
• Catching diabetic retinopathy at this stage can save vision and avoid further damage to the eye
• Advanced stage
• Neovascularization –new leaky blood vessel growth
• Bleeding into the vitreous
• Leads to vision loss and scarring, can be permanent
NPDR (non-proliferative
diabetic retinopathy)
PDR (proliferative
diabetic retinopathy)
Image Credit: Sarah Michaels, COA
Flaum Eye Institute, Rochester, NY
• Healthy retina
• Clear view to the back
of the eye
• No hemorrhages
• Good supply of nutrients
to retina
• Moderate NPDR (non-proliferative
diabetic retinopathy)
• Vessels become damaged
from high sugars
• Bleeding from vessels begins
• Vision may not be affected yet
• High Risk PDR (proliferative diabetic
retinopathy)
• Hemorrhage in the jelly of
the eye (vitreous)
• New blood vessel growth
due to low oxygen levels
from damaged vessels
DIABETIC RETINOPATHY PROGRESSION
DIABETIC RETINOPATHY PROGRESSION
• Moderate PDR (proliferative diabetic
retinopathy)
• NVD (neovascularization of the optic
disc)
• Blood vessels hemorrhage
• Vision may still not be
affected at this stage but
damage could be permanent
• Laser treatment used to
decrease the need of new
blood vessel growth
• Vitreomacular traction
begins to pull on retina,
could lead to retinal
detachment
• Surgical treatment likely
required
• May have permanent vision
loss despite treatment
Diabetic Retinopathy Treatment
• Medical Control
• Maintain good blood sugars
• Maintain good blood pressure
• Medications
• Anti-VEGF (vascular endothelial growth factor)
injections of medication into the eye (to stop the growth of new blood vessels)
• Laser Surgery
• Seal off leaking blood vessels with laser
• Surgical Intervention
• Removal of vitreous gel and blood from leaking vessels from the back of the eye
Laser treatment spots
“ Prevention is key!
o Get a comprehensive
dilated eye exam at least
once a year
o Control blood sugar
o Maintain healthy blood
pressure and cholesterol
levels
o Quit smoking
o Exercise
Five steps to help prevent
diabetic eye disease:
