Expert eye care for patients with diabetes

It is estimated that nearly 10 million people with diabetes in the U.S. have diabetic retinopathy and, for 2 million of those, the condition threatens their vision.

In Maine, according to MaineGeneral Eye Center’s Dr. Sirus Hamzavi, pre-COVID statistics estimated that 12 percent of the population has diabetes and 3 to 5 percent don’t know they have it. If they don’t know they have the disease, these individuals are at higher risk for developing diabetic retinopathy, a vision-threatening condition for which symptoms may not appear until it has advanced.

Dr. Hamzavi and colleagues Dr. Michael Nolan and Dr. Patrick Rapuano strongly encourage people with diabetes to have an annual dilated eye screening examination, as part of their overall health maintenance, to discover and treat the condition as early as possible. And the trio – all experienced in diagnosing and treating diabetic retinopathy – is ready to provide expert care to help patients protect and preserve their vision.

What is diabetic retinopathy?

According to the American Academy of Ophthalmology, diabetic retinopathy occurs when high blood sugar levels cause damage to blood vessels in the retina. The vessels then can swell and leak, or close and stop blood from passing through. The condition also can cause abnormal new blood vessels to grow on the retina, known as proliferative diabetic retinopathy. All of these changes can cause permanent vision loss.

“Treating patients with diabetes is a significant part of what our practice does because diabetes is such a big problem in our country,” Dr. Hamzavi says. “The problem with diabetes in the eye is that people can have diabetic retinopathy, not have any symptoms and still have good vision. And by the time they have symptoms, the disease is already very advanced.”

Treating the condition

For mild cases, the patient may only need monitoring and not immediate treatment. With more advanced cases, Dr. Hamzavi and his colleagues are most concerned with diabetic macular edema, or swelling around the center of the retina, which is the number one cause of vision loss related to diabetes.

Patients with this condition are treated in the practice’s Fairfield location in one of two ways – with medicine injections in the eye or with laser treatment.

"We've been doing eye injections for quite some time and, while it may sound daunting, we have a very good technique to make patients comfortable," Dr. Hamzavi says. “It’s very effective and has become the most common treatment in ophthalmology because we can do injections to treat several conditions including diabetic retinopathy, age-related macular degeneration and retinal vein occlusion.”

Patients treated with injections receive them over a period of time, sometimes as frequently as once per month to start and then once or
twice per year once their condition stabilizes. Laser treatment also can an be an option for patients with diabetic retinopathy, macular edema or proliferative diabetic retinopathy.

“The choice of treatment depends on what their main problem is. Laser treatment is very effective for macular edema but it does leave some scarring, so if the edema is in the center of the patient’s vision, we can’t laser it,” Dr. Hamzavi says. “In that case, we’d use injections.”

What patients can do

Dr. Hamzavi says one of the most effective actions patients can take to help avoid issues from diabetic retinopathy is to partner with their primary care clinicians to keep their blood sugar and blood pressure under control. The second is to receive regular diabetic eye care from the experts at MaineGeneral Eye Center.

“Adults with type 2 diabetes who come to us may have had it for some time before they were diagnosed, so they could already have the start of diabetic retinopathy,” Dr. Hamzavi says. “We recommend they get a proper dilated eye exam in short order, to really examine the retina for retinopathy.”

“For younger patients with type 1 diabetes, while the general recommendation is for them to have a dilated eye exam within five years of diagnosis, we want to see them sooner to establish a baseline,” he adds.

“And if you start seeing floaters or flashes, don’t wait to receive care, thinking they will just ‘go away,’ as we sometimes hear from patients. Any new changes in vision should be evaluated immediately.”

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