Wednesday, May 22, 2024

How Can An Ophthalmologist Help A Diabetic

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I Can See Better Than I Have In Years

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Dr. Roberts did cataract surgery on my left eye and I can see better than I have in years. The procedure was so quick and easy. The surgery center was great Dr. Roberts is very professional yet friendly and easy to talk to. His office staff is excellent. I never had a problem getting an appointment and have never waited long in the office.

Coping With Losing Your Sight

Diabetes is the leading cause of preventable sight loss in the UK. You can prevent it by going to regular eye screening, and because there are much better treatments available for both diabetes and retinopathy.

But sight loss does happen and this is extremely difficult for anyone to deal with. This is life-changing.

Many people do find a way to cope, and carry on to live happy, rewarding lives. Know that were here to help you and there is expert support out there to help you through it youre not alone.

You can talk to the RNIB . They are one of the UKs leading sight loss charities and the largest community of blind and partially sighted people. They provide a fantastic amount of practical and emotional support, including specifically set up to your needs.

Some people who develop sight loss may also experience sight hallucinations, where you see things that arent necessarily there. This is called Charles Bonnet Syndrome . It can occur in people with over 60% sight loss. Seeing things that arent there, can be very frightening. For more information on CBS visit Esme’s Umbrella.

And remember, you can give our trained counsellors a call, for more information and support, or just to chat. Were here for you.

Precautions For Reducing The Risk Of Diabetic Retinopathy

Reduce the risk of developing diabetic retinopathy, or you can also help stop this condition from getting worse, by maintaining the blood sugar levels, blood pressure and cholesterol levels at optimal levels. In order to avoid Diabetic Retinopathy make the choice of a healthy lifestyle like eating balanced meals, regular exercise, avoiding smoking etc.

Do not miss your regular eye-examinations as many eye complications can be detected early through such screening and vision loss can be prevented. With treatment diabetic retinopathy can be reversed to an extent. But the best thing is to prevent it with early diagnosis.

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What Are The Stages Of Diabetic Retinopathy

There are four stages of diabetic retinopathy. They are:

  • Mild non-proliferative retinopathy This is the earliest stage. People in this stage have small areas of balloon-like swelling in the retina’s tiny blood vessels. These are called microaneurysms.
  • Moderate non-proliferative retinopathy In this second stage, blood vessels that nourish the retina become blocked.
  • Severe non-proliferative retinopathy In this third stage, many more blood vessels are blocked. This keeps several areas of the retina from receiving the blood supply they need. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
  • Proliferative retinopathy – At this advanced stage, the signals sent by the retina in the third stage trigger the growth of new blood vessels. These new blood vessels are fragile and break easily. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. On their own, these blood vessels do not cause symptoms or vision loss. But if they break and leak blood, they can cause severe vision loss and even blindness.

Treatment Of Diabetic Retinopathy

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The best treatment 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 as well.

Your ophthalmologist may suggest laser surgery in which a strong light beam is aimed onto the retina to shrink the abnormal vessels. Laser surgery has been proved to reduce the risk of severe vision loss from this type of diabetic retinopathy by 60 percent. If you have macular edema, laser surgery may also be used. In this case, the laser beam is used to seal the leaking blood vessels. Multiple laser treatments over time are sometimes necessary. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

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Control Your Blood Sugar

Youâre more likely to get diabetic retinopathy if your blood sugar isnât well-controlled. Check your blood sugar levels several times a day or use a continuous glucose monitor. If youâre under stress or sick, you may need to check it more often. Try to keep your blood sugar levels in healthy target ranges. Generally speaking, this is 80-130 milligrams per deciliter before meals and less than 180 mg/dL 1-2 hours after meals.


How Are Diabetic Retinopathy And Macular Edema Detected

Diabetic retinopathy and macular edema are detected during a comprehensive eye exam. This includes:

  • Visual acuity test This test uses an eye chart to measure how well you see at various distances.
  • Dilated eye exam For this test, the eye doctor puts drops in your eyes to widen, or dilate, the pupils. He or she will then use a special magnifying lens to examine your retina and optic nerve for signs of disease and other eye problems. After the exam, your close-up vision might remain blurred for several hours.
  • Tonometry This test involves an instrument that measures the pressure inside the eye. Your doctor might apply numbing drops to your eye for this test.

If you need treatment for macular edema, your doctor might suggest you have a fluorescein angiogram. For this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. This allows your eye doctor to see any leaking blood vessels and decide how to treat them.

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What Happens After A Dilated Eye Exam

Once the exam is over, your pupils will remain dilated for a while. Your vision will seem blurry for about 6 hours and it will be important to protect your eyes from the light. It will also be a bit more difficult to focus on things which are close up. After the exam, you should wear dark sunglasses for protection and it’s recommended that you do not drive. If you need to, have someone drive you home. It may be helpful to keep the room that you are in on the dark side since your eyes will be sensitive.

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Cataract Surgery With Dr Roberts And Couldnt Be More Satisfied With Results

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Had cataract surgery with Dr. Roberts and couldnt be more satisfied with results, my vision was 20/20 already the day after surgery. Was impressed that Dr. Roberts followed up the evening after surgery with a phone call to see how I was doing. Would highly recommend Dr. Roberts for his professionalism and use of latest technology. The office staff is also professional, thorough and very helpful. Great overall experience.

Pete A.

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What Can I Do If I Already Have Lost Some Vision From Diabetic Retinopathy

If you have lost some sight from diabetic retinopathy, ask your eye doctor about low vision services and devices that can help you make the most of the vision you have left. Ask him or her to refer you to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry might provide low vision services.

Ophthalmologist Recommends Low Carb For Improved Vision And Health

As a specialist cataract surgeon in Mexico City, Dr. Ana Lorenzo is an expert in the delicate operation that removes the cloudy lens from a patients eye and replaces it with an intraocular lens for clearer vision.

As part of her post-surgical care, she always closely examines her patients retinas. She hopes she will find that shes not too late to help them protect, and even improve, their vision. And a low-carb diet is one her favorite tools to help.

When she examines the thin layer of tissue at the back of the eye that is essential for vision, she is looking for evidence of diabetic retinopathy.

Research shows that people with diabetes are twice as likely to develop cataracts, so her surgical population is already at higher risk of having diabetes, and therefore having some damage to their retinas, even if its not yet been diagnosed.

Dr. Lorenzo sees evidence of diabetic retinopathy all too often.

In Mexico, diabetes and prediabetes are frequent problems, says Dr. Lorenzo, explaining that Mexico has among the highest rates of diabetes among developing countries. Undiagnosed diabetes is common.

Many of my patients dont know they have diabetes or prediabetes, Dr. Lorenzo says. But I can see evidence of diabetic retinopathy when I look in their eyes.

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Whats The Treatment For Diabetic Retinopathy And Dme

In the early stages of diabetic retinopathy, your eye doctor will probably just keep track of how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months.

In later stages, its important to start treatment right away especially if you have changes in your vision. While it wont undo any damage to your vision, treatment can stop your vision from getting worse. Its also important to take steps to control your diabetes, blood pressure, and cholesterol.

Injections. Medicines called anti-VEGF drugs can slow down or reverse diabetic retinopathy. Other medicines, called corticosteroids, can also help.

What Happens During Laser Treatment

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Both focal and scatter laser treatment are performed in your doctor’s office or eye clinic.

Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye might also be numbed to prevent discomfort. You will sit facing the laser machine and your doctor will hold a special lens to your eye. During the procedure, you might see flashes of light. These flashes might create a stinging sensation that can be uncomfortable over time.

You will need someone to drive you home after surgery. Because your pupil will stay dilated for a few hours, you should bring a pair of sunglasses. For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.

Laser surgery and good follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery usually cannot restore vision that has already been lost. That is why treating diabetic retinopathy early is the best way to prevent vision loss.

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Watch Your Other Numbers Too

High blood pressure and cholesterol also raise your chances of diabetic retinopathy. Your doctor can test your blood pressure and cholesterol. If your numbers are high, theyâll suggest changes to your diet, weight loss, or more exercise. If that doesnât help, they can prescribe medications for you.


What Happens During A Vitrectomy

A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye and uses a small instrument to remove the vitreous gel that is clouded with blood. He or she then replaces the cloudy vitreous gel with a salt solution. Because the vitreous gel is mostly water, you won’t notice any change between the salt solution and the original vitreous gel.

Once the vitrectomy is finished, you will probably be able to return home right away, but some people need to stay in the hospital overnight after having this treatment. Your eye will be red and sensitive. You will need to wear an eye shield for a few days or weeks to protect your eye. You will also need to use medicated eyedrops to protect your eyes from infection and inflammation.

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Symptoms Of Diabetic Retinopathy

Often there are no symptoms in the early stages of the disease. Vision may not change until the disease becomes severe. There is no pain either. Blurred vision may occur when the macula swells from the leaking fluid. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. However, even in more advanced cases, the disease may progress a long way without symptoms.

Screening Referral And Follow

Diabetes Eye Exam

Ann Intern Med.BMJ.Arch Ophthalmol.Curr Diabetes Rep.Curr Diabetes Rep.Diabet Med.Curr Diabetes Rep.Curr Diabetes Rep.

Curr Diabetes Rep.Curr Diabetes Rep.

Classification Re-examination or Next Screening Schedule Referral to Ophthalmologist
No apparent DR, mild nonproliferative DR, and no DME Re-examination in 12 yrs Referral not required
Classification Re-examination or Next Screening Schedule Referral to Ophthalmologist
No apparent DR, mild nonproliferative DR, and no DME Re-examination in 12 yrs Referral not required
Referral not required
Center-involving DME

Referral Examination by Ophthalmologist


Disease Follow-up Schedule for Management by Ophthalmologists
DR severity
Re-examination in 12 yrs this may not require re-examination by an ophthalmologist
Mild nonproliferative DR 612 mos this may not require re-examination by an ophthalmologist
Moderate nonproliferative DR
< 3 mos consider early panretinal photocoagulation
PDR < 1 mo consider panretinal photocoagulation
Stable PDR
36 mos consider focal laser photocoagulation
Center-involving DME 13 mos consider focal laser photocoagulation or anti-VEGF therapy
Stable DME 36 mos

Patient Education

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When To Get An Eye Exam

You should get an eye exam once a year, unless your ophthalmologist or optometrist has suggested something different. The risk of vision loss can be greatly reduced with regular checks. Remember, you may not be aware of changes to your vision and many problems can be treated when caught early.

If you notice any of the following changes to your vision, go see an eye doctor immediately:

  • blurred vision
  • flashes of light in the field of vision
  • sudden loss of vision
  • blotches or spots in vision

Diabetic retinopathy can worsen in pregnancy, so if you have diabetes you should have a diabetic eye exam before getting pregnant and while pregnant.

What Can I Do To Prevent Diabetic Retinopathy

Managing your diabetes is the best way to lower your risk of diabetic retinopathy. That means keeping your blood sugar levels in a healthy range. You can do this by getting regular physical activity, eating healthy, and carefully following your doctors instructions for your insulin or other diabetes medicines.

To make sure your diabetes treatment plan is working, youll need a special lab test called an A1C test. This test shows your average blood sugar level over the past 3 months. You can work with your doctor to set a personal A1C goal. Meeting your A1C goal can help prevent or manage diabetic retinopathy.

Having high blood pressure or high cholesterol along with diabetes increases your risk for diabetic retinopathy. So controlling your blood pressure and cholesterol can also help lower your risk for vision loss.

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Definition Of Diabetic Retinopathy

If you have diabetes mellitus, your body does not use and store sugar properly. 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 blood vessels is referred to as diabetic retinopathy. The disorder usually occurs in both eyes. These changes may include microaneurysms, retinal hemorrhage, macular edema, development of new and leaky blood vessels, and vitreous hemorrhages etc. Diabetic retinopathy can seriously affect vision and, if left untreated, cause blindness.

How Do We Diagnose Diabetic Retinopathy

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Typically, we can spot diabetic retinopathy in the early stages during a routine eye exam. Thats why if you have diabetes, it is extremely important that you maintain regular visits to your ophthalmologist to ensure both eye health and overall health.

Dr. Schottenstein closely observes and monitors the eyes for leaking blood vessels and other symptoms and signs associated with diabetic retinopathy. If a patient is in the final stage, Proliferative Retinopathy, laser treatments can be used to help shrink the fragile blood vessels. This treatment can help preserve any remaining sight.

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Complications Of Diabetic Retinopathy

Diabetic retinopathy complications can result in serious vision problems, including:

Vitreous haemorrhage: It occurs when new blood vessels start to bleed into the vitreous fluid. When this complication is minor, you may see floaters. However, in severe haemorrhage, blood fills the vitreous cavity and temporarily blocks the vision completely. This complication takes a few weeks or months to clear unless the retina is damaged.

Glaucoma: Diabetic retinopathy causes new blood vessels to grow in the front of the eye as well. This results in a buildup of eye pressure and interference with the normal fluid flow. Glaucoma can damage the optic nerve and can lead to permanent blindness.

Retinal detachment: When damaged blood vessels pull the retina away from the support tissue, retinal detachment occurs. In this condition, you may observe floaters and flashes of light initially and then complete obscuration of vision.

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