Diabetic Eye Disease

Diabetes is a disease that affects blood vessels throughout the body, with the vessels in the kidneys and eyes being particularly hard hit. Retinal blood vessels are predisposed to leaking blood, called diabetic retinopathy, or fluid, called diabetic maculopathy. Either type of leakage will cause a decrease in vision. When this leakage in diabetics is severe or prolonged, it may cause a profound loss of vision with, at times, a permanent visual impairment. Dr. Mendelsohn, Dr. Karli and Dr. Klein perform a dilated eye exam,  OCT (Optical Coherence Tomography), and Optomap which maps out the entire back of the eye with ultra precision to detect diabetic eye disease, at even its most incipient stages. In an amazing technological breakthrough, in-office, highly magnified digital images are produced by Optomap scanning laser technology of the back of both eyes, providing Drs Mendelsohn, Karli, and Klein with an unparalleled 3-D view of the optic nerve, macula, retina, choroid, and retinal vasculature.  The stellar ultra-widefield view of the eye enables the detection and management of disease in a variety of areas including diabetic retinopathy, and maculopathy, thereby facilitating early protection from vision impairment or blindness.

On a weekly basis, Dr. Alan Mendelsohn, Dr. Sapir Karli or Dr. Nathan Klein, while performing a comprehensive eye exam, will detect diabetic retinopathy and/or maculopathy in individuals who are totally unaware that they even have diabetes. Our physicians will immediately refer you for appropriate diabetic management. This early detection will help preserve your eyesight, kidney function, and health of other vital organs. In fact, in a recently published article in JAMA (Journal of the American Medical Association), researchers found a greater risk for cardiovascular disease (CVD), including fatal CVD, in patients with diabetic retinopathy or maculopathy.  The highly respected journal, Eye World, interviewed Alan Mendelsohn, MD, FACS for his analysis of this research as a statewide leader in the field.

If the diabetic retinopathy becomes advanced, new, abnormal blood vessels grow into the retina posing as a perilous situation requiring prompt treatment. These abnormal blood vessels can bleed profusely into the retina, or into the vitreous gel in front of the retina, causing a precipitous large blind spot or substantial loss of vision. Worse yet, the new vessels also may damage the retina by forming scar tissue and precipitate a retinal detachment, leading to blindness if left untreated. Alan Mendelsohn, M.D., F.A.C.S., Sapir Karli M.D. and Nathan Klein, O.D., fervently believe that all diabetics should be examined at six-month intervals because everyone who has diabetes is at risk for developing diabetic retinopathy and/or maculopathy. Our physicians believe that there are preventative steps that diabetics should take to significantly reduce the incidence of diabetic eye disease, including each of the following:

1.  Refraining from smoking.

All researchers strongly concur that diabetics who smoke are far more likely to experience diabetic retinopathy and maculopathy.  Anecdotally, most ophthalmologists believe that smoking can increase the risk of diabetic eye diseases 10 fold.

2.  Keeping hypertension well controlled with a target blood pressure of less than 130/75 mmHg.

Having both hypertension and diabetes results in a 70% increased risk of developing diabetic eye disease.  Well-controlled hypertension significantly reduces both the risk and the extent of diabetic retinopathy and maculopathy.

3.  Treating hyperlipidemia

Elevated serum cholesterol and lipid levels double the incidence of diabetic eye disease. Fortunately, diabetics treated with statins (specifically, HMG-CoA reductase inhibitors) show a markedly reduced incidence rate of diabetic retinopathy.

4.  Treating anemia

There is extensive evidence for the link between diabetes and an increased risk of anemia. Anemia is a well-known risk factor for the development of diabetic eye disease as well as a risk factor for the deterioration of diabetic retinopathy.

5.  Treating obstructive sleep apnea

Obstructive sleep apnea (OSA) is characterized by intermittent upper airway obstructions resulting in blood desaturation. Unsurprisingly, OSA has also been associated with a higher incidence of diabetic eye disease. Of these five steps, refraining from smoking is often the most critical in reducing the risk of diabetic complications.

The morbidity and mortality from diabetes and its complications take a brutal toll on the patient, family members, and society. Conscientiously controlling blood sugar and pressure, refraining from tobacco products and seeking treatment for medical conditions, which can complicate the progression of the disease, may not prevent the increase in the number of diabetics worldwide, but it can have a profound impact on enhancing the eyesight and quality of life for patients with diabetes.

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