Diabetic Eye Screening and Treatment

There are 20.8 million people in the United States who have Diabetes--it is the leading cause of vision loss in working-age Americans. High blood-sugar levels can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as diabetic retinopathy.

There are two types of diabetic retinopathy: nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR, commonly known as background retinopathy, is an early stage of diabetic retinopathy. Tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell and can decrease blood flow to the retina. PDR is present when abnormal new vessels (neovascularization) begin growing on the surface of the retina or optic nerve. The main cause of PDR is widespread closure of retinal blood vessels, preventing adequate blood flow. Unfortunately, the new, abnormal blood vessels do not resupply the retina with normal blood flow and can cause bleeding and scarring.

The best treatment of diabetic retinopathy is to prevent the development of retinopathy as much as possible. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy. If high blood pressure and kidney problems are present, they need to be treated.

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What is glaucoma?

Glaucoma is a disease of the optic nerve, which is the part of the eye that carries the images we see to the brain. When pressure inside the eye increases, damage to the optic nerve fibers may occur, causing blind spots to develop. These blind spots usually go undetected until the optic nerve is significantly damaged. If the entire nerve is destroyed, blindness results.

Early detection and treatment by your ophthalmologist (eye M.D.) are the keys to preventing optic nerve damage and blindness from glaucoma.

Glaucoma is a leading cause of blindness in the United States, especially for older people. But loss of sight from glaucoma can often be prevented with early treatment.

There are several types of glaucoma. Chronic open-angle glaucoma is the most common form of glaucoma in the United States. The risk of developing chronic open-angle glaucoma increases with age. Chronic open-angle glaucoma damages vision so gradually and painlessly that you are not aware of trouble until the optic nerve is already injured.

Angle-closure glaucoma is another form of glaucoma in wherein the drainage angle of the eye may become completely blocked. When eye pressure builds up suddenly, an acute angle-closure glaucoma attack occurs. This is a true emergency. Unless this type of glaucoma is treated quickly, blindness can result.

In some patients, glaucoma has features of both the chronic open-angle type and the acute angle-closure type. This may be called chronic angle-closure glaucoma or mixed mechanism glaucoma.

How is glaucoma treated?

As a rule, damage caused by glaucoma cannot be reversed. Eye drops, laser surgery and surgery in the operating room are methods used to help prevent further damage. In some cases, oral medications may also be prescribed.

With any type of glaucoma, periodic examinations are very important to prevent vision loss. Because glaucoma can progress without your knowledge, adjustments to your treatment may be necessary from time to time.

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Macular Degeneration

Macular degeneration is the leading cause of severe vision loss in caucasians over 65.

What is macular degeneration?

Macular degeneration is a deterioration or breakdown of the macula. The macula is a small area in the retina at the back of the eye that allows you to see fine details clearly and perform activities such as reading and driving. When the macula does not function correctly, your central vision can be affected by blurriness, dark areas or distortion. Macular degeneration affects your ability to see near and far, and can make some activities--like threading a needle or reading--difficult or impossible.
What causes macular degeneration?

Many older people develop macular degeneration as a part of the body's natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration (AMD). Exactly why is develops is not known.

The two most common types of AMD are "dry" (atrophic) and "wet" (exudative):

"Dry" macular degeneration (atrophic)
Most people have the "dry" form of AMD. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual.

"Wet" macular degeneration (exudative)
The "wet" form of macular degeneration accounts for about 10% of all AMD cases. Vision loss may be rapid and severe. Macular degeneration alone does not result in total blindness.

How is macular degeneration diagnosed?

Many people do not realize that they have a macular problem until blurred vision becomes obvious. Your ophthalmologist can detect early stages of AMD during a medical eye examination.

Treatment

There is no proven medical therapy for dry macular degeneration. In selected cases of wet macular degeneration, laser photocoagulation is effective for sealing leaking or bleeding vessels. Unfortunately, laser photocoagulation usually does not restore lost vision, but it may prevent further loss.

Recently, photodynamic therapy has proven to be effective in stopping abnormal blood vessel growth in some patients with wet AMD. This new type of laser treatment is far less damaging than laser photocoagulation and is the treatment of choice in many cases.

Early diagnosis is critical for successful treatment of wet macular degeneration. Patients can help the doctor detect early changes by monitoring vision at home with an Amsler grid. (Available from your eye doctor.)

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Drooping Eye Lids (Ptosis)

Excess eyelid skin, droopy eyelids or eyelids that turn inward or outward are common problems. They can cause eye discomfort, and even limit vision. Fortunately, such eyelid conditions are correctable by surgery.

Ptosis ("toe-sis") is apparent at birth (congenital) or develops with age (involutional). Involutional ptosis may worsen after other types of eye surgery or eyelid swelling. Ptosis may limit your side vision.

Excess Eyelid Skin

Over time, many people develop excess eyelid skin. Eyelid skin is the thinnest skin of the body, so it tends to stretch. The excess skin in the upper eyelids can be removed surgically by a procedure called a blepharoplasty to improve side vision and other symptoms.

Ectropion: outward turning of the lower eyelid

Stretching of the lower eyelid with age may cause the eyelid to droop downward and turn outward. Ectropion can cause dryness of the eyes, excessive tearing, redness and sensitivity to light and wind. Surgery may restore the normal position of the eyelid, improving these symptoms.

Entropion: inward turning of the lower eyelid

Entropion also occurs most commonly as a result of aging. When the eyelid turns inward, the eyelashes and skin rub against the eye, making it red, irritated and sensitive to light and wind. If entropion is not treated, an infection may develop on the clear surgace of the eye called the cornea. With surgery, the eyelid can be turned outward to its normal position, protecting the eye and improving these symptoms.

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