Hello and welcome to Case of the Day. I’m Dr Croley and today we’re gonna discuss an interesting case that came in with an elderly gentleman who came in who has a history of diabetes for many years. Unfortunately, he had never been to an ophthalmologist or an optometrist in the last several years. And he woke up this morning with sort of a dark red blob floating in his vision in his right eye. And so he called his medical doctor and they referred him immediately to see us.
Fortunately, his vision was not reduced that much from the hemorrhages. He was about 20/40. But when we examined his eye, he had a hemorrhage inside the eye which is called a vitreous hemorrhage, that is, the jelly that fills up the back part of your eye, he had hemorrhage into that part. It was not a large one, that’s the reason why his vision was still okay. It was a fairly small hemorrhage. He also had scattered hemorrhages to his retina, as well.
There are different kinds of diabetic retinopathy, that’s which this is called. He had some abnormal vessels on the surface of his disc, that is called neovascularization. So, he’s gonna be referred to a retinal specialist to then probably do a laser treatment to diminish those bad leaky vessels that are bleeding. He probably still gonna be okay. But you have to realize the diabetes is the number one cause of blindness in United States in people under age sixty. As we get older macular degeneration and those kind of things become more prevalent, but in people under age sixty, diabetes is the number one cause of permanent blindness in the United States.
So what happens with diabetes? Well, diabetes, the blood sugar is elevated, obviously and that’s what you’re probably well aware of. What happens is that the blood flow inside your body gets altered so what happens in the retina is you have the arteries that push blood into your retina and then it gets down to the smaller arteries and smaller arteries till you get to a capillary, which is a tiny little blood vessel. And then from the capillary, the oxygen and nutrients diffuse that into your tissue or retina or body and then the vein carries the blood away. There are little cells that surround the capillaries that keep the cell wall of the capillary intact, called the pericyte. And so in diabetics, from the diabetes, those pericytes die and so therefore the capillaries close down and now you have altered blood flow through your body. People who have diabetes have trouble with their retinas, their kidneys, their lower extremities because of poor circulation; they’ve lost that capillary network. And so when we look in the eye, we see that these vessels are abnormal and what happens is, is that they leak blood into your retina and they have little blotches of blood scattered around the retina and also the serum part of fluid in your blood leaks out and so that you have yellowish whitish deposits that are collecting and that is the solids and cholesterol-type things in the serum of your blood collects into the retina. So people lose vision several different ways from diabetes.
Initially, when people just start hemorrhaging in little spots and different things happen in the retina, we call that background diabetic retinopathy. In that scenario, you have these hemorrhages, and the last thing, hemorrhages happen right in your macula, you won’t even know anything’s going on. But as it progresses, and you get hemorrhages into the central part of your vision or macula, or the fluid is leaking into your macula and causing a dimmer or swelling in your macula, then you will start to have diminished vision. And the sooner these things are caught, the better the treatment and the better your prognosis is.
Then there’s a second type of diabetic retinopathy and that is called proliferative diabetic retinopathy and that’s what this gentleman had. The circulation gets so altered in your retina, then actually your retina starts producing a chemical factor that stimulates new blood vessels to grow because you’re not getting enough circulation to your retina so you think, “okay our body’s gonna regenerate some new vessels to take care of their problem.” The problem is these new vessels are not growing in the right direction or right way and these vessels are not normal vessels. They’re very fragile and they break open and bleed.
So that’s what happened to this particular gentleman, is this morning when he woke up, one of those little vessels, those abnormal vessels on the disc on the surface of the disc, hemorrhaged into his eye and then he noticed that blood being there. So this is a more severe form of diabetic retinopathy. But again, if caught early enough, still with laser treatment and injections or medicines we still can keep that under control. If left uncontrolled, and these vessels keep growing and growing, they actually cause the retina to detach. When it gets to that severe form of proliferative diabetic retinopathy, with traction retinal detachments, those people, a lot of times, do not do very well. So the bottom of this story is, is that, this gentleman had not been seen by an eye doctor in many years. So he’s now at risk of having significant problems in his vision.
So if you’re a diabetic, it is the standard of care in the United States that you get your eyes examined, dilated and your eyes examined every year because the earlier this is caught, the better your results are. And also, as far as trying to keep and preventing this from happening, the better you control your diet, the better you maintain your blood sugar in a consistent normal level, less likely are you gonna have anything of this type of things happen to you.
So if you have any questions about diabetes and how it affects the eye, you can contact us through the website. If not, may God bless you with healthy vision and great eyes.