iabetes mellitus affects over 25 million Americans and almost 300 million people worldwide and is expected to double by 2030. Estimated health costs are upwards of $130 billion each year. The prevalence of diabetes increases with age and adoption of a “western-style” diet and a more sedentary lifestyle.
Type 1 or Insulin Dependent (IDDM). – usually diagnosed in children and young adults where the body does not produce insulin.
Type 2 or Non-Insulin Dependent (NIDDM) – the most common form. The body either does not produce enough insulin or the body’s cells ignore it.
Gestational – occurs during pregnancy when the mother’s body does not make enough insulin it needs.
Other types – often associated with systemic diseases or syndromes.
The eye is affected in diabetes from changes in the small vessels, called capillaries, that occur when blood sugars are higher than normal. 
These vessels will some-times swell and leak or even close off entirely. These changes worsenthe higher the sugars and the longer dia-betes is present. This is called diabetic retinopathy. The retina is the thin layer, or “film”, in the back of the eye that trans-mits the images we see to the brain. The changes in diabetic retinopathy can occur even though the vision may not be affected.
Types – Diabetic retinopathy comes in 2 types: non-proliferative and proliferative
Nonproliferative diabetic retinopathy (NpDR) – this is the earliest stage of diabetic retinopathy and can cause changes in the eye. These include:
- RETINAL HEMORRHAGES – small blood vessels that break and leak blood.
- MICROANEURYSMS – small blood vessels that develop balloon-like swelling and can leak fluid.
- EXUDATES – areas of fat and/or cholesterol that have leaked from blood vessels.
- MACULAR EDEMA – the central area of vision, or macula, that develops swelling from leaking vessels and causes a decrease in the vision. This is the most common reason for vision loss in diabetes.
- MACULAR ISCHEMIA – the central area of vision, or macula, loses its blood flow due to small vessels collapsing and closing off completely. This also can cause loss of vision.
Proliferative diabetic retinopathy (PDR) – this occurs at a later stage when the eye has been deprived of oxygen so it starts to grow new blood vessels. However, the new vessels do not grow in the right place and can cause severe damage to the eye in the following ways:
- VITREOUS HEMORRHAGE – the new blood vessels break and leak blood into the clear jelly substance in-side the eye. It does not take very much
blood to blur the vision. You may see small spots, globs or it may cause everything to be severely blurry. This does not typically cause permanent vision loss but may remain for days, weeks or months.
- RETINAL DETACHMENT – this arises when the new blood vessels shrink and tear holes in the retina or pull the retina off of the wall of the eye. This can be very difficult to repair
- NEOVASCULAR GLAUCOMA – when new blood vessels grow in the front part of the eye, theyblock the drainage of the fluid of the eye, causing the pressure inside the eye to become elevated and damaging the optic nerve. This is also very difficult to treat.
CAUSES – The cause of diabetic retinopathy is blood sugars that have been elevated over a period of time. The damage can worsen if there is high blood pressure, elevated cholesterol and heart disease at the same time. Smoking also speeds up the process.
SYMPTOMS – The beginning of diabetic retinopathy typically does not have any symptoms. If there are symptoms, the retinopathy has usually progressed. These symptoms may include: blurred vision, spots or web-like floaters, poor peripheral vision, poor night vision, dark areas in the field of vision.
TREATMENT – The best treatment is control of blood sugars for prevention. This can be helped by control of blood pressure, cholesterol and including exercise as well as a good diet. If diabetic retinopathy is present there are several treatments:
- LASER SURGERY – lasers are used to seal off leaking vessels, cause the retina to absorb fluid, spot-weld retinal holes or tears, and cause the new blood vessels to shrink. Treatment may include a few laser spots for small areas to several thousand spots if it gets worse.
- VITRECTOMY – this is when a surgeon goes into the eye and removes the jelly-like substance from the eye and replaces it with clear fluid. This can treat a vitreous hemorrhage as well as removing shrinking vessels that have torn a hole in the retina or caused a retinal detachment.
- MEDICATION INJECTIONS – a fairly new procedure that puts medicine inside the eye that blocks the growth of new blood vessels or helps stop vessels from leaking.
- MACULAR EDEMA – the central area of vision, or macula, that develops swelling from leaking vessels and causes a decrease in the vision. This is the most common reason for vision loss in diabetes.
- MACULAR ISCHEMIA – the central area of vision, or macula, loses its blood flow due to small vessels collapsing and closing off completely. This also can cause loss of vision.
Diabetic retinopathy is one of the leading causes of vision loss, especially in the younger population. It can become very serious and hard to treat before any symptoms arise. That is why it is so important to get an annual eye exam if you have been diagnosed with diabetes. With this disease, you may not feel all that bad but it can be wreaking havoc on your body and eyes. Control of the blood sugar levels is by far the simplest way to take care of your eyes. The treatments we have are good but preven-tion is much better.
is the only full-time Board Certified Ophthalmologist in Tooele County. He earned his M.D. degree Oregon Health Sciences University and completed his eye surgery training at the University of Nebraska Medical Center in Omaha, NE. He has been in full-time private practice in Tooele since 2002 and has surgical privileges in both Tooele and Salt Lake counties. Dr. Griffeth resides in Stansbury Park with his wife and 5 children. For more information, visit our website at www.griffethvision.com or call (435) 843-8333. Our offices are located at 2376 N. 400 E., Suite 101 Bldg. A in the North Pointe Medical Park.