The Glaucoma and Diabetes Eye Institute

 

Glaucoma
The Glaucoma Service at Harper’s Point Eye Associates offers comprehensive consultations and long-term care for all forms of glaucoma, including medical, laser, and surgical treatment. We utilize computerized optic disc nerve fiber layer and visual field analysis available using state-of-the art perimetry. Our state of the art electronic medical records system allows our doctors to immediately access your test data from any point in our office. Dynamic Contour Tonometry, which is considered to be the most precise method of eye pressure measurement, is the standard in our practice. Such tests can lead to early treatment before obvious vision problems materialize.

The Glaucoma and Diabetes Eye Institute at Harper’s Point Eye Associates is recognized as a regional center for glaucoma research and management where many area eye doctors refer their patients for glaucoma care.

  • Glaucoma Defined
    A group of diseases characterized by increased pressure inside the eye. If left untreated, it causes blindness through permanent damage to the optic nerve. Sometimes glaucoma is called a “thief in the night” because there are often no symptoms until damage has been done. Diagnosis involves measurement of eye pressure, visual field testing, optic nerve imaging and direct observation of the optic nerve. The treatment for early glaucoma is usually eye drops, which lower eye pressure. More serious types of glaucoma may require surgery.
    Dr. Kirstein has and continues to conduct glaucoma research. He is the glaucoma research coordinator for Ziemer Ophthalmology, AG, Switzerland.

  •  A scene as it might be viewed by a person with Glaucoma:

A scene as it might be viewed by a person with Cataracts

 

Diabetes Management at the Glaucoma and Eye Institute
The diabetic eye disease service at Harper’s Point Eye Associates offers comprehensive consultations and long-term care for all forms of eye problems associated with diabetes, including medical, laser, and surgical treatment. We utilize computerized retinal imaging and visual field analysis available using state-of-the art perimetry. Our state of the art electronic medical records system allows our doctors to immediately access your test data from any point in or away from our office. Such tests can lead to early treatment before obvious vision problems materialize.

As always, our emphasis is on our patients, realizing how important it is for you to have an excellent understanding of glaucoma and that we remain vigilant about answering your valuable questions.

What is Diabetic Eye Disease?
Diabetic eye disease refers to a group of eye problems including diabetic retinopathy, cataracts, glaucoma and extraocular nerve palsies.

Diabetes
Dr. Kirstein and Dr. Zelczak work closely with the primary care physicians in the surrounding community to ensure that patients receive appropriate diabetic eye care. Diabetes can cause a potentially blinding complication know as diabetic retinopathy. Patients are usually unaware that they have a problem until they lose vision.

When patients receive an eye examination at our office they are checked carefully for diabetic retinopathy. Photographs are taken of the retina to follow potential problem areas. Regular communication is made between our office and your doctor's office with respect to our findings. When necessary, patients with diabetic retinopathy are referred to retina specialists for laser treatments or surgery.

Blindness from diabetes is very preventable. Having an eye examination at the time of your diabetes diagnosis and then annually thereafter will help ensure that healthy vision is maintained for years.

  • Diabetes and Diabetic Retinopathy
    Diabetes often causes a weakening of the tiny blood vessels in the retina which can leak fluid into surrounding tissue causing blurred vision and severe vision loss. It tends to occur more often in individuals whose diabetes is poorly controlled. It is best prevented and controlled by early diagnosis and aggressive systemic management of the diabetes. Various surgical treatments exist and can be extremely effective in preventing serious vision loss. All diabetics should have a thorough eye examination at least once per year.

  • A scene as it might be viewed by a person with diabetic retinopathy:


A scene as it might be viewed by a person with diabetic retinopathy

What is Diabetic Retinopathy?
Diabetes is a condition where your body can’t use and store sugar.  When your blood sugar gets too high, it can cause damage to the small blood vessels in your eyes leading to what’s referred to as Diabetic Retinopathy.  The extent of blood sugar elevation as well as the length of time someone has diabetes increases the incidence and severity of retinopathy.  Other risk factors that can increase your risk of retinopathy include smoking, pregnancy, high cholesterol, and high blood pressure.  If undetected, this process can seriously affect vision and, if left untreated, can ultimately lead to blindness. 
People who are diabetic are 25 times more likely to lose their vision than those who are not diabetic.  Diabetic Retinopathy is the leading cause of blindness in American adults.

Background Diabetic Retinopathy is the earliest stage of the disease when the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages.  These leaking vessels often lead to swelling or edema in the retina and decreased vision.

Proliferative Diabetic Retinopathy is the later stage where circulation problems cause areas of the retina to become oxygen deprived, or ischemic.  New, fragile, vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina.  This process is called neovascularization.  Unfortunately, these delicate vessels hemorrhage easily.  Blood may leak into the retina and vitreous causing spots or floaters, along with decreased vision.


In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment and glaucoma.

Symptoms of Diabetic Retinopathy
It's possible to have diabetic retinopathy and not know it. In fact, it's uncommon to have symptoms in the early stages of diabetic retinopathy.
As the condition progresses, diabetic retinopathy symptoms may include: 

• 
Spots or dark strings floating in your vision (floaters) 
• 
Blurred Vision  
• 
Fluctuating vision  
• 
Dark or empty areas in your vision
• 
Poor night vision  
• 
Impaired color vision  
• 
Vision loss Diabetic retinopathy usually affects both eyes.

When to See Our Doctors
Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see on of our doctors for a yearly dilated eye exam even if your vision seems fine, because it is important to detect diabetic retinopathy in the earliest stages.  Contact our office right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.

Diagnosis and Treatment of Diabetic Retinopathy
Diagnosis of diabetic retinopathy is best diagnosed with a dilated eye exam.  This allows our doctors to get a better view inside your eye during our evaluation.  Other tests that may be used to diagnose or monitor the progression of your condition may include: 

• 
Digital Imaging and Retinal Photography 
• 
Fluorescein Angiography – special testing where dye is injected in your arm and photographs are taken as dye circulates to determine retinal vessels that are closed or leaking.
• 
Optical Coherence Tomography – provides cross-sectional images of the retina showing thickness and leakage
• 
Focal Laser Treatment – Procedure to slow or stop the leakage of blood and fluid in the retina. 
• 
Scattered Laser Treatment – Procedure performed in attempt to shrink abnormal blood vessel growth. 
• 
Vitrectomy – Procedure used to remove blood or scar tissue from the middle part of the eye (vitreous).
 

Diabetic procedures performed by a retinal surgeon often slow or stop the progression of diabetic retinopathy, but it's not a cure. Diabetic laser treatments may result in temporary or permanent blind spots and/or reduced peripheral and night vision. 
Because diabetes is a lifelong condition, future retinal damage and vision loss is possible. Even after treatment for diabetic retinopathy, you'll need regular eye exams. Additional visits throughout the year are often times are necessary to monitor the progress of your condition.

Researchers are studying new treatments for diabetic retinopathy, including medications that may help prevent abnormal blood vessels from forming in the eye. Some of these medications are injected directly into the eye to treat existing swelling or abnormal blood vessels.

Prevention
If you have diabetes, reduce your risk of diabetic retinopathy by doing the following:  

• 
Make a commitment to managing your diabetes
• 
Set goals to eat healthy and exercise regularly 
• 
Monitor your blood sugar daily
• 
Ask your doctor about your glycosylated hemoglobin test (A1C) 
• 
Quit smoking   
• 
Follow your doctor’s instructions 
• 
Have eye exams regularly