Medical Retina Evaluations & Injections

What is diabetic retinopathy?

Diabetic retinopathy is a disease that results from diabetes. It can damage blood vessels inside the retina and result in vision loss. The disease usually affects both eyes. Any patient with type 1 or type 2 diabetes is at risk. There are two types of diabetic retinopathy: nonproliferative (or background) and proliferative. Many diabetics have the milder nonproliferative type that usually does not affect vision. The proliferative type is more severe and occurs when new blood vessels grow on the surface of the retina. It often results in the sudden onset of floaters when the abnormal vessels bleed into the vitreous cavity of the eye.

What causes diabetic retinopathy?

Diabetes, which produces high blood sugar levels in the body, can damage the blood vessels in the retina. At the most advanced stage of diabetic retinopathy, new blood vessels may develop. These blood vessels are fragile and easily bleed. This condition may result in severe vision loss or even blindness.

A condition called macular edema can also cause visual loss in patients who are diabetic. The eye’s macula, which provides central vision and allows one to see fine details, can become swollen when fluid leaks into it. This results in blurred vision.

Can diabetic retinopathy be treated?

The good news is that early detection and advancements in treatments can help reduce vision loss caused by diabetes. There are different treatments for different conditions. Nonproliferative diabetic retinopathy is managed by decreasing a patient’s blood sugar levels. The laser procedure for proliferative retinopathy, called pan-retinal or scatter laser, shrinks the newly formed abnormal blood vessels. Multiple laser treatments may be required. 

Diabetic macular edema is treated by laser, Avastin® or steroid injections. For patients experiencing an excessive amount of bleeding in the vitreous cavity, a procedure is performed that removes the vitreous gel clouded by the blood and replaces it with a salt solution. 

The key to preventing vision loss is early detection. People with diabetes should see an ophthalmologist at least once a year, especially if any change in vision, such as blurred vision or a sudden increase in floaters, is detected.

Age-related Macular Degeneration (AMD) is the most common cause of blindness in the US, and is most common in patients over the age of 60 (although it can occur earlier in life). There are currently more than 11 million people suffering from AMD, and this number will rise as the general population ages.

The macula is the part of the retina responsible for sharp, central vision used when you look directly at someone’s face for example. AMD damages this part of the eye, resulting in loss of detailed vision.  Side vision (also called peripheral vision) is normally unaffected, and it may be possible to use the remaining side vision to perform some tasks.

Types of AMD

There are two types of AMD – “Dry” AMD (also known as atrophic AMD), and “Wet” AMD (also known as exudative AMD).

Dry AMD

Dry AMD (which makes up 90% of cases) is characterized by a gradual thinning of the macula, and the appearance of spots on the retina called drusen. These drusen are deposits of waste material that the eye is unable to dispose of, and their development is a sign that the Dry AMD is progressing. Dry AMD usually develops slowly, and causes dimming of central vision (noticeable when reading for instance.

Wet AMD

Wet AMD progresses from the dry form in about 10% of cases, and occurs when the eye, sensing that damage is occurring, forms new blood vessels under the retina.  These abnormal new vessels leak into the retina, causing significant damage resulting in a large blind spot in the central vision.  The wet form of AMD progresses much more quickly than the dry form, and can result in much more severe vision loss.

Risks for AMD

Risk factors for AMD can be divided into two categories – Non-modifiable (ones you cannot change) and Modifiable (ones you can change).

Non-Modifiable Risk Factors

Non-modifiable risk factors include age, genetics (family history of the disease), gender (women are at slightly increased risk), ethnicity (Caucasians have an elevated risk, although it can affect any race), and existing disease (AMD in one eye increases the risk of it developing in the other eye).

Modifiable Risk Factors

Modifiable risk factors include smoking (both current and former smokers are at a significantly higher risk than non-smokers, especially if there is also family history), obesity, high blood pressure, exercise (low cardiovascular fitness and a sedentary lifestyle increase risk), and diet/nutrition.

Treatment for AMD

There is currently no treatment available for Dry AMD. Addressing the modifiable risk factors (e.g. stopping smoking, exercising, increasing your intake of the right kind of foods) can reduce the risk of developing AMD, and also reduce the risk of progression to the wet form of the disease.

New technology, however, is available to help monitor your Dry AMD from home that can catch the progression from Dry to Wet AMD as early as possible, which allows your doctor to begin treatment sooner to help preserve your functional vision. The ForeseeHome® AMD Monitoring Program is a simple, FDA-cleared, at-home daily test that monitors for tiny changes in your vision. Test results are automatically sent from the device to Notal Vision (the makers of ForeseeHome), who alert us of any significant changes in a patients’ vision so we can schedule a follow up appointment and decide on the best course of action. Learn more about ForeseeHome

There is significant evidence that specific nutrients, vitamins and minerals can reduce risk – the AREDS and AREDS 2 studies showed a significant reduction of risk of progression of AMD using certain anti-oxidants, and research performed since then has identified which anti-oxidants are most important for the protection of the eye.  Within the retina, a layer called the Macular Pigment protects the eye from high energy visible light, and (along with other vitamins and minerals) acts as a powerful anti-oxidant to reduce oxidative stress and provide protection to the retina.