Diabetic retinopathy occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

Symptoms
At first, you will see a few specks of blood, or spots, "floating" in your vision. If spots occur, see your eye care professional as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.

Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can recur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.

If left untreated, Proliferative Retinopathy (when fragile, abnormal blood vessels develop and leak blood into the center of the eye, blurring vision) can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.

Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

Proliferative Retinopathy
Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.

Macular Edema
Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.

Diabetic retinopathy has four stages:

Mild Non-proliferative Retinopathy. At this earliest stage, micro-aneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.

Moderate Non-proliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.

Severe Non-proliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye.
By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

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Know Your Risk Factors

All people with diabetes--both type 1 and type 2--are at risk for diabetic retinopathy. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year.

Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.

During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

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Manage Your Risk Factors

Don't wait for symptoms. Diabetic retinopathy often has no early warning signs. Be sure to have a comprehensive dilated eye exam at least once a year.

Everyone with diabetes should have a comprehensive dilated eye exam at least once a year. If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness with timely treatment and appropriate follow-up care.

Better control of blood sugar levels slows the onset and progression of retinopathy. Be sure to speak to your doctor about the benefits of controlling your blood sugar.

Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision. Speak to your doctor about the benefits of controlling your cholesterol and your blood pressure.

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Work with Your Doctor

If you have diabetes, get a comprehensive dilated eye exam at least once a year.

Remember:

Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.

Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.

You can protect yourself against vision loss by working in partnership with your eye care professional. Ask questions and get the information you need to take care of yourself and your family.

Here are some questions to ask your eye doctor:

About your eye disease or disorder:

What is my diagnosis?

What caused my condition?

Can my condition be treated?

How will this condition affect my vision now and in the future?

Should I watch for any particular symptoms and notify you if they occur?

Should I make any lifestyle changes?

About your treatment:

What is the treatment for my condition?

When will the treatment start and how long will it last?

What are the benefits of this treatment and how successful is it?

What are the risks and side effects associated with this treatment?

Are there foods, drugs, or activities I should avoid while I'm on this treatment?

If my treatment includes taking medicine, what should I do if I miss a dose?

Are other treatments available?

About your tests:

What kinds of tests will I have?

What can I expect to find out from these tests?

When will I know the results?

Do I have to do anything special to prepare for any of the tests?

Do these tests have any side effects or risks?

Will I need more tests later?

Other suggestions:

If you don't understand your eye care professional's responses, ask questions until you do understand.

Take notes or get a friend or family member to take notes for you. Or, bring a tape recorder to help you remember the discussion.

Ask your eye care professional to write down his or her instructions to you.

Ask your eye care professional for printed material about your condition.

If you still have trouble understanding your eye care professional's answers, ask where you can go for more information.

Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too.

Today, patients take an active role in their health care. Be active in your eye care.

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Glaucoma

Know the Facts
Know Your Risk Factors
Manage Your Risk Factors
Work with Your Doctor

Know the Facts

Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. The optic nerve is a bundle of more than 1 million nerve fibers that connects the retina to the brain. The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision. With early treatment, you can often protect your eyes against serious vision loss.

Glaucoma may develop in one or both eyes.

Open-angle glaucoma is the most common form of glaucoma. (The angle is a space inside the eyeball through which fluid flows from inside the eyeball to the outside of the eyeball.)

Symptoms

At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal.

As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye.

Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains.

Detection:

Glaucoma is detected through a comprehensive eye exam that includes:

Visual acuity test. This eye chart test measures how well you see at various distances.

Visual field test. This test measures your peripheral (side) vision. It helps your eye care professional tell if you have lost side vision, a sign of glaucoma.

Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. (The retina is the light-sensitive tissue at the back of the eye.) After the exam, your close-up vision may remain blurred for several hours.

Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Pachymetry. A numbing drop is applied to your eye. Your eye care professional uses an ultrasonic wave instrument to measure the thickness of your cornea

There is no cure for glaucoma. Vision lost from the disease cannot be restored.

Glaucoma can be treated. Early treatment can delay progression of the disease. That's why early diagnosis is very important.

Other Forms of Glaucoma

Low-Tension or Normal-tension Glaucoma

Angle Closure Glaucoma

Congenital Glaucoma

Secondary Glaucoma

Low-tension or Normal-tension Glaucoma
Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is not as common as open-angle glaucoma.

In low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures.

A comprehensive medical history is important in identifying other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma.

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Angle Closure Glaucoma
In angle-closure glaucoma, the fluid at the front of the eye cannot reach the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately. This is a medical emergency. If your doctor is unavailable, go to the nearest hospital or clinic. Without treatment to improve the flow of fluid, the eye can become blind in as few as one or two days.

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Congenital Glaucoma
In congenital glaucoma, children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing.

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Secondary Glaucoma
Secondary glaucoma can develop as complications of other medical conditions. These types of glaucomas are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). Pigmentary glaucoma occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Corticosteroid drugs used to treat eye inflammation and other diseases can trigger glaucoma in some people.

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Know Your Risk Factors

Increased eye pressure means you are at risk for glaucoma, but does not mean you have the disease. A person has glaucoma only if the optic nerve is damaged.

Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.

Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That's why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.

Anyone can develop glaucoma. Some people are at higher risk than others.
They include:

African Americans over age 40.

Everyone over age 60, especially Mexican Americans.

People with a family history of glaucoma.

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Manage Your Risk Factors

If you have increased eye pressure but no damage to the optic nerve, you do not have glaucoma. However, you are at risk. Follow the advice of your eye care professional.

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Work with Your Doctor

You can protect yourself against vision loss by working in partnership with your eye care professional. Ask questions and get the information you need to take care of yourself and your family.

If you are being treated for glaucoma, be sure to take your glaucoma medicine every day. See your eye care professional regularly.

You also can help protect the vision of family members and friends who may be at high risk for glaucoma. Encourage them to have a comprehensive dilated eye exam at least once every two years. Remember: Lowering eye pressure in glaucoma's early stages slows progression of the disease and helps save vision.

Here are some questions to ask your eye doctor:

About your eye disease or disorder:

What is my diagnosis?

What caused my condition?

Can my condition be treated?

How will this condition affect my vision now and in the future?

Should I watch for any particular symptoms and notify you if they occur?

Should I make any lifestyle changes?

About your treatment:

What is the treatment for my condition?

When will the treatment start and how long will it last?

What are the benefits of this treatment and how successful is it?

What are the risks and side effects associated with this treatment?

Are there foods, drugs, or activities I should avoid while I'm on this treatment?
If my treatment includes taking medicine, what should I do if I miss a dose?
Are other treatments available?

About your tests:

What kinds of tests will I have?

What can I expect to find out from these tests?

When will I know the results?

Do I have to do anything special to prepare for any of the tests?

Do these tests have any side effects or risks?

Will I need more tests later?

Other suggestions:

If you don't understand your eye care professional's responses, ask questions until you do understand.

Take notes or get a friend or family member to take notes for you. Or, bring a tape recorder to help you remember the discussion.

Ask your eye care professional to write down his or her instructions to you.

Ask your eye care professional for printed material about your condition.

If you still have trouble understanding your eye care professional's answers, ask where you can go for more information.

Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too.

Today, patients take an active role in their health care. Be active in your eye care.

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Cataract

Know the Facts
Know Your Risk Factors
Manage Your Risk Factors
Work with Your Doctor

Know the Facts

A cataract is a clouding of the eye's lens that causes loss of vision. (The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye.)

A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

Symptoms The most common symptoms of a cataract are:

Cloudy or blurry vision.
Colors seem faded.
Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
Poor night vision.
Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
Frequent prescription changes in your eyeglasses or contact lenses.

These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.

Detection

Cataracts are detected through a comprehensive eye exam that includes:

Visual acuity test. This eye chart test measures how well you see at various distances.
Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional also may do other tests to learn more about the structure and health of your eye.

Types of Cataracts

Although most cataracts are related to aging, there are other types of cataracts:

Secondary cataract. Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.
Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
Radiation cataract. Cataracts can develop after exposure to some types of radiation.

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Know Your Risk Factors

The risk of cataract increases as you get older. Other risk factors for cataract include:

Certain diseases (for example, diabetes)
Lifestyle (smoking, alcohol use).
The environment (prolonged exposure to ultraviolet sunlight).

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Manage Your Risk Factors

Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract.

If you smoke, stop. If you would like information about HIP's Free and Clear Quit Smoking Program, call 1-800-292-2336. For more information, click here.

Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants.

If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataracts, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders.

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Work with Your Doctor

Although a cataract can be detected without dilated pupils, your eye care professional can see the back of your eye better using this exam. Getting a good view of the retina and optic nerve is important in detecting eye diseases such as glaucoma and macular degeneration.

You can protect yourself against vision loss by working in partnership with your eye care professional. Ask questions and get the information you need to take care of yourself and your family.

Here are some questions to ask your eye doctor:

About your eye disease or disorder:

What is my diagnosis?
What caused my condition?
Can my condition be treated?
How will this condition affect my vision now and in the future?
Should I watch for any particular symptoms and notify you if they occur?
Should I make any lifestyle changes?

About your treatment:

What is the treatment for my condition?
When will the treatment start and how long will it last?
What are the benefits of this treatment and how successful is it?
What are the risks and side effects associated with this treatment?
Are there foods, drugs, or activities I should avoid while I'm on this treatment?
If my treatment includes taking medicine, what should I do if I miss a dose?
Are other treatments available?

About your tests:

What kinds of tests will I have?
What can I expect to find out from these tests?
When will I know the results?
Do I have to do anything special to prepare for any of the tests?
Do these tests have any side effects or risks?
Will I need more tests later?

Other suggestions:

If you don't understand your eye care professional's responses, ask questions until you do understand.
Take notes or get a friend or family member to take notes for you. Or, bring a tape recorder to help you remember the discussion.
Ask your eye care professional to write down his or her instructions to you.
Ask your eye care professional for printed material about your condition.
If you still have trouble understanding your eye care professional's answers, ask where you can go for more information.
Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too.

Today, patients take an active role in their health care. Be active in your eye care.

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Macular Degeneration

Know the Facts
Know Your Risk Factors
Manage Your Risk Factors
Work with Your Doctor

Know the Facts

Age-related macular degeneration (AMD) is a disease that blurs the sharp, central vision you need for "straight-ahead" activities such as reading, sewing, and driving. AMD affects the macula, the part of the eye that allows you to see fine detail.

AMD is a leading cause of vision loss in Americans 60 years of age and older.

AMD causes no pain.

In some cases, AMD advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a loss of vision in both eyes.

AMD occurs in two forms: wet and dry.

Wet AMD
Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly.

With wet AMD, loss of central vision can occur quickly. Wet AMD is considered to be advanced AMD and is more severe than the dry form.

An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition or other changes to your vision, contact your eye care professional at once. You need a comprehensive dilated eye exam.

All people who have the wet form of AMD had the dry form first.

Dry AMD
Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision in the affected eye can be lost gradually.

The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces. You may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected.

One of the most common early signs of dry AMD is drusen. Drusen are yellow deposits under the retina. They often are found in people over age 60. Your eye care professional can detect drusen during a comprehensive dilated eye exam.

Dry AMD has three stages, all of which may occur in one or both eyes:

Early AMD. People with early AMD have either several small drusen or a few medium-sized drusen. At this stage, there are no symptoms and no vision loss.
Intermediate AMD. People with intermediate AMD have either many medium-sized drusen or one or more large drusen. Some people see a blurred spot in the center of their vision. More light may be needed for reading and other tasks.
Advanced Dry AMD. In addition to drusen, people with advanced dry AMD have a breakdown of light-sensitive cells and supporting tissue in the central retinal area. This breakdown can cause a blurred spot in the center of your vision. Over time, the blurred spot may get bigger and darker, taking more of your central vision. You may have difficulty reading or recognizing faces until they are very close to you.

The dry form of AMD can advance and cause vision loss without turning into the wet form. The dry form also can suddenly turn into the wet form, even during early stage AMD. There is no way to tell if or when the dry form will turn into the wet form.

If you have vision loss from dry AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you still can drive, read and see fine details. You may notice changes in your vision only if AMD affects both eyes. If blurriness occurs in your vision, see an eye care professional for a comprehensive dilated eye exam.

The dry form of AMD is much more common. More than 85 percent of all people with intermediate and advanced AMD combined have the dry form.

Detection

AMD is detected during a comprehensive eye exam that includes:

Visual acuity test. This eye chart test measures how well you see at various distances.
Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of AMD and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional also may do other tests to learn more about the structure and health of your eye.

During an eye exam, you may be asked to look at an Amsler grid. The pattern of the grid resembles a checkerboard. You will cover one eye and stare at a black dot in the center of the grid. While staring at the dot, you may notice that the straight lines in the pattern appear wavy. You may notice that some of the lines are missing. These may be signs of AMD.

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Know Your Risk Factors

AMD can occur during middle age. The risk increases with aging. Other risk factors include:

Smoking.
Obesity. Research studies suggest a link between obesity and the progression of early and intermediate stage AMD to advanced AMD.
Race. Caucasians are much more likely to lose vision from AMD than African Americans.
Family history. People with a family history of AMD are at higher risk of getting the disease.
Gender. Women appear to be at greater risk than men for AMD.
People who have advanced AMD in one eye are at especially high risk of developing advanced AMD in the other eye.

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Manage Your Risk Factors

Your lifestyle can play a role in reducing your risk of developing AMD.

Eat a healthy diet high in green leafy vegetables and fish.
Don't smoke.
Maintain normal blood pressure.
Watch your weight.
Exercise.

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Work with Your Doctor

You can protect yourself against vision loss by working in partnership with your eye care professional.

Dry AMD.
If you have dry AMD, you should have a comprehensive dilated eye exam at least once a year. Your eye care professional can monitor your condition and check for other eye diseases.

Because dry AMD can turn into wet AMD at any time, you should get an Amsler grid from your eye care professional. Use the grid every day to evaluate your vision for signs of wet AMD. This quick test works best for people who still have good central vision. Check each eye separately. Cover one eye and look at the grid. Then cover your other eye and look at the grid. If you detect any changes in the appearance of this grid or in your everyday vision while reading the newspaper or watching television, get a comprehensive dilated eye exam.

Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, treatment can delay and possibly prevent intermediate AMD from progressing to the advanced stage, in which vision loss occurs.

Wet AMD.
If you have wet AMD and your doctor advises treatment, do not wait. After laser surgery or photodynamic therapy, you will need frequent eye exams to detect any recurrence of leaking blood vessels. Studies show that people who smoke have a greater risk of recurrence than those who don't. In addition, check your vision at home with the Amsler grid.

If you detect any changes, schedule an eye exam immediately.

Ask questions and get the information you need to take care of yourself and your family.

Here are some questions to ask your eye doctor:

About your eye disease or disorder:

What is my diagnosis?

What caused my condition?

Can my condition be treated?

How will this condition affect my vision now and in the future?

Should I watch for any particular symptoms and notify you if they occur?

Should I make any lifestyle changes?

About your treatment:

What is the treatment for my condition?

When will the treatment start and how long will it last?

What are the benefits of this treatment and how successful is it?

What are the risks and side effects associated with this treatment?

Are there foods, drugs, or activities I should avoid while I'm on this treatment?

If my treatment includes taking medicine, what should I do if I miss a dose?

Are other treatments available?

About your tests:

What kinds of tests will I have?

What can I expect to find out from these tests?

When will I know the results?

Do I have to do anything special to prepare for any of the tests?

Do these tests have any side effects or risks?

Will I need more tests later?

Other suggestions:

If you don't understand your eye care professional's responses, ask questions until you do understand.

Take notes or get a friend or family member to take notes for you. Or, bring a tape recorder to help you remember the discussion.

Ask your eye care professional to write down his or her instructions to you.

Ask your eye care professional for printed material about your condition.

If you still have trouble understanding your eye care professional's answers, ask where you can go for more information.

Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too.

Today, patients take an active role in their health care. Be active in your eye care.

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