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The numbers are in, and they’re not good. A recent study by the U.S. Centers for Disease Control and Prevention shows that the rate of new diabetes cases almost doubled in the past decade. The current rate in Arkansas is 10 adults per 1,000 being diagnosed with the disease.

Now take in account that the National Eye Institute says that nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime.

What this means is that diabetes, over time, can damage blood vessels in the eyes, causing them to become swollen or blocked. When this happens, blood can leak into the retina — the part of your eye that, like film in a camera, forms the pictures of what you see — and cause vision problems.

What to do? Diabetics and their families know they must exercise, watch what they eat and keep their blood sugar in control. They should also add seeing an eyecare professional to the list.

Carol Randolph, a nurse practitioner at the Little Rock Diagnostic Clinic in endocrinology (working with Dr. Ganesh Nair and Dr. Rick Rapp), stresses the importance of prevention and early detection.

“We recommend all patients with Type 1 and Type 2 diabetes have an annual dilated eye exam,” Randolph says. “The ophthalmologist will then advise the patient regarding appropriate followup, but this should be at least annually. Many patients who develop diabetic retinopathy have no symptoms until the late stages — it may be too late then for the most effective treatment. Early detection significantly improves outcomes.”

Dr. Susan Blair, an ophthalmologist at Pleasant Valley Ophthalmology, explains that in its earliest stages it’s called nonproliferative diabetic retinopathy and is characterized by small aneurysms of the capillary blood vessels, intraretinal hemorrhages and small isolated closures of capillary blood vessels. Increased permeability of the retinal vessels can occur at this stage or later, she says, and results in thickening of the retina (edema). If it occurs close to the center of the retina (the macula), it is called clinically significant macular edema.

According to Blair, as diabetic retinopathy progresses, there is a gradual closure of retinal vessels, which results in decreased oxygen to the retinal tissue. As this increases in severity, the lack of oxygen to the tissue induces new blood vessel growth in the retina. This is known as proliferative diabetic retinopathy and can lead to membrane formation, retinal detachments, bleeding inside the eye and new blood vessel growth in the iris that can lead to a severe type of glaucoma (increased pressure inside the eye).

She can cite numbers and percentages, but the bottom line, Blair says, is “the longer a patient has diabetes, the more likely they are to develop some sort of diabetic retinopathy” and that “controlling the blood sugar is the most important thing that patients can do to decrease their risk.” In addition, she says that intensive management of hypertension (high blood pressure) has been demonstrated to slow progression as well.

Like Randolph, Blair emphasizes that patients should get a dilated eye exam at least annually.

“Early on, diabetic retinopathy has no symptoms, so the only way to know if there is retinopathy present is for your eye doctor to examine your retina,” Blair says. “Once retinopathy is found, patients may be seen more frequently than once a year, depending on the severity of the retinopathy…. Other tests may be done to help determine the extent of the disease process.

“One test is a fluorescein angiography, which entails injection of a dye into the vein and taking pictures of the retina as the dye travels through it to determine the location and amount of leakage and also to determine if there are areas which do not have blood supply because of closure of the capillary blood vessels. Another test is an OCT, which can measure retinal thickness without the injection of a dye to determine the presence of edema.”

She says that pregnant women with diabetes should have an eye exam in their first trimester because retinopathy can progress quickly during pregnancy.

Treatment, Blair says, depends on the severity of the retinopathy, but recent advances have brought good news. “If you have diabetes, with today’s improved methods of diagnosis and treatment, a smaller percentage of people who develop retinopathy have serious vision problems. Early detection of diabetic retinopathy is the best protection against loss of vision.” l