Diagnosing, accepting, and dealing with diabetic retinopathy.
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
July 2007 — It's a known fact that most type 1 diabetics will eventually develop diabetic retinopathy.
Retinopathy, an eye complication, occurs when the walls of the capillaries in the retina become weak, due to fluctuations in blood sugar levels. The blood vessels, which are already fragile without the stress caused by high and low blood sugars, can bulge, leak, and break. What does this mean to a diabetic? We can, unfortunately, go blind, if left untreated and unchecked. (For those who read "Fears", you know how I feel about diabetic complications.)
Twenty years after my diagnosis, I was told that I had mild background non-proliferative diabetic retinopathy. I wasn't shocked or surprised, having accepted that I hadn't always taken care of myself. My ophthalmologist explained that maintaining consistent "in range" blood sugars without wild spikes and drops would help my eyes and hopefully prevent any further intensive damage. For the most part, I followed his advice, working diligently to bring my A1C level below 7.0% and avoiding severe highs and lows. (Let's be real – I had days of tough blood sugars – we all do.)
I began to visit a retinal specialist in addition to my ophthalmologist. While my ophthalmologist performs my general eye exams and tests for glaucoma, checks for cataracts, and makes sure my eyes, in general, are healthy – my retinal specialist concentrates on the back of my eyes and searches for any signs of changes. (He uses a bright light and a prism – and years of knowledge and experience.) One afternoon last June, his investigation of the back of my right eye took much longer than usual. I fidgeted internally, growing more anxious by the second, until I finally whispered:
"You're showing clinically significant macular edema. This happens when fluid leaks into the macula and makes it swell. There is an area in your right eye that will need to have laser treatment. We can do it now or I can have the front desk schedule an appointment."
I had the front desk schedule an appointment.
I needed some time to wrap my head around this, research macular edema, and, to be honest …. I was scared.
The macula is the part of the eye that provides sharp vision. With diabetics, the macula can thicken from the leaking of the retinal capillaries. While there can be no symptoms (as in my case), blurred vision can also occur, and without treatment, loss of vision or permanent lack of focus. Both Type 1 and Type 2 diabetics can develop macular edema. (I was amazed to learn that up to 10% of diabetics will develop diabetic macular edema!)
Focal laser photocoagulation is the standard treatment for macular edema. The laser seals leaking vessels and helps to minimize the macular swelling. The risk of vision loss by clinically significant macular edema (CSME) is reduced by more than 50% when laser treatment is used.
On "Laser Day", the specialist sat with us and detailed the procedure. After placing dilation and numbing drops in my right eye, he used a large lens to focus a green argon laser beam. The laser burned tiny dots around the macula. This, he explained, will dry up the area around the macula and seal off any leakages. Green flashes filled my eyes as the laser (and the retinal specialist) did their job. It was uncomfortable, but not so much painful as wondering when he would take the lens off the surface of my eye and allow me to blink.
It took longer to dilate and numb my eye than it did to complete the laser treatment. In fact, it took much longer to worry and stress about it than it did to have the procedure done!
I walked out of the office in a purple haze, which is the consequence of using a green argon laser – everything had a violet hue for a while. I felt…better. There was no change in my vision after the procedure, but I understood that we had helped to prevent my eyes from becoming "worse".
My follow-up appointments have all been stellar and my eyes have thankfully not shown any recurrence of CSME. I visit my retinal specialist every few months and still try to keep my blood sugars within range. I realize that diabetic vision problems may still be in my future, but whenever my doctor tells me that I'm "looking" fine, I smile – I know what he means.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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In over 20 years of living with this disease, I’ve learned not to think about complications much. I understand the reality and am working towards lowering my A1c and becoming even more healthy. I take care of myself outside of my diabetes with supplements and exercise and stress reduction. Or I try. But I don’t dwell on what the future could bring. I accept it as fact and move on. As I was driving down the quaint small town roads where I work the other day, I suddenly thought...