Advertisement

Endocrine

, Volume 32, Issue 1, pp 107–116 | Cite as

How the diabetic eye loses vision

  • Jaime A. Davidson
  • Thomas A. Ciulla
  • Janet B. McGill
  • Keri A. Kles
  • Pamela W. Anderson
CASE

Abstract

The objective is to review the most common causes of vision loss in patients with diabetes with the goal of better managing patients with diabetic eye disease. In this review, the causes of vision loss, and the clinical evaluation and management of diabetic retinopathy (DR) and diabetic macular edema (DME) are outlined. Patients with diabetes mellitus have an increased risk of vision loss and blindness. In patients with diabetes, the primary mechanism responsible for vision loss is centrally involved DME or clinically significant macular edema (CSME), defined as vascular leakage resulting in fluid accumulation that affects the center of the macula. DR and DME are thought to result from the effects of excessive blood glucose on the vessels that produces microvascular damage. The progression of DR can be slowed by intensive glycemic and blood pressure control. Severe visual loss from proliferative DR and moderate visual loss from DME can be reduced by laser photocoagulation. DR and DME are diagnosed on dilated retinal examination and confirmed with diagnostic testing. Many experts and associations recommend that patients with diabetes have an yearly, thorough, dilated eye exam. This manuscript describes the case history of a patient with diabetes and vision loss.

Keywords

Diabetic retinopathy Diabetic macular edema Vision loss 

Abbreviations

ADA

American Diabetes Association

ARB

Angiotensin receptor blocker

COM

Center of the macula

CSME

Clinically significant macular edema

DR

Diabetic retinopathy

DME

Diabetic macular edema

ETDRS

Early treatment diabetic retinopathy study

HbA1c

Hemoglobin A1c

IRMA

Intraretinal microvascular abnormalities

MVL

Moderate visual loss

NPDR

Non-proliferative diabetic retinopathy

NCSME

Non-clinically significant diabetic macular edema

OCT

Optical coherence tomography

PDR

Proliferative diabetic retinopathy

VEGF

Vascular endothelial growth factor

TZD

Thiazolidinedione

References

  1. 1.
    National Eye Institute, Prevalence of Blindness and Low Vision Among Adults Aged 40 Years and Older in the United States (National Eye Institute, Bethesda, MD, 2004), Accessed July, 2006, at http://www.nei.nih.gov/eyedata/pbd_tables.asp
  2. 2.
    Centers for disease control (CDC), Diabetes Surveillance System (2003), CDC Accessed July, 2006, at http://www.cdc.gov/diabetes/statistics/index.htm
  3. 3.
    A.H. Mokdad, E.S. Ford, B.A. Bowman, D.E. Nelson, M.M. Engelgau, F. Vinicor, J.S. Marks, Diabetes Care, 23, 1278–1283 (2000)PubMedCrossRefGoogle Scholar
  4. 4.
    American Optometric Association, Optometric Clinical Practice Guideline: Care of the Patient with Diabetes Mellitus: Reference Guide for Clinicians, Third Revision (2002), Accessed May, 2006, At: http://www.aoa.org/documents/CPG-3.Pdf
  5. 5.
    American Diabetes Association: Clinical Practice Recommendations (2002). The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, Diabetes Care 25, S1–S147 (2002)Google Scholar
  6. 6.
    R. Klein, B.E. Klein, S.E. Moss, M.D. Davis, D.L. DeMets, Ophthalmology 91, 1464–1474 (1984)PubMedGoogle Scholar
  7. 7.
    D.S. Friedman, N. Congdon, J. Kempen, J.M. Tielsch, Accessed May, 2006, At: http://www.Preventblindness.org/vpus/vp.html (2006)
  8. 8.
    J.H. Kempen, B.J. O’Colmain, M.C. Leske, et al., Arch. Ophthalmol. 122, 552–563 (2004)PubMedCrossRefGoogle Scholar
  9. 9.
    R. Klein, B.E. Klein, S.E. Moss, M.D. Davis, D.L. Demets, Arch. Ophthalmol. 102, 527–532 (1984)PubMedGoogle Scholar
  10. 10.
    R. Klein, B.E. Klein, S.E. Moss, M.D. Davis, D.L. Demets, Arch. Ophthalmol. 102, 520–526 (1984)PubMedGoogle Scholar
  11. 11.
    Refractive Error (American Academy Of Ophthalmology, San Francisco, CA, 1997)Google Scholar
  12. 12.
    J.M. Tielsch, A. Sommer, J. Katz, R.M. Royall, H.A. Quigley, J. Javitt, JAMA 266, 369–374Google Scholar
  13. 13.
    H.A. Quigley, S. Vitale, Invest. Ophthalmol Vis. Sci. 38, 83–91 (1997)PubMedGoogle Scholar
  14. 14.
    N.G. Congdon, D.S. Friedman, T. Lietman, JAMA 290(15), 2057–2060 (2003)PubMedCrossRefGoogle Scholar
  15. 15.
    The Eye Disease Prevalence Research Group, Arch. Ophthalmol. 122, 477–485 (2004)CrossRefGoogle Scholar
  16. 16.
    S.E. Moss, R. Klein, B.E. Klein, Ophthalmology 105, 998–1003 (1998)PubMedCrossRefGoogle Scholar
  17. 17.
    R. Klein, B.E. Klein, S.E. Moss, K.J. Cruickshanks, Ophthalmology 105(10), 1801–1815 (1998)PubMedCrossRefGoogle Scholar
  18. 18.
    D.S. Fong, L. Aiello, T.W. Gardner, G.L. King, G. Blankenship, J.D. Cavallerano, F.L. Ferris, R. Klein, Diabetes Care 27(Suppl 1), S84–S87 (2004)PubMedCrossRefGoogle Scholar
  19. 19.
    C.P. Wilkinson, F.L. Ferris, R.E. Klein, P.P. Lee, C.D. Agardh, M. Davis, D. Dills, A. Kampik, R. Pararajasegaram, J.T. Verdaguer, Ophthalmology 110(9), 1677–1682 (2003)PubMedCrossRefGoogle Scholar
  20. 20.
    Early Treatment Diabetic Retinopathy Study Research Group, Ophthalmology 98, 766–785 (1991)Google Scholar
  21. 21.
    Diabetes Guidelines, American Association Of Clinical Endocrinologists. Endocr. Pract. 8(Suppl 1), 40–82 (2002)Google Scholar
  22. 22.
    Early Treatment Diabetic Retinopathy Study Research Group, Early Treatment Diabetic Retinopathy Study Report Number 1, Arch. Ophthalmol. 103, 1796–1806 (1985)Google Scholar
  23. 23.
    M. Henricsson, A. Sellman, M. Tyrberg, L. Groop, Acta. Ophthalmol. Scand. 77, 218–223 (1999)PubMedCrossRefGoogle Scholar
  24. 24.
    DCCT Research Group, N. Engl. J. Med. 329, 977–986 (1993)CrossRefGoogle Scholar
  25. 25.
    UK Prospective Diabetes Study (UKPDS) Group, Lancet 352, 837–853 (1998)CrossRefGoogle Scholar
  26. 26.
    The Diabetic Retinopathy Study Research Group, Am. J. Ophthalmol. 81(4), 383–396 (1976)Google Scholar
  27. 27.
    Diabetic Retinopathy Study Research Group, DRS Report Number 8, Ophthalmology 88, 583–600 (1981)Google Scholar
  28. 28.
    American Diabetes Association, Diabetes Care 21, 296–309 (1998)CrossRefGoogle Scholar
  29. 29.
    D.R. Globe J. Wu S.P. Azen R. Varma, The Los Angeles Latino Eye Study Group, Ophthalmology 111(6), 1141–1149 (2004)CrossRefGoogle Scholar
  30. 30.
    S. Sharma, A. Oliver-Fernandez, W. Liu, P. Buchholz, J. Walt, Curr. Opin. Ophthalmol. 16(3), 155–159 (2005)PubMedCrossRefGoogle Scholar
  31. 31.
    M.M. Brown, G.C. Brown, S. Sharma, B. Busbee, Ophthalmology 110(6), 1076–1081 (2003)PubMedCrossRefGoogle Scholar
  32. 32.
    Preferred Practice Patterns: Diabetic Retinopathy (American Academy Of Ophthalmology, San Francisco, CA, 1998)Google Scholar
  33. 33.
    S. Rowe, C.H. Maclean, P.G. Shekelle, JAMA 291(12), 1487–1495 (2004)PubMedCrossRefGoogle Scholar
  34. 34.
    International Diabetes Center, Type 2 Diabetes Practice Guidelines (International Diabetes Center, Minneapolis, MN, 2001)Google Scholar
  35. 35.
    National Guideline Clearinghouse, Guideline Title: VA/Dod Clinical Practice Guideline for the Management of Diabetes Mellitus (2006), Accessed May, 2006, At: http://www.guideline.gov/summary/summary.aspx?doc_id=5185&nbr=003567&string=diabetes+and+mellitus
  36. 36.
    G.M. Zoega, T. Gunnarsdottir, S. Bjornsdottir, A.B. Hreietharsson, G. Viggósson, E. Stefánsson, Acta. Ophthalmol. Scand. 83, 687–690 (2005)PubMedCrossRefGoogle Scholar
  37. 37.
    P.P. Lee, Z.W. Feldman, J. Ostermann, D.S. Brown, F.A. Sloan, Ophthalmology 110(10), 1952–1959 (2003)PubMedCrossRefGoogle Scholar
  38. 38.
    D.S. Fong, L.P. Aiello, F.L. Ferris, R. Klein, Diabetes Care 27(10), 2540–2553 (2004)PubMedCrossRefGoogle Scholar
  39. 39.
    G.M. Comer, T.A. Ciulla, Expert Opin. Emerg. Drugs. 10(2), 441–455 (2005)PubMedCrossRefGoogle Scholar
  40. 40.
    T.A. Ciulla, A.G. Amador, B. Zinman, Diabetes Care 26(9), 2653–2664 (2003)PubMedCrossRefGoogle Scholar
  41. 41.
    R. Klein, B.E. Klein, S.E. Moss, M.D. Davis, D.L. Demets, Ophthalmology 91, 1464–1474 (1984)PubMedGoogle Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Jaime A. Davidson
    • 1
  • Thomas A. Ciulla
    • 2
  • Janet B. McGill
    • 3
  • Keri A. Kles
    • 4
  • Pamela W. Anderson
    • 4
  1. 1.Division of EndocrinologyUniversity of Texas, Southwestern Medical SchoolDallasUSA
  2. 2.Retina Service, Midwest Eye InstituteMethodist HospitalIndianapolisUSA
  3. 3.Washington University School of MedicineSt. LouisUSA
  4. 4.Lilly Research LaboratoriesIndianapolisUSA

Personalised recommendations