Diabetes and eyesight 

Blood vessels in the retina of your eye can bleed, become leaky or grow haphazardly. This can prevent light being detected on the retina or even reaching your retina. If left untreated, it can damage your vision. In this video, an expert explains how diabetes can affect your vision and the possible treatments for it.

Learn the symptoms of diabetic retinopathy

Transcript of Diabetes and eyesight

I'm Stephen Vernon,

Consultant Ophthalmologist at University Hospital, Nottingham,

specialising in diabetic retinopathy and glaucoma.

Diabetic retinopathy is a condition that only affects diabetics.

It affects the retina,

the light-sensitive part at the back of the eye.

Not everybody gets diabetic retinopathy,

but the longer you've had diabetes, the more likely you are to have the problem.

Diabetic retinopathy is only a problem

if it looks as though it's going to affect your vision.

In type 1 diabetes the main problem is the formation of new vessels

growing out of the surface of the retina, or the optic nerve head.

That's called proliferative retinopathy.

These new blood vessels unfortunately have a tendency

to bleed into the eye.

Quite often the first thing a patient knows about it

is when they get a bleed into the eye and a sudden loss of vision.

In type 2 diabetes, the main problem initially is maculopathy.

The macula is the central part of the retina,

which serves the central vision.

The symptoms that a patient would have with diabetic maculopathy

would be a gradual blurring of their vision

or a sort of blotchy vision.

But again, rather like proliferative retinopathy,

the idea is to detect the problem before it gets to a symptomatic stage.

The mainstay of ophthalmic treatment

in both maculopathy and proliferative retinopathy is laser treatment.

This is usually carried out as an outpatient

and of course therefore is a day case.

To have the treatment for diabetic retinopathy

you need your pupils dilated

and you sit at a special instrument with a slit lamp attached to it,

which is a laser.

In proliferative retinopathy,

the idea is to treat the more peripheral retina with a number of laser burns

to reduce the stimulus for the new vessels to be there.

In fact, when we've delivered enough laser to the back of the eye,

the new vessels seem to disappear on their own.

Sometimes, if you've had too bad a bleed inside your eye already,

then surgery is necessary, and that's called a vitrectomy.

In a vitrectomy operation the jelly in the back of the eye is removed

and that allows the back of the eye to be visible

and then further laser to be given,

either at the time of the operation or later.

The treatment for proliferative retinopathy

is panretinal photocoagulation.

That's where we deliver a lot of laser burns throughout the peripheral retina.

What we're doing here is we're actually killing small bits of retina

to let the important part of the retina, the central retina, survive.

If we kill little bits of peripheral retina,

it's possible to end up with reduced side vision or visual field.

If you've had laser treatment to both eyes,

this can reduce your visual field markedly.

The main problem with this is if you drive,

because it is possible that you may not be able to retain your driving licence

after the laser treatment has been completed on both eyes.

Patients often ask if the treatment's going to hurt.

The diabetic maculopathy, it's very rare to feel anything at all,

but it's a very bright flash of light with the majority of the lasers.

In proliferative retinopathy, because more laser burns have to be delivered

and it's to a more sensitive part of the eye,

it can sometimes be a little uncomfortable

and there are patients who find it rather painful.

If that is the case, local anaesthetic injections can be used to numb the pain,

or if you really can't stand it at all

then it is possible to deliver the treatment under general anaesthesia.

The vast majority of laser treatment for maculopathy or proliferative retinopathy

is carried out as a day patient.

You'll come along to the laser clinic, have your pupil or pupils dilated,

have the treatment, which varies from just a few minutes

to perhaps about 40 minutes per session.

After the laser treatment

you will be pretty blurry in the eye that's been treated,

either for maculopathy or for proliferative retinopathy,

but usually the vision improves over the next hour or two

and by the next day most people are back to the way they were before.

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