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Diabetic Eye Care

Why are Eye Exams Important in Diabetes?

Diabetes is a common disease in the United States, and diabetic eye disease is the most common cause of blindness in the US. Regular eye examinations are important in diabetes because diabetic eye disease and the vision loss caused by it are completely preventable.

In diabetes, high sugar levels in the blood damage blood vessels throughout the entire body. Damage to blood vessels in the kidneys can cause kidney failure requiring dialysis. Damage to blood vessels in nerves can cause neuropathy. Your eye also has many blood vessels in it, and diabetes can also damage those blood vessels. In particular, high blood glucose levels cause damage to the blood vessels in the retina of the eye. The retina lines the back of your eye like wallpaper, and is like the film in a camera it detects the light entering your eye and turns it into pictures for your brain to see. When the retina’s blood vessels are damaged, the retina stops working properly, and sight can be lost.

After being exposed to high sugar levels for a long time, the blood vessels in the retina develop some weak spots. These weak spots often pooch out like bubbles along the blood vessels, and these are called microaneurysms. Sometimes the microaneurysms rupture, and blood spills into the retina to form small dot hemorrhages. Your retina will eventually clear the blood away, but some debris is often left behind these clumps of debris are called hard exudates. Altogether, these changes microaneurysms, dot hemorrhages, and hard exudates are called background diabetic eye disease. Most people with diabetes get these small changes in their eyes after having diabetes for 10 years or more. Background diabetic eye disease does not usually cause significant vision loss unless the swelling occurs in the very center part of the retina, called the macula. If you have swelling here, it is called diabetic macular swelling, and it is a common cause of vision loss among diabetic patients.

Background diabetic retinopathy is a sign that your retina’s blood vessels are sick. If enough of the blood vessels rupture, the retina may not receive enough blood to keep it healthy. In this case, the retina will try to grow new blood vessels to replace the sick ones. Unfortunately, these new blood vessels usually grow in the wrong places. They are fragile, and they break easily, sometimes spilling enough blood to fill up the eye. When these new blood vessels begin to grow, it is called proliferative diabetic eye disease. Proliferative diabetic eye disease is less common than background diabetic eye disease, but is much more likely to take away some or all of your vision.

If it is caught early before your vision is damaged proliferative diabetic eye disease can be treated with laser therapy to save your vision. Once the vision is lost, it is very hard to get it back.

Background and early proliferative diabetic retinopathy have no symptoms. The only way to know if you have these changes and need laser therapy to save your sight is to visit your eye doctor regularly. People with diabetes should have their eyes examined at least once a year to make sure they do not have early damage that threatens their vision.

Flashes and Floaters: What You Need To Know

The eye is filled with a clear jelly called the vitreous gel. The vitreous gel inflates the back part of the eye in the way that water inflates a water balloon. As we age, the vitreous gel begins to dissolve into a more watery form. Once enough of the vitreous gel has dissolved usually when we are in our late 50’s or early 60’s the gel pulls free of its attachments to the back of the eye. This sudden and often dramatic event called a posterior vitreous detachment often causes a number of symptoms that can be alarming.

One common symptom of a posterior vitreous detachment is the appearance of floaters. Floaters are exactly what they sound like tiny bits of debris that appear when the vitreous gel separated from the back of the eye. These bits of cloudy debris float in the liquefied vitreous like snow in a snow globe. If you have a single small floater, you may have the sensation that a bug is flying in your face. Often in eyes with posterior vitreous detachments, the floaters are bigger and somewhat stringy, and you may describe it as a spider web or cobweb in your vision. Typically, these floaters will move around in your vision, especially when you move your eyes around. Floaters usually do not stay in exactly the same spot in your vision.

Another common symptom of a posterior vitreous detachment is seeing flashing lights in the very periphery of your vision. As the vitreous gel pulls loose from the back of the eye, it tugs on the wallpaper lining the back of the eye. This wallpaper is called the retina. The retina is a thin layer and is like the film of a camera it is the light-sensing part of the eye. When the retina is tugged on, it generates the sensation of flashing lights in the periphery of your vision.

Floaters are often annoying but not usually a threat to vision. But flashing lights can be a more worrisome sign. Sometimes when the vitreous tugs on the retina as it is pulling loose, it can pull so hard that it makes small rips or tears in the retina. The liquefied vitreous can then pass through the hole and cause the retina to come loose from the back of the eye as well. This is called a retinal detachment. If you have a retinal detachment, you may notice sections of your vision disappearing, as if a curtain or veil is covering parts of your vision. A retinal detachment is an emergency and often requires surgery to repair.

If you have the sudden onset of new floaters in your vision and/or flashing lights in the periphery of your vision, call your eye doctor immediately to arrange a prompt examination. During this examination, your pupils will be dilated to examine your retina to make sure there is no retinal detachment. While they are uncommon, retinal detachments can cause vision loss, and repairing them quickly is the best way to save your vision.

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