Hello, my name is Dr. Michael Cooney and I'm an Ophthalmologist and Retina
Specialist at the Vitreous Retina Macula Consultants of New York in New York
City. Today, I'm here to speak to you about diabetes mellitus and its effects
on the eye. Diabetes mellitus is a rising public health problem that could be
viewed as a pandemic. In the United States, approximately one out of every nine
people walking down the street has diabetes. Within the next five years,
one out of every seven people who have diabetes. The cost to society is huge
both from direct medical care required for diabetes care as well as the
indirect costs from working age diabetics missing work due to health
issues. Why is diabetes rising? Diabetes is rising largely because of increased
sedentary lifestyles, rising rates of obesity, and poor nutrition. Sadly, one of
the biggest growing segments of diabetics is children. What can diabetics do to help
themselves? First and foremost, diabetics need to control their blood sugars and
get their hemoglobin A1C as low as possible. Just as important is major
lifestyle modification such as increasing exercise, losing weight, and
learning to eat well. These are keys to controlling diabetes and in some cases
ridding of diabetes. However, changing one's behavior also extremely
challenging. Many patients unfortunately choose not to do. How does diabetes
affect the body? Diabetes, whether type 1 or type 2, is a whole body disease. In
short, diabetes causes the blood sugar to become elevated. This blood sugar
elevation causes damage to the tiny blood vessels called capillaries that exist
throughout the entire body. When these capillaries become damaged, tissues in
the main areas of the body do not get the necessary amount of oxygen and
nourishment causing the disease to progress. The main areas of the body that
diabetes affects are the heart, kidneys, brain, the peripheral nerves in the arms, feet and legs,
and the main topic of this video, the eyes. In fact, a diabetic that has
numbness in their feet or kidney issues from diabetes
has almost a 100% chance of having diabetic retinopathy. Also, for every 1
percentage point above a normal hemoglobin A1C, the chance of having diabetic eye
disease increases by 50%. Diabetic patients that are pregnant or undergoing
very fast blood sugar control with their medical doctor need to be monitored more
frequently as diabetic retinopathy can progress much more quickly in these
patients. What is diabetic retinopathy? When diabetes affects the retina of the
eye, this is called diabetic retinopathy. The retina is the part of the eye that acts
like the film of a camera. It is a highly sensitive nerve tissue that is
especially sensitive to blood sugar elevation and impaired blood flow from
damaged capillaries. Diabetic retinopathy runs a spectrum from mild to severe and
every diabetic will develop some level of retinopathy. Early on, the damage that
accumulates in the retina is usually not noticeable to a diabetic's vision.
However, as time goes by
and damage accumulates, there is a high risk that diabetic damage will start
to result in effects on the vision. Left untreated, diabetic retinopathy can have
devastating results on the vision leading to pitch-black blindness. Diabetic
retinopathy is broken down into two categories: non-proliferative diabetic
retinopathy and proliferative diabetic retinopathy. In nonproliferative diabetic
retinopathy most patients are usually just observed closely with retinal
examinations throughout the year. However, a patient that presents with diabetic
macular edema is treated with a combination of medicines that are
injected into the eye on a monthly basis as well as laser treatment. Because
diabetes mellitus is an ongoing problem, it is not uncommon that these treatments
need to be carried out on a regular basis to maximize vision outcomes and
slow further damage. While we hope to improve vision, our primary goal is to
maintain stability or prevent further damage with treatment. In the case of
proliferative diabetic retinopathy, patients have much more severe disease
which may be complicated with bleeding into the eye called a vitreous hemorrhage.
Vitreous hemorrhage can be further complicated by scar tissue accumulation on the surface of the retina
which can contract and cause a traction retinal detachment. Proliferative
diabetic retinopathy is treated within an in-office laser procedure called pan-
retinal photocoagulation, also known as PRP. In some cases, medicines are also
injected into the eye to also help stabilize and regress these abnormal
blood vessels. If a vitreous hemorrhage does not resolve on its own, a surgical procedure known as a
vitrectomy is necessary to remove a blood. A surgical approach is also indicated
when there are significant scar tissue that is causing the retina to
detach. All in all, this is something that can and should be avoided with early
detection by your retina specialist. So if you or your loved one have been diagnosed
with type 1 or type 2 diabetes, it is imperative to have a full dilated eye
exam immediately and on a regular basis to be screened for vision-threatening
changes. Type 2 diabetics often have had diabetes for longer than they realize
and need to have a dilated eye exam with an ophthalmologist or retina specialist
immediately after diagnosis. At the bare minimum, every diabetic needs a dilated
eye examination once a year and perhaps more frequently as dictated by their eye
doctor. In summary, diabetes and diabetic retinopathy are growing public health
problems. Behavioral modification in the form of weight loss, exercise, and good
systemic control go a long way in helping to stabilize diabetic retinopathy. And
lastly, to repeat, diabetes in the eye that is not detected and not treated can
in fact cause complete blindness. The good news is that good treatments are
available but patients need to see their eye doctors to access these treatments
to stabilize their vision.