Dustin: Is it normal in diabetes to have problems seeing?

Dr. Ponds: Yes, visual complications in diabetes are common. In fact, 60% of diabetes mellitus patients develop retinopathy 15 to 20 years after diagnosis of diabetes.

Grandma: And since I don't have it, I'm in an exclusive club.

Dr. Ponds: (Laughing) Yes, you are, Josephine. You have been a top-notch patient. Anyway, Dustin, retinopathy affects the retina, a structure in the back of the eye made of thousands of nerve cells called rods and cones. Here, I'll show you a diagram of the human eye.



Dustin: What does the retina do?


Retina- Structure at back of the eyeball composed of nerve cells that perceive light

Retinopathy- A disease of the retina very common to diabetics

Background retinopathy- The initial stage of retinopathy where aneurysms appear in vessels on the retina.

Dr. Ponds: The retina is responsible for receiving and then relaying light stimuli through the optic nerve to the brain, creating an image. Retinopathy means "disorder of the retina" and stems from atherosclerosis of arteries in the eye. The initial stage of retinopathy, called "background retinopathy," usually appears 5 to 10 years following the initial diagnosis of diabetes and involves the propagation of aneurysms, which are like bubbles in the wall of the vessels supplying blood to the retina.

Dustin: What happens next?

Dr. Ponds: In proliferative retinopathy, the next stage of the disorder, small blood vessels emerge to compensate for blood deprivation in the retina. These smaller vessels are incompletely formed and poorly supported by surrounding tissues. Eventually, the vessels invade the vitreous space against the retina. The jelly-like vitreous substance rubs excessively on the vessels, inducing ruptures or tears. Blood fills the spaces of the eye and the patient goes temporarily blind. Blood then clots and may form a scar, causing the retina to tear loose, which we call retinal detachment. Permanent vision loss is caused by retinal detachment.




Proliferative retinopathy- The second stage of retinopathy where small vessels emerge on the retina and burst due to friction with the vitreous.

Vitreous- Jelly-like substance that fills the space within the eyeball.

Dustin: Is retinopathy the only eye complication in Type II diabetes?

Dr. Ponds: No, some diabetics may get glaucoma or cataracts. Glaucoma is a build-up of pressure in the eyeball. Cataract is when excessive blood-glucose levels change proteins in the lens. The altered proteins cause the lens to lose its elasticity, and patients are unable to focus clearly.

Dustin: These eye troubles sound terrible. What can be done to prevent them?

Dr. Ponds: To prevent these visual disorders, the patient must keep blood-sugar levels steady and schedule regular eye exams with an opthamologist. An opthamologist can check for retinopathy during a routine eye examination. If the patient follows those two rules, there should be no hidden ocular complications.

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