Diabetes is the leading cause of new blindness among working age Americans. The most common cause of this vision loss is "diabetic retinopathy." Diabetic retinopathy occurs when the disease damages the very delicate blood vessels that supply the eye's retina and also reduces the amount of oxygen the blood within these vessels is able to supply. This problem will, to some degree, affect virtually every diabetic at some time during the course of his or her life. It is generally accepted that diabetic retinopathy is more likely to be present the longer an individual has been diabetic.

There are two types of diabetic retinopathy. The most common variety, and fortunately the least damaging, is called "non proliferative (background) retinopathy." This is generally the earliest form of diabetic retinopathy and causes vessels within the retina to leak. These leaks are usually small and self contained and unless they leak directly into the area of central vision (macula), eyesight is not likely to be affected. When the "macula" is involved eyesight may, to varying degrees, become blurred requiring special testing (fluorescein angiography) and laser treatment. This type of problem may resolve partially or completely on its own or may necessitate treatment with a laser to limit the damage. This type of problem may leave central vision permanently decreased but only rarely is the loss severe.

"Proliferative diabetic retinopathy" is a very serious condition with a potentially devastating impact upon vision. At this point the diabetes has affected the quality of the body's blood flow resulting in poor circulation within the eye. Being deprived of a normal oxygen supply the eye tries to help itself by growing new vessels on the retina. Unfortunately, these new vessels are extremely fragile and readily bleed into the rest of the eye. Depending on how much bleeding occurs the individual may feel like he is looking through a dark haze or may even be left with no useful eyesight. If untreated, certain cases may even progress to the formation of scar tissue within the eye leading to detachment of the retina. It is not uncommon to find that the only opportunity for improvement is offered by surgery (vitrectomy).

Fortunately, it has been found through impressive national studies that timely laser treatment for both forms of diabetic retinopathy can prevent serious vision loss for the large majority of diabetics. With "non proliferative retinopathy" laser treatment can seal small leaks which threaten central vision. Regular eye examinations can usually determine whether the eye appears likely to develop "proliferative retinopathy" at which time appropriate laser treatment may prevent the ominous changes described above.

The important thing for all diabetics to remember is that early diagnosis and treatment of retinal problems is their best chance to prevent significant visual problems. Treatment for such problems is best provided by retinal specialists who, having received extensive specialized training in diseases of the retina, generally treat only patients with such problems.

Routine eye examinations for diabetics are the "key" to such success. Diabetics who do not seek care until they actually suffer vision problems have likely experiencing relatively advanced retinal disease. At such times treatment becomes more difficult and the likelihood of a satisfactory visual outcome is reduced.