We help you with eye diseases resulting from diabetes
Ophthalmologist for diabetic retinopathy
Diabetes has become epidemic: In Germany, there are almost six million people suffering from diabetes. Diabetes is a disorder of the metabolism: Those affected have a higher risk of developing eye illnesses, especially diabetic retinopathy.
Ophthalmologists specialised in diabetic retinopathy and diabetic macular edema
Diabetic illnesses can cause changes inside the eye and especially inside the retina. We are an ophthalmic practice specialised on these accompanying illnesses.
We take a lot of time for our patients. We offer preventive screenings for risk patients, in particular for people with diabetes.
Diabetes mellitus and its effects on the eye: Diabetic retinopathy
Through diabetes, the eye can be affected in various ways:
- Diabetic retinopathy
- Diabetic macular edema
- Clouding of the lens (cataract)
Diabetic retinopathy / Diabetic retinal disease
What is diabetic retinopathy?
Diabetic retinopathy or disease of the retina is the most common microvascular accompanying illness of diabetes mellitus and to this day the No 1 cause for blindness for adult people in the Western world.
Retinal changes in the course of diabetes
The occurrence of diabetic retinopathy depends not only from blood sugar levels but also very strongly from the duration of illness. After 20 years, more than 90 percent of all diabetics show diabetic retinal changes.
Risk factors for diabetic retinopathy
- The main risk factor for the development of a diabetic retinopathy are bad blood sugar levels over a longer period of time.
- Arterial hypertension (high blood pressure) as well as smoking are other risk factors.
- At puberty or during pregnancy, a diabetic retinopathy can worsen.
Emergence of diabetic retinopathy:
In the course of the disease, blood vessels undergo changes. The small (capillary) vessels inside the eye get damaged, mainly through high blood sugar and high blood pressure.
The vascular walls become thicker and fragile, vessels are bulging (microaneurysms). The blood vessels may begin to leak, so liquids and blood are likely to enter the retina. When liquids enter the central retina, we speak of diabetic macular edema.
Additionally, profound arteriosclerosis can emerge. This obstructs the blood flow, so the eye experiences a lack of oxygen. This is called microangiopathy.
Forms of diabetes-induced retinopathy
Diabetic retinopathy is divided into various types:
Non-proliferative diabetic retinopathy (NPDR)
This stage of illness is subdivided from mild to severe. Most diabetics have non-proliferative diabetic retinopathy. At this stage, vessel bulging (microaneurysms), retinal bleeding, fat deposits (hard exsudates), capillary damages as well as nerve fibre infarcts (so-called cotton-wool nests) may arise. At its initial stage, the illness does not need therapy apart from ideal blood sugar leveling and only needs control screening. These screenings must become more frequently, according to the course of illness. At an increase of pathological findings, laser treatment of the retina may be indicated.
At this stage, most patients don’t suffer any symptoms. The retina is damaged without any notice of the patient. Therefore, annual preventive screenings are so important.
When treated early, the progression of the disease can be stopped.
Proliferative diabetic retinopathy
Proliferative diabetic retinopathy is more frequently among teenagers with type 1 diabetes than among those with type 2 diabetes. As a consequence of a lack of oxygene for the retina (retinal ischaemia), new vessels form (neovascularisation). Due to their modified wall structure, they leak, tend to bleed and let liquids ooze out into the retina. A sudden bleeding into the vitreous chamber can occur, causing a sudden severe visual loss up to blindness. In some cases, scar membranes may form on the retina which contract the retina and can cause a retinal detachment.
When not treated at all, new vessels may form on the iris and inside the iridocorneal angle (the structure where eye liquids can drain off). This may lead to a rising intraocular pressure.
The stage of proliferative diabetic retinopathy requires immediate treatment. The treatment consists mainly of panretinal laser coagulation (laser treatment of the whole retinal periphery). In case of macular edema, the therapy may be combined with intravitreal medicament application into the eye. When viteral haemorrhages without resorption or strong traction membranes threatening retinal detachment occur, surgery may be indicated.
At this stage, close treatment and monitoring is crucial.
Our ophthalmologist practice is specialised on diabetic retinopath and provides top-notch diagnostic and therapeutic instruments. If need be, we also conduct intravitreal injections.
Diabetic maculopathy and diabetic macular edema
Whenever diabetes-induced changes on the retina affect the macula, the point of sharpest vision, we speak of diabetic maculopathy. This often results in a leaking of liquids from the small vessels and a swelling at the central retina (macular edema). The macular edema affects the vision and, if not treated, may lead to a constant damage of the central retina with a permanent disorder of the eye.
Therefore, this stage, too, requires early treatment in any case.
The diabetic macular edema treatment consists of repeated intravitreal injections which we conduct ourselves.
Regular retina monitoring for diabetics
Examination of the retina for diabetics
We recommend diabetic persons to regularly undergo ophthalmologist examination. At our ophthalmologist practice, we are able, thanks to our state-of-the-art equipment, to diagnose diabetes-induced changes of the retina at all stages and treat them, as well.
Depending on the stage of illness, one of the following examinations is appropriate:
OCT – Optical coherence tomography
Optical coherence tomography is a contact-free, non-invasive procedure for the representation of single layers of the central retina. Through this examination, the ophthalmologist can distinguish diagnostic findings that are impossible to make otherwise. For example, macular edema can be shown in all accuracy including the size as can be the whole course of illness. This is how we can identify the need for a new treatment.
OCT angiography is a modern non-invasive procedure to display the small retinal vessels around the macula area and the adjacent region of the retina. It enables us to show e.g. small vessel bulgings (aka microaneurysms), pathological forming of new vessels, as well as areas without any blood vessels (so-called ischaemic maculopathy), all of which can occur at diabetes-induced changes of the retina. The examination is conducted without any injection of colourants. This procedure is also very suitable for diabetic retinal disease follow-ups.
FLA Fluorescene angiography
Fluorescene angiography is the procedure of choice, when a detailed statement on the retinal perfusion is wanted. This examination makes sense, for example, at the stage of proliferative diabetic retinopathy, for both diagnostics and progress monitoring. During the examination, a well-tolerated yellow colourant (fluorescene) is injected into the arm vein. The colourant is spread all across the body, finally reaching the vessels at the ocular fundus. Using a special camera, these vessels can be photographed over the course of time. Many pathological changes, such as new vessel forming at diabetic retinopathy, can be shown that way.
Ocular fundus photography and wide-angle photography of the retina
Wide-angle photography of the retina is executed with a special camera. The reproduction can be done in parts without a dilatation of the pupil. Many pathological changes, e.g. bleedings, can be documented in that way. The images are helpful later for progress monitoring, too.
Diabetic retinopathy therapy
How to treat diabetic retinopathy
Diabetic retinopathy therapy varies according to the respective stage. In the first stages, for example at mild to moderate non-proliferative diabetic retinopathy, a therapy is usually not necessary.
But all findings must be checked well. A good blood sugar and blood pressure leveling is very important and quite often defining the further course of illness.
The severe non-proliferative diabetic retinopathy and the proliferative diabetic retinopathy always require laser treatment. Diabetic macular edema with visual impairment needs intravitreal injections.
Therapies available for diabetic retinopathy:
Laser therapy of diabetic retinopathy
Laser treatment is usually indicated when proliferative changes have occurred (forming of new vessels). But there are other pathological changes, too, that call for targeted and careful laser treatment.
Intravitreal injection therapy
Intravitreal injection therapy is required for a clinically significant diabetic macular edema. An early therapy provides for a better prognosis. Hence, patients with beginning diabetic vessel changes should be examined regularly, so a possible therapy can be started timely.