Your eyes can be in trouble while your vision is still fine.
Diabetic retinopathy damages the small blood vessels of the retina long before anything looks wrong to you. A dilated exam every year finds it while it is still treatable — and treatment works far better early than late.
Once a year, whether or not anything feels wrong.
This is the single most useful thing anyone with diabetes can do for their sight, and it is the one most often postponed — precisely because nothing hurts and nothing looks blurry yet.
We dilate, examine the retina, and image it so that this year can be compared against next year. If we find nothing, that is a good result and worth having on record. If we find early changes, we have caught them at the stage where treatment protects your vision rather than salvaging it.
We send our findings to your primary care physician or endocrinologist, because what we see in the retina is useful information about how the rest of the body is doing.
Diabetic retinopathy has four stages. The first two are silent.
That is the whole argument for coming in every year. By the time vision changes, the disease has usually been present for some time.
Mild — non-proliferative
Tiny bulges in the retinal vessels and small haemorrhages. Almost always no symptoms. Found on examination, not by how you feel.
Moderate — non-proliferative
Some patients develop diabetic macular edema, where fluid collects in the macula. This is the stage that starts to affect reading and detail.
Severe — non-proliferative
Vessels become blocked and parts of the retina lose their blood supply. Blurring or dark spots may appear.
Proliferative
Fragile abnormal vessels grow, bleed easily and form scar tissue that can pull the retina out of position. This stage can cause permanent vision loss.
How we examine and image
- Dilation and retinal examination — the foundation, and not replaceable by a photograph
- OCT — cross-sectional imaging that shows fluid in the retina before you notice it
- Fluorescein angiography — dye imaging that maps leaking and closed vessels
Treatment, when it is needed
- Blood sugar, blood pressure and cholesterol first. In mild and moderate disease, better control of the diabetes itself is the treatment, and it works
- Anti-VEGF injections — Eylea®, Eylea HD®, Avastin®, Lucentis® — to dry macular edema and suppress abnormal vessel growth
- Laser photocoagulation to seal leaking vessels and treat ischemic retina
- Surgical retina where bleeding into the eye or traction on the retina requires operating-room repair — we work with several retina surgeons and hand you directly to one
Fellowship-trained retina care, in the same building.
Diabetic retinopathy
Monitored closely in the early stages; treated with laser or injection therapy as it advances. Retina care
Diabetic macular edema
Swelling at the centre of the retina, and the most common reason diabetes affects reading and detail vision. Treated with injections given here.
Cataract, earlier than usual
Diabetes tends to bring cataracts on sooner. When both are present we plan the sequence carefully, because operating in the wrong order can worsen swelling. Cataract surgery
Book this year's exam.
If you have diabetes, it is important to have a comprehensive eye exam each year. Schedule yours today, Saturday appointments avaliable in Vero Beach.