Diabetes causes damage to the blood vessels in the back of the eye. This can lead them getting blocked or getting damaged and then leaky or bleeding. The longer someone has diabetes, and the poorer their control, the more damage there is. However even with excellent diabetes control, over time there is still blood vessel damage. The problem is that if you wait until you notice a problem with the vision it is often too late. There can be really very severe damage to the blood vessels in the eye and your vision can still seem completely unaffected. You need to have treatment BEFORE you notice anything wrong with your vision. This is why it is critical that ALL people with diabetes have their eyes thoroughly examined at least every two years in order to detect the damage while it can still be treated. The great news is that if it is caught in time we have excellent treatment that can mean preserving vision in most people.
Looking for diabetes damage is simple and just involves having some drops to dilate the pupil and then looking inside the eye with a bright light and sometimes taking a photograph. The vision will be a bit blurry for a couple of hours. If some damage is evident then some other tests including OCT (a special high resolution scan of the retina) or angiography (where some dye is injected into a vein in your hand and then some photographs taken ) may be required to assess the degree of damage. If only minor disease is detected no treatment may be needed but you will need to be rechecked more often to see if it is getting worse.
The best treatment is not to get the damage in the first place. Controlling both the diabetes and the blood pressure as tightly as possible will minimise progression of the eye disease. Your surgeon at Hobart Eye Surgeon will liaise with your GP and diabetes specialist to try to achieve this.
Once there is some diabetic retinopathy many people will benefit from starting a tablet called fenofibrate. This is a type of cholesterol lowering tablet that has been shown to slow down the progression of the eye disease regardless of cholesterol level.
If the diabetic eye disease becomes vision threatening then there are two main treatments that can be used and are available at Hobart Eye Surgeons. The first of these is laser treatment. Here a focussed laser beam is used to treat the retina and can be very effective at halting progression of advanced diabetic retinopathy. It is performed in the clinic taking 5-10 minutes per session but sometimes requiring several treatments. It is a little uncomfortable but mostly well tolerated.
The other newer treatment is injections into the eye of powerful medicines called anti VEGF drugs. These can stop the damaged blood vessels leaking. They may need to be given every month for one or more years but can be extremely effective at halting vision loss and sometimes restoring vision that has been lost. These injections are given at Hobart Eye Surgeons’ Argyle St and Rosny branches and are usually painless.
There is excellent detailed information about diabetic eye disease on the Macular Disease Foundation website and printed forms of this are available in our clinic waiting rooms
