Retina specialists are often asked by general ophthalmologists or optometrists to treat the eye complications of diabetes.  One of the most common complications is diabetic macular edema or DME.  Retina specialists use clinical examination in the office to determine if the edema (or swelling) is “clinically significant.”  Signs of clinically significant macular edema are blurred vision, trouble seeing during the day, difficulties reading, and (less commonly) eye floaters.

Clinically significant macular edema (CSME) is present if any of the three exam findings are seen by your ophthalmologist.

• Any retinal edema within 500 microns of the center of the fovea (the most central part of your vision)
• Hard exudates (fats) within 500 microns of the center of the fovea if associated with retinal thickening
• Retinal edema greater than one optic nerve disc in size and within one disc diameter of the center of the fovea

My eye doctor found macular edema.  How can I be treated?

Patients with clinically significant macular edema may benefit from eye laser or eye injections.  Common eye injections include Avastin, Lucentis, and Eylea.  Eye injections of steroids can be helpful in some cases.  Steroids are used sparingly as they can cause cataracts and glaucoma over time and with repeated use.  Good control of blood sugars and blood pressure is critical in the treatment of macular edema.

How can I be tested for macular edema?

A dilated eye exam is the most useful test to determine if you have macular edema.  Your retina specialist may take OCT images (showing the retina in cross section) to show the degree of retinal edema and your improvement over time with repeated eye injections.  A fluorescein angiogram (FA) may be helpful to determine the degree and severity of the retinal swelling.

Without treatment, your vision may become blurred over time since macular edema involves the part of the retina responsible for central vision.

If you are interested, here is some additional reading about macular edema from EyeWiki.

If you are diabetic and think you may have diabetic macular edema, call Dr. Stelton today or contact him here.

Diabetic retinopathy is a serious public health issue.  

Diabetic retinopathy is the leading cause of blindness in people of working age in developed countries.  In 2012, nearly 30 million Americans were diagnosed with diabetes per the American Diabetes Association.

Diabetic retinopathy is the visible manifestation of longstanding diabetes in the retina.  

Changes in the eye caused by diabetes are due to a combination of the longevity of disease duration and degree of blood sugar control.  Diabetes will affect the eyes of nearly all patients with sufficient duration of uncontrolled disease.  If left untreated, diabetic retinopathy can result in eye pain over time and can even result in permanent vision loss or blindness.

As with many eye problems, symptoms may not manifest until late in the disease.  Common symptoms include:

• Decreased vision
• Floaters
• Blind spots
• Distortion
• Eye pain
• Loss of vision
• Poor color vision
• Poor night vision

The number one risk factor for the development of diabetic retinopathy is the duration of diabetes.

In short, the longer you have diabetes, the more likely you are to develop bleeding in the retina.  Other factors include poor blood sugar control, poor blood pressure control, high cholesterol, pregnancy, and barriers to healthcare access.

Diabetes causes damage to the small blood vessels in the eye.  

This leads to poor blood flow in the eye.  A low oxygen state triggers a series of biochemical and cellular events that can cause damage to the eye over time.

Diabetic retinopathy progresses through a series of very predictable stages. 

Diabetic retinopathy begins as a “non-proliferative” disease, meaning that hemorrhages begin to form in the retina and small vascular abnormalities form within the retina.  If left untreated, the diabetic retinopathy becomes increasingly more severe, until it eventually enters a proliferative stage.

This proliferative stage is identified by the development of abnormal, new blood vessels.  These blood vessels can lead to hemorrhaging with the gel in the middle of the eye (vitreous hemorrhage), scar tissue formation on the retina, retinal detachment, or a painful type of glaucoma (neovascular glaucoma).  The abnormal vessels can be treated with a laser procedure called pan-retinal photocoagulation (PRP).  If left untreated, an eye will become blind and painful over time. Ophthalmologists and retina specialists like to identify and treat the disease before it gets to the “proliferative” stage.

Patients can help prevent diabetic retinopathy by getting a yearly dilated eye exam. 

Eye exams help with early detection and prevention.  The American Academy of Ophthalmology recommends an eye exam at the time of diagnosis of diabetes then yearly for Type 2 diabetics.  Intensive blood sugar control both reduces the risk of progression and slows progression in most patients.

Treatment options include close observation, laser, or injections of medications like Avastin, Lucentis, and Eylea into the eye.  Ophthalmologists commonly work with primary care doctors and endocrinologists in patients at high risk for vision loss.

For further reading, check out the American Academy of Ophthalmology’s Preferred Practice Patterns regarding diabetic retinopathy.

It is very important for diabetics to have their eyes checked annually for any signs of diabetic retinopathy.  Call today if you are due for your yearly eye exam – 941-777-5000.

My regular eye doctor sent me to a retinal specialist.  What is a retina specialist?

A retinal specialist is an eye physician whose focus is primarily on the structures at the back part of the eye.  Retina specialists often work in conjunction with general ophthalmologists, medical retina specialists, optometrists, and other eye care providers.  They treat eye diseases in the office and can go to the operating room to fix some eye problems with surgery.

What type of training does a retina specialist have?

Retina specialists go to medical school.  Retinal specialists have advanced medical training after medical school including 1 year of internship, 3 years of ophthalmology residency, and an additional 2 years of vitreoretinal surgical training.   They can interpret sophisticated imaging of the back part of the eye like optical coherence tomography (OCT) or fluorescein angiography (FA).

What types of diseases do retina specialists treat?

Most commonly, retina specialists treat complex eye diseases like eye floaters, macular degeneration, retinal detachment or tear, or diabetic eye disease.   Due to their advanced training, they deal with many problems which can lead to blindness or loss of vision and can offer both great advice and treatment.

What types of surgery or procedures do retina specialists perform?

Retina specialists perform intravitreal injections for diabetic retinopathy or macular degeneration.  They can perform lasers for retinal tears or detachment.  They perform vitrectomy surgery for many eye issues including:

• eye floaters
• retinal detachment
• macular hole
• epiretinal membrane (ERM)
• posterior vitreous detachment
• intraocular bleeding (vitreous hemorrhage) from diabetic retinopathy or macular degeneration

A yearly diabetic eye exam is recommended for patients with diabetes.

WHAT IS DIABETIC RETINOPATHY?

Diabetic retinopathy is a condition that can affect anyone with Type 1 or Type 2 diabetes.  It is caused by damage to the small blood vessels at the back part of the eye and can lead to bleeding and swelling within and close to the retinal layers.  It is hard to detect without the help of a skilled ophthalmologist.  Diabetic retinopathy can be severe and can lead to blindness, in some cases.  The more uncontrolled a patient’s blood pressure and blood sugar, the higher the likelihood they have diabetic retinopathy causing problems with their vision.

HOW CAN A RETINAL SPECIALIST HELP WITH DIABETIC RETINOPATHY?

Retinal specialists can help by monitoring for the development of diabetic retinopathy and treating retinopathy when it occurs.  It is recommended that every diabetic gets a yearly routine screening eye examination.  Request an appointment today by calling 941-777-5000!

Video courtesy of National Eye Institute, NIH