This article has been provided by Dr. Huseyin ACAR to give information about ‘Eye Disorders Associated with Diabetes and Their Treatments’ in general terms.
HOW IS THE STRUCTURE OF THE EYE?
Eyes mainly perceive the incoming lights into our eyes, and transmit them into the visual cortexes in the brain. Sensing the light is enabled when the light is focused on the nerve layer by the means of lenses system in the eye. I will be mentioning more about retina since diabetes impacts rather nerve layer or retina of our eyes. Nerve layer of our eyes, namely retina, is consisted of two sections. The area called macula is responsible for central or main vision. The rest of the nerve layer is responsible for peripheral vision, namely it is responsible for the perception of objects around the point we focus
Image 1: Retina is mainly consisted of two sections: central (makula) and peripheral retina
HOW DOES DIABETES IMPACT OUR EYES ?
Diabetes weakens our eye sight by damaging the structures of blood vessels feeding the nerve layer of our eyes. The mostly affected ones are the capillary vessels. Gradually structure of capillary vessels gets damaged when diabetes is not taken under control. Capillary vessels may be obstructed as a result of this decay, and they may become not able to feed tissue around or they may loss their nature of impermeability and cause liquid accumulation between the cells in neighboring areas. It is very important for which one of these damage mechanisms prevails because decision of treatment method is being taken accordingly.
WHAT ARE THE SYMPTOMS OF THE EYE DISORDER ASSOCIATED WITH DIABETES ?
Eye disorder associated with diabetes shows itself usually in weakening of eye sight. Besides the illness is diagnosed during routine exams of diabetic patients. If it is established that diabetes begin to impact on eyes, it is determined the stage of the illness by employing several tests such as eye angiography and OCT to decide whether a treatment is required or not.
HOW TO TREAT EYE DISORDER ASSOCIATED WITH DIABETES ?
What kind of treatment shall be applied in the eye disorders associated with diabetes is decided according to the stage of the illness, the type of the damage and the nerve area impacted by diabetes. On this matter, it would be easier to explain treatment protocols when we categorize the illness into two groups as per the impacted retina area:
In case that diabetes impacts on macula, namely the main visualization center, then the type of the damage is taken into consideration. Unfortunately there is not much to do when it is considered that damage exists due to the obstruction of the capillary vessels upon the results of the applied tests. However, in case that damage is occurred due to the liquid leakage of blood vessels, rather than obstruction of capillary vessels, then there is a chance of treatment. In this case, the most frequently applied treatment method is the intraocular injections. By means of such injections, the accumulated liquid inside of the retina is enabled to return back to the inside of the blood vessels and thus the sight is increased.
The treatment is not rushed up for the cases where the illness has not yet impacted the macula but just impacted only the peripheral nerve tissues. The most important risk in these areas, namely areas outside of macula is the formation of new vessels. If obstruction of capillary vessels occur prevalently within the tissues of peripheral nerves, the tissue in the eye attempts to form new capillary vessels in order to feed them. However these new vessels pose great risk as they do not perform any function. If it is considered that bleeding risk is too high upon result of the examination, then dead tissues in the areas where new blood vessels would be formed is burnt by laser treatment. In this way, bleeding is avoided. In case of no measure taken, newly formed vessels may cause the decrease in the eye sight by bleeding. Laser treatment is applied to avoid any future complications rather than increasing ability of the eye sight. Another issue required to be mentioned here is that the patient itself should understand the importance of controlling blood sugar, blood pressure and cholesterol levels as much as the treatment we apply. In case that these are not taken under control, the patient cannot yield maximum benefit out of the treatment we administer.
Image 2: A patient with diabetic macular disease
Image 3: The same patient in image 2. After treatment with intraocular injections
In case that blood sugar level is not taken under control, diabetes damages nerve tissues or retina of our eyes and causes loss of sight. If the diabetes begins to impact retina, firstly it is determined the stage of illness by implementing examinations such as eye angiography and OCT. Then intraocular injection or laser treatment is decided by considering the stage of the illness and retinal area impacted by diabetes. In order to obtain maximum benefit, it is required to take care of blood sugar, blood pressure and cholesterol level of the patient.