Your Guide to Diabetic Retinopathy

Transcription

1 Your Guide to Diabetic Retiopathy

2 2 Welcome Welcome to Your Guide to Diabetic Retiopathy, a helpful ew resource desiged to give you a better uderstadig of diabetic retiopathy what it is, how it s diagosed, how it ca be treated, as well as how you ca reduce your risk of developig diabetic retiopathy if you have t already bee diagosed. This guide also provides helpful iformatio ad tips to assist you i maagig your diabetes if you ve experieced visio loss. Just as importatly, this guide is desiged to show you that if you ve experieced visio loss, you re ot aloe. CNIB has a rage of services available to help you adjust to visio loss ad lead a full, idepedet life. Lear more olie I additio to this guide, we ve also developed a comprehesive web portal to support you as you adapt to diabetic retiopathy ad discover that a fulfillig, idepedet life is absolutely withi your reach. At cib.ca/dr, you ll fid the iformatio you eed to uderstad your coditio, the skills to live idepedetly ad the cofidece to keep doig the thigs you love. You ll also get more iformatio about how others with diabetic retiopathy have overcome the challeges of sight loss, how to fid helpful CNIB services i your area ad how to get the most out of your remaiig visio. Visit us today at cib.ca/dr. Help is just a click away.

3 3 What is Diabetic Retiopathy? Affectig 500,000 Caadias, diabetic retiopathy is a eye coditio where elevated blood sugar levels cause blood vessels i the eye to swell ad leak i the retia. Normal Visio* Without treatmet, the coditio ca result i ucorrectable visio loss or eve blidess. But with regular, comprehesive eye exams by a eye doctor, diabetic retiopathy ca be detected early ad treated. Visio with Diabetic Retiopathy* Did you kow? Diabetic retiopathy is the leadig cause of blidess ad partial sightedess i Caadias uder the age of 50. Nearly all patiets with Type 1 diabetes ad 60 percet of those with Type 2 diabetes develop some form of diabetic retiopathy i the first 20 years after the oset of diabetes.

4 4 Types of Diabetic Retiopathy There are four stages of diabetic retiopathy, ragig from mild to severe: Stage 1: Mild o-proliferative retiopathy Tiy blood vessels swell i the retia, which may cause some early leakage. Stage 2: Moderate o-proliferative retiopathy Some blood vessels that feed the retia become leaky or blocked. Stage 3: Severe o-proliferative retiopathy More blood vessels are beig blocked ad other areas of the retia are affected as a result. Stage 4: Proliferative retiopathy New abormal blood vessels grow alog the retia ad the clear, vitreous gel iside the eye. These vessels have thi, fragile walls that leak easily, causig blurred visio, severe visio loss or blidess. Visio loss ca occur quickly at this stage. Macular edema where blood ad fluid leaks ito the macula may also occur at ay stage, causig visio loss i the cetral retia. The Huma Eye

5 5 Symptoms I the early stages of diabetic retiopathy, there are ofte o symptoms ad your visio may ot be affected. People with proliferative retiopathy or macular edema may experiece visio loss whe blood from leakig blood vessels blocks the field of visio. At this stage, it s still possible to have o oticeable symptoms, or for symptoms to occur suddely ad without apparet warig. That s why it s critical for people livig with diabetes to see their eye doctor regularly for comprehesive eye exams. The earlier diabetic retiopathy is detected, the better the chace that it ca be effectively treated ad further visio loss preveted. Visit your eye doctor right away if you otice: Dark spots i your visual field. Blurred, distorted or double visio. Large floaters specks i the form of dots, circles, lies or cobwebs that move across your field of visio. It s critical for people livig with diabetes to see their eye doctor regularly for comprehesive eye exams.

6 6 Prevetio ad Risk Factors Everyoe with diabetes is at risk of developig diabetic retiopathy, but there are certai factors that icrease this risk. Some of these risk factors ca be cotrolled, but others ca t. Ucotrollable risk factors: Type of diabetes: People with Type 1 diabetes are more likely to experiece visio loss sooer. Ethicity: Aborigial Caadias are three to five times more likely tha the geeral populatio to develop Type 2 diabetes, placig them at a much higher risk of developig visio problems related to diabetes. Cotrollable risk factors: High blood sugar: Target rages for blood sugar levels vary depedig o age, medical coditio ad other risk factors. Ask your doctor or diabetes educator what your levels should be. Smokig: Whe you have diabetes, smokig icreases your risk of visio loss, it also icreases blood pressure ad blood sugar levels, makig it harder to cotrol diabetes. High blood pressure ad cholesterol: If you have diabetes ad you also have high blood pressure ad/or high lipid (fat) levels, you re more likely to develop diabetic retiopathy. People with Type 1 Diabetes Aborigial Caadias People with High Blood Sugar People who Smoke People with High Blood Pressure & Cholesterol High Risk Groups

7 7 Reducig Your Risk Fortuately, there are ways that people livig with diabetes ca proactively reduce their risk of experiecig visio loss due to diabetic retiopathy. Maitaiig blood sugar levels Blood sugar levels are measured with a blood sugar moitor. Your diabetes educator ca help determie which moitor is right for you ad provide you with traiig o how to use it. Maitaiig a proper diet ad exercisig regularly also helps achieve target blood sugar levels. edocriologist about referrig you to a registered dietitia ad diabetes educatio program for healthy eatig support. Physical activity Stayig active with aerobic exercise (like walkig or cyclig) ad weight traiig ca reduce your risk of developig complicatios from diabetes. Exercise ca affect blood sugar ad sesitivity to isuli so make sure to speak with your doctor before begiig ay type of exercise program. optios that may prevet future visio loss. Your eye doctor will recommed how ofte you should have your eyes checked. Healthy eatig A balaced meal pla typically icludes three meals per day at regular times (spaced o more tha six hours apart) ad healthy sacks. Limit sugars ad high-fat foods, ad eat more high-fibre foods. Talk to your family doctor or Regular eye exams It s importat for people with diabetes to have their eyes examied regularly. With regular eye exams, your eye doctor ca provide you with a early diagosis if you have diabetic retiopathy, as well as treatmet

8 8 Visitig Your Eye Doctor If you do t already visit a eye doctor regularly, make a appoitmet immediately with a optometrist to have your eyes tested for ay sigs of eye disease, icludig diabetic retiopathy. Depedig o your visio health history, risk factors ad symptoms, your optometrist may refer you to a ophthalmologist or retial specialist for further medical care. Whe bookig your appoitmet with a eye doctor: Ask if your visio will be temporarily affected by ay tests. Ask if your provice s health pla or private isurace will cover the cost of the exam. Before a eye exam, make otes about: Ay problems you ve oticed with your visio. For example, blurred visio, dark spots or floaters i your visual field. Ay recet eye ijuries or eye surgeries you ve had. Iclude dates, doctors ames ad the ames of hospitals where you were treated. All curret ad previous sigificat medical coditios or operatios you ve had, whether they relate to your visio or ot. Do t forget to iclude ay diagosed eye coditios (glaucoma, blood pressure or chroic health problems. Your family s curret ad previous history of sigificat medical coditios. Whe you get to the exam, brig the followig with you: Your otes from above. Your glasses, cotact leses, sample bottles of your curret prescriptio ad over-the-couter medicatios, ad your health isurace card. Ay low visio aids or devices that you ve bee usig (magifiers, readig glasses, etc.). Do t have a eye doctor? Visit cib.ca/fidaoptometrist or call the CNIB Helplie at to fid oe i your area today.

9 9 Diagostic Tests Your eye doctor might wat to coduct oe or more of the followig tests to diagose diabetic retiopathy: Visual acuity test: This is the stadard measuremet of a perso s ability to see, usig a eye chart. Dilated eye exam: I this test, drops are placed i the eye to wide (dilate) the pupils to allow a direct view of the iside of your eye, icludig the retia. This test may temporarily blur your visio for oe to two hours, so you will wat to brig a fried or family member with you to help you get home. Toometry: This is a test that measures pressure iside the eye. Optical coherece tomography (OCT): I this test, a diagostic imagig device is used to detect retial disease. Fudus photography: This test ivolves takig colour photographs of both the cetral ad peripheral retia, which allows your eye doctor to moitor chages i your retia ad documet the extet ad stage of ay diabetic retiopathy. Fluorescei agiogram: Your optometrist may refer you to a ophthalmologist for this test, where a dye is ijected ito a vei ad the circulated withi the eye. Photographs are the take of ay abormal blood vessels.

10 10 If You ve Bee Diagosed with Diabetic Retiopathy take heart. You may be feelig overwhelmed or afraid, but kowledge is your best tool to help you overcome those feeligs ad take a active role i maagig your diabetic retiopathy i the future. Questios for your eye doctor If you ve recetly developed diabetic retiopathy, uderstadig what s happeig to your visio will help you make cofidet, iformed decisios as you move forward. Sit dow with your eye doctor ad have a ope coversatio about how diabetic retiopathy is affectig your eyes ad what you ca do to help preserve or make the most of your remaiig sight. The followig questios may help you start that coversatio: What is my exact diagosis? What are the risks ad side effects? What is the typical progressio for someoe with this disease? Do you kow how my visio will be affected i the ear ad distat future? Do you kow if my visio will get worse? Are there ay sigs or symptoms that I should watch for ad otify you about? How ofte should I get my eyes examied? If my diabetic retiopathy ca be treated, what are your recommedatios, the risks, beefits ad costs ivolved? What ca I do to protect or prolog my visio? Ca I make ay lifestyle chages to try to prevet further visio loss?

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12 12 Treatmet Although lost visio from diabetic retiopathy ca t be restored, early treatmet is ofte successful ad ca prevet visio from gettig worse. Treatmet optios for proliferative retiopathy ad macular edema are described below. Discuss your optios with your eye doctor to determie which is right for you. Scatter laser treatmet: This treatmet uses a large umber of microscopic thermal laser burs i the retia to shrik abormal blood vessels. Vitrectomy: If blood has leaked ito the cetre of the eye, the vitreous gel must be removed. A tiy icisio is made i the eye, ad the vitreous gel is replaced with a salt solutio that mimics the ormal fluids of the eye. Itraocular (ati-vegf) ijectios: I this treatmet, ati-agiogeic drugs are ijected ito your eyes, sometimes for two years or loger, to stop the growth of abormal blood vessels ad treat macular edema. The oly ati-agiogeic therapy approved by Health Caada for the treatmet of macular edema associated with diabetic retiopathy is Raibizumab (Lucetis).

13 New treatmets for diabetic retiopathy are costatly evolvig so it s importat to cosult regularly with a eye doctor ad visit cib.ca/dr. 13 Macular edema is treated by: Focal laser treatmet: I this treatmet, microscopic thermal laser burs are made aroud the macula, which slows the leakig from the blood vessels. This treatmet ca reduce the risk of further visio loss by 50 per cet ad may improve visio for a small umber of people. Itraocular ati-iflammatory ijectios: This short procedure ivolves a ijectio used to reduce iflammatio iside the eye. I some severe cases, several treatmets may be required. Side effects may iclude the developmet of cataracts or glaucoma. I the more advaced stages of diabetic retiopathy, other eye complicatios, such as a retial detachmet, may eed to be treated.

14 14 Maagig Diabetes with Visio Loss The oset of visio loss may make it more challegig for you to maage your diabetes, but your health care team ad CNIB are here to help you lear ew ways of adjustig to ad maagig diabetes with visio loss. Testig blood sugar levels Blood sugar testig is doe with a small portable device called a blood sugar moitor. Regular blood sugar testig helps you to kow if your blood sugar is at target. If you re uable to see well eough to read a moitor or measure dosages, testig your blood sugar ad takig medicatio or isuli ca be challegig. Your family doctor, diabetes educator ad local CNIB specialist ca support you with techiques for maagig your diabetes effectively. Talkig blood sugar moitors (glucometers) Your diabetes educator ad CNIB ca also show you how to use a talkig blood sugar moitor, which lets you hear as well as see your sugar levels. For more iformatio o talkig glucometers, visit the Caadia Diabetes Associatio website at diabetes.ca. Adaptive techiques for maagig your diabetes Lightig: You may fid it helpful to brig a light closer to your blood glucose moitor (a headlamp or illumiated magifier) or brig the moitor closer to the light (a adjustable task lamp) i order to better see what you re doig. Orgaizatio: Checkig your blood sugar withi a cofied space with oly essetial moitorig supplies ca make orgaizatio much easier. A tray with a lip to hold moitorig equipmet ca also make it easier to locate items ad prevet items from scatterig. Tactile cues: Havig otched, cut-out, raised or recessed areas o your blood sugar moitor ca help you with orietatio ad placemet. If you re havig trouble

15 15 Resources Maagig diabetes with visio loss Prevetio ad reducig risk with sesatio i your figers, brigig your figer to your lip to search for the sesatio of wetess ca help you locate the blood sample o your figer. Ladmarks: Usig ladmarks o your figertip such as the top, middle ad bottom of the figerail ad the first joit of the figer may help you locate the blood sample more easily. Writig aids: If you have low visio, thick-lie or large-prit paper ad fibre tip pes (gel pes, 20/20 pes, Sharpie pes) are just a few of the writig aids you ca use to help keep track of your blood sugar. For more iformatio o writig aids, visit the CNIB olie store at cib.ca/shop. Maagig medicatios: Oral medicatios are ofte prescribed to help maage diabetes. Take them as directed by your doctor ad talk with your diabetes educator to esure proper maagemet is i place. A CNIB specialist ca help you idetify ad mark your medicatios with high-cotrast or tactile markigs. Takig isuli: If you have Type 1 diabetes, or if you have Type 2 diabetes ad your blood sugar levels ca t be kept at target with diet, exercise ad oral medicatios, it may be ecessary to take isuli. A CNIB specialist ca work with your diabetes educator to determie the adaptive techiques that will best help you to take your isuli. Foot care: Diabetes ca lead to reduced sesatio i the feet, ad visio loss may prevet you from feelig or oticig blisters or cuts that, if utreated, ca become ifected ad lead to serious complicatios. It s importat for you or someoe else to examie your feet daily, ad to have your feet checked regularly by your health care provider. For a detailed daily foot care regime ad more iformatio o adaptive techiques for maagig diabetes, visit cib.ca/dr.

16 16 Livig with Diabetic Retiopathy The life you wat is still i sight For may people, adjustig to visio loss ca be extremely challegig, ad it s ot ucommo to feel scared or overwhelmed after beig diagosed with a eye disease. But there is help available to you. You do t have to be totally blid to come to CNIB for support (i fact, ie out of 10 people we help have some degree of visio), ad you do t eed a referral of ay kid. How CNIB ca help you If you ve experieced a loss of sight because of diabetic retiopathy or for ay other reaso the CNIB team is always here to help. Our commuity-based services ca help you build the skills ad cofidece to lead a full, active life with visio loss. Our carig specialists will speak to you about your specific challeges ad eeds, ad develop a pla to get you back o the road to idepedece whether that meas learig to cook agai after a loss of visio, beig able to read the ewspaper agai, travellig with cofidece, or gettig the emotioal support you eed to move forward. If you eed us, all you have to do is call the toll-free CNIB Helplie at or visit cib.ca. Adjustig to visio loss If you re livig with visio loss, CNIB s services ca teach you ew ways to perform your daily activities idepedetly ad with cofidece, from learig how to do commo household tasks to gettig aroud safely at home, at work or i your commuity. Maitaiig your love of readig Home to more tha 80,000 accessible materials i formats like braille ad audio, the CNIB Library is Caada s largest library for people who are uable to read traditioal prit. If you d like help fidig a book, movie or other library material, call or library@cib.ca.

17 17 Livig idepedetly with low visio If you ve experieced a partial loss of visio, learig to maximize your remaiig sight ca be life-chagig. Our low visio specialists ca give you a specialized visio assessmet, teach you to use helpful tools, ad show you special tricks ad techiques to make the most of your remaiig sight. Coectig with people who uderstad Adaptig to life with visio loss ca be challegig, but peer support ca help you build friedships ad share experieces with other people who uderstad the impact of visio loss o everyday life. If you feel that you or your family could beefit from additioal support, speak to your doctor about beig referred to a cousellor, therapist or psychologist. Accessig support ad iformatio for family ad frieds Watchig a loved oe experiece visio loss ca be very difficult for frieds ad family members as well, but there is help available. Call the CNIB Helplie at to lear more.

18 18 Services for Québec Residets I Québec, may vital services for people livig with visio loss - such as mobility ad life skills traiig - are fuded by the provicial govermet ad available through a etwork of locally-based agecies ad rehabilitatio cetres. If you ve experieced a loss of sight, our carig specialists ca help you lear to avigate Québec s health care system ad refer you to rehabilitatio services i your commuity. Ad to complemet those services, CNIB offers other helpful forms of support to make life with visio loss easier, icludig: Telephoe couselig ad peer support Specialized computer traiig for people who are blid or partially sighted Access to the CNIB Library ad its biligual collectio A wide rage of iovative assistive products Call the CNIB Helplie at or visit cib.ca to lear more about the support services available to you. CNIB helps people i every provice across Caada, ad we deliver our services right where you eed them over the phoe, olie, or i your ow home, commuity or local CNIB office.

19 19 CNIB Resources Olie CNIB s Eye Coect: Diabetic retiopathy olie portal - cib.ca/dr CNIB s mai website, where you ll fid visio health publicatios, forums with experts, blogs, ews, support - cib.ca The CNIB Library, home to more tha 80,000 books, magazies, ewspapers ad other materials i alterative formats like braille ad audio - ciblibrary.ca The CNIB olie store, offerig hudreds of products that ca make life with visio loss easier - cib.ca/shop Disclaimer The cotet of this guide is for iformatioal purposes oly ad is ot iteded to be a substitute for professioal medical advice, diagosis or treatmet. Always see the advice of your doctor or aother qualified health provider with ay questios you may have regardig a medical coditio.

20 This resource has bee made possible through a fiacial cotributio from the Public Health Agecy of Caada. The views expressed herei do ot ecessarily represet the views of the Public Health Agecy of Caada. CNIB Helplie: cib.ca Charitable Registratio #: RR0003