Diabetes and Eye Problems
Treatment of Diabetic Retinopathy continued...
Your doctor may recommend vitrectomy surgery if you have a hemorrhage that doesn't clear, if you have retinal detachment, or if laser treatment doesn't sufficiently halt the growth of new vessels. During vitrectomy, the doctor drains the gel-like substance inside the eye, allowing her to clear any lingering blood and to remove scar tissue. The vitreous fluid is then replaced with a substitute fluid.
Rare complications of treatment may include blurred vision, headache, glaucoma, difficulty seeing in the dark, decreased peripheral and color vision, and bleeding. In most cases when treatment is recommended, the benefits outweigh the risks.
Although both of these treatments can be very effective, your expectations for either treatment should be realistic. Typically laser or surgical treatment will not restore lost vision; however, treatment can prevent any additional loss of eyesight. If you already have vision loss, your doctor can counsel you about options for visual rehabilitation.
Prevention of Diabetic Retinopathy
Diabetic retinopathy can be minimized with a combination of strict blood sugar control and routine screening with eye exams -- though even with optimal medical care, it is not always possible to prevent or slow retinal damage.
Studies have shown that maintaining near-normal blood sugar can decrease the chance of developing retinopathy and can help keep existing retinopathy from getting worse. Your doctor can provide guidelines that may include insulin and other medications, dietary modifications, and exercise. Intensive insulin therapy, which may include frequent blood sugar testing and the use of an insulin pump, may be an option. It's not always easy to stick to the disciplined lifestyle necessary to control blood sugar; don't hesitate to tell your doctor if you need extra support to adhere to his guidelines.
Routine screening offers the best hope for early detection of diabetic retinopathy. People with type 1 diabetes should have a complete eye exam within five years of diagnosis; those with type 2 should have an eye exam at the time their diabetes is diagnosed. After these initial exams, all people with diabetes should have an eye exam at least once a year. Your doctor may recommend more frequent screenings depending on the severity of retinal damage and on other diabetes complications you have.
Pregnancy can precipitate or worsen retinopathy in women with diabetes who take insulin, so any such woman considering pregnancy should discuss the risks with her doctor. Your doctor will usually recommend an eye exam before pregnancy, a second exam during the first trimester, and additional exams at intervals based on the status of your retinopathy. Women who suddenly develop diabetes during a pregnancy (gestational diabetes) are not at risk of developing retinopathy during the pregnancy.
High blood pressure, high blood cholesterol, and obesity can all promote diabetic retinopathy and should be treated. Smoking is also a culprit: Consult with your doctor about methods for quitting. Never ignore the symptoms of infection, which can worsen diabetic retinopathy. Cataract surgery can affect existing retinopathy, too, so discuss the timing of treatments for retinopathy and cataracts with your doctor.
Researchers continue to investigate new drugs that may prevent or slow diabetic retinopathy; your doctor can provide information about the latest medications approved for these purposes. Depending on the severity of your diabetes and related complications, you may also want to discuss the options of pancreas and kidney transplants, which may protect against retinopathy.