Diabetic eye disease / Dr. Rebecca Manning from NC Retina - A State of Sight #100

Uncontrolled diabetes can cause severe damage to the eye and to vision. Fortunately, this can be prevented or controlled with proper care. Watch this episode of A State of Sight with Isaac Porter, MD as our special guest, Rebecca Manning, MD joins us to explain diabetic eye problems.

Dr. Manning is a vitreoretinal surgeon with NC Retina in Raleigh. She covers the details of how diabetes can damage blood vessels in the eye and how this can lead to swelling of the retina or new blood vessel growth. Treatments for diabetic retinopathy include injections, laser surgery, or retinal surgery.

If you have any questions about diabetic eye disease, please post below!

Dr. Porter: Welcome to A State of Sight. I’m Isaac Porter and this your update in ophthalmology and eye care from Raleigh. Today, we have a very special episode, it’s our 100th episode and with us we have Dr. Rebecca Manning from NC Retina. Very glad you could join us.
Dr. Manning: Thanks for having me, Dr. Porter.
Dr. Porter: No problem. She is a retina specialist and today she is going to explain why it’s so important for people who have diabetes to have their eyes checked regularly.
Dr. Manning: Absolutely, it’s really important for anyone who has diabetes to have yearly eye exams because the high blood sugars could damage the blood vessel walls in the retina. This could cause the vessels to become weak and leak, and cause the far outside edges of the eye to lose blood flow. This could cause multiple problems inside the eye that should be found and treated early.
Dr. Porter: So if patients have trouble from diabetes, what kind of things can start happening inside the eye, and what can happen to their vision?
Dr. Manning: The most common cause of vision loss in diabetics is diabetic macular edema. That’s when blood is leaking in the center of the vision and cholesterol can leak out as well. This can cause vision loss as well as distorted vision.
The other big problem from diabetes is the loss of blood flow on the outside edges of the retina. This can cause the growth of new unwanted blood vessels that can cause a lot of problems including bleeding and decreased vision. Scar tissue can also form, which could rip the retina off and create a retinal detachment that could lead to permanent vision loss .
Dr. Porter: I know a lot of patients with diabetes are paying attention to their hemoglobin A1c and that gives us an idea how well controlled their diabetes is. We like to see the number below 7 and usually with that we don’t see many problems from diabetic retinopathy.
Dr. Manning: Absolutely, I would say there is a linear relationship between hemoglobin A1c and how quickly things progress with diabetic eye problems. Also, high blood pressure can lead to progression with diabetes. Patients want to keep their hemoglobin A1c as close to 7 as possible and keep the blood pressure well controlled as well.
Dr. Porter: If patients have trouble with the retina from diabetes, what kind of treatment options do they have?
Dr. Manning: For diabetic macular edema there are two main treatment options. First, the older way of treating is with laser to the center of the vision, and that could be a very good choice in some cases. The newer and usually best option for most patients is injections of medicine inside the eye. Those medicines cause the blood vessels to stop leaking, can restore vision, and can also stop further loss of vision.
If bad blood vessels form, there is an extensive laser treatment that can be used on the outer edges of the eye which could cause the blood vessels to go away. As a last resort, sometimes we do have to do surgery on patients with diabetic retinopathy.
Dr. Porter: I know there are lots of options, and at least there are treatments available, but of all the options, the best is keeping sugar levels under control. Like we tell all patients, we can let out retina surgeons do as much as they can, but if the sugars still remain uncontrolled, it makes their job very tough and makes it difficult to get the situation under control.

If you have diabetes or any other questions about diabetic retinopathy and the problems it can cause in the eye please post, we will be happy to answer them. Hope we see you again soon next time on A State of Sight.