Chapel Hill Eyecare

• Don’t Lose Sight of Your Diabetes
• Set Your Sight on Macular Degeneration
• Retinal Imaging Technology Available

Don’t Lose Sight of Your Diabetes

The blood vessels in the back part of the eye, are particularly sensitive to the damaging effects of elevated blood sugar. If bleeding or sweeling in the retina is found during the comprehensive examination, this is called diabetic retinopathy. Retinopathy does not always produce symptoms, only when the central area of the retina, called the fovea, is affected will the vision be disturbed.

In fact, up to 40 percent of newly diagnosed diabetics will have retinopathy at the time they are diagnosed. Early detection and careful monitoring is essential. If retinopathy progresses, the retinal blood supply becomes compromised. This can ultimately result in permanent vision loss or even blindness. Although in certain circumstances, treatment with lasers and/or surgery can slow the progression of the disease, it cannot reverse its effects. Anyone with diabetes should get a dilated eye exam at least once a year. The best way to prevent the development or progression of diabetic retinopathy is to eat healthy, exercise regularly, and work with your doctor to control not only your blood sugar, but blood pressure and cholesterol as well.

Two well recognized studies have looked at the level of blood sugar control and the development of diabetes related complications. The first, called the Diabetes Control and Complications Trial (or DCCT) found that tight control of blood sugar levels reduces the risk of developing diabetic retinopathy by 76%, and those who already had evidence of diabetic retinopathy were 54% less likely to have progression of their disease over 5 yrs. Kidney disease was reduced by 50% and nerve disease (diabetic neuropathy) by 60% as well. The other study, called the United Kingdom Prospective Diabetes Study, or UKPDS, looked at tight control of blood sugar levels as well as blood pressure. This study found that tight control of blood pressure reduces the rate of progression of diabetic retinopathy as well as kidney disease, stroke, heart failure and diabetes-related death.

Set Your Sight on Macular Degeneration

Age-related Macular Degeneration, AMD or just simply Macular Degeneration is one of the more common diseases of the aging eye. In the United States it affects over 10 million people and is the leading cause of blindness in Americans over 65. The loss of vision associated with this condition can significantly impact someone’s lifestyle and independence. And with the baby-boomers approaching there 6th and 7th decades, the socio-economic burden of this disease is feared by many.

 The macula is the most sensitive area of the retina and is crucial for things like driving, reading, sewing or any other visual task that requires sharp resolution and detail. The reason that this area is so sensitive is that it is here that the photoreceptors (our rods and cones) are most dense. Like pixels in a camera, the more packed the receptors are in a given area, the greater the resolution.

A consequence of having such a large number of receptors is that it requires a lot of nutritional support to function properly. Much of this comes from a rich blood supply called the choroid and thin layer of cells behind the receptors called the Retinal Pigmented Epithelium or RPE. The RPE cells are responsible for transferring nutrients from the choroid to the receptors and removing any waste products they produce.

It is these RPE cells that are damaged in Macular Degeneration. Without the proper nutrients and waste removal, our receptors get "sick" and slowly die. This process is typically slow and is termed Dry Macular Degeneration. In some circumstances as the condition progresses, the body will try to grow a new blood supply under the retina to compensate for the damaged RPE. These new blood vessels however, are actually more detrimental that beneficial. They tend to leak blood and plasma under the retina and further disrupt the normal retinal architecture.

The development of new blood vessels is called neovascularization and when this occurs, the disease is classified as Neovascular AMD or Wet AMD. Wet AMD can produce a more rapid and significant loss of vision than the dry form. Fortunately, the wet form of macular degeneration is much less common than the dry. But given its devastating effects on vision, it has been the primary focus for treatment. In fact, the few treatments currently available are aimed at controlling and/or eliminating neovascularization. To improve the quality of life for those with vision loss, visual aids such as special glasses and magnifiers can help with things like reading, writing, cooking and other activities.

The exact mechanism of the disease development and progression is not well known; however, certain risk factors have been recognized. It primarily affects those over 60 and is much more prevalent in those with blue eyes, fair skin and a strong family history of the disease as well. People with cardiovascular disease and elevated cholesterol are also at a greater risk.

A diet rich in anti-oxidants may help slow the progression of the disease. One well recognized study has shown that certain vitamin supplements in higher doses can reduce the risk of developing advanced AMD in certain individuals, but one should always consult their doctor before taking supplements. Smoking or a history of smoking significantly increases ones risk for developing AMD. UV light has been associated with AMD as well, thus protecting your eyes with sunglasses year-round is always recommended.

Routine eye exams especially for those over 50, can allow for early detection of the disease. Early detection and intervention can help reduce your chances of losing vision. Talk to your eye doctor about your risk factors and what you can do to maintain healthy eyes for a lifetime.

Retinal Imaging Technology Available

At Chapel Hill Eyecare, we are committed to providing your eyes with the highest level of care with the most progressive technology available.  That’s why we’ve upgraded to the Spectralis™ OCT. Optical Coherence Tomography (OCT) technology is used to capture high-quality cross-sectional images of the retina.  The Spectralis™ OCT is a second generation scanning laser with not only higher resolution images, but also automatic retinal recognition technology that enables follow-up examinations to be scanned in the same exact location in the retina.  

This instrument can aid in earlier diagnosis and management of glaucoma and retinal diseases such as diabetic retinopathy and macular degeneration.