Evidence Based

Diabetic Diseases of the Eye

Eye health is one of the biggest concerns for people with diabetes. The most common health issues affecting the vision of diabetics include:

  • Retinopathy
  • Macular edema
  • Cataracts
  • Glaucoma

Left unmanaged, diabetes can ravage eye health but it doesn’t have to. It’s possible to take steps to protect your vision even after you have diabetes.

What is Diabetic Retinopathy?

Diabetic retinopathy, one of the biggest health concerns for people with diabetes, causes damage to retinal blood vessels in the eyes. There are usually no symptoms in the early stages of diabetic retinopathy, but unmanaged it can eventually lead to blindness. 

Diabetic Retinopathy

Diabetic retinopathy is a risk for anyone with type 1 or type 2 diabetes. 

There are two types of diabetic retinopathy:

Early or Non-Proliferative Diabetic Retinopathy

This is the most common form of the disease. Instead of new blood vessels forming, the existing blood vessels in the retina grow weak and leak fluid and blood into the retina. Swelling and dilation of the blood vessels might also occur. This form of diabetic retinopathy can range from mild to severe. 


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Advanced or Proliferative Diabetic Retinopathy

Over time, diabetic retinopathy leads to the proliferation of new blood vessels. These poorly formed blood vessels are prone to leakage and eventually, scar tissue will begin to grow. Advanced diabetic retinopathy increases a person’s risk for retinal detachment.

Causes & Symptoms of Diabetic Retinopathy

Diabetic retinopathy is caused by too much sugar in a person’s blood which leads to weakening and blockage of the blood vessels that nourish the retina. Over time, the eye tries to grow new blood vessels, which tend to be poorly developed and prone to leaking.

There might not be any symptoms in the earliest stages of diabetic retinopathy. As the condition progresses, you’ll experience:

  • Floaters (spots or strings you see floating in your field of vision that aren’t there)
  • Blurry vision
  • Impaired color vision
  • Dark or empty spots in your field of vision
  • Vision loss

During a medical exam for diabetic eye health or diabetic retinopathy, your doctor will look for:

  • Growth of abnormal blood vessels
  • Fatty deposits or any swelling in the retina
  • Scar tissue
  • Bleeding in the retina or into the vitreous
  • Abnormalities in your optic nerve
  • Retinal detachment

Other Conditions Associated with Diabetic Retinopathy

There are several other eye health issues linked to diabetic retinopathy, including:

Neovascular Glaucoma

Neovascular glaucoma causes the angle of the eye between the iris and the cornea to close due to the formation of new blood vessels.  

Retinal Detachment

Retinal detachment is an eye health emergency in which the retina (the thin layer of tissue at the back of the eye) detaches from where it should be. This causes the retinal cells to separate from the blood vessels that provide oxygen and nourishment. Left untreated, even for a short time, can cause blindness. 

Symptoms of retinal detachment include:

  • Floaters
  • Flashing
  • Reduced vision
  • Shadows or curtains over your vision

Diabetic macular edema (DME)

Diabetic macular edema (DME) occurs when the macula of the eye swells due to fluid accumulation. The macula contains cells that provide sharp, straight-ahead vision. You might notice issues with reading or driving if you are developing DME. Other symptoms include blurry vision and distortion in the vision.

Who Is At Risk of Developing a Diabetic Eye Disease?

Anyone with diabetes is at risk of developing eye problems. However, some factors increase the risk of vision problems, including:

  • Duration of the disease – over time the risk of eye health problems increase for people with diabetes
  • Unmanaged blood sugar levels
  • Elevated blood pressure
  • Elevated cholesterol levels
  • Tobacco use
  • Pregnancy
  • African-American, Hispanic, or Native American heritage

Preventing Diabetic Retinopathy

For some people, it’s difficult to prevent diabetic retinopathy once they’ve developed type 2 diabetes. For type 1 diabetics, it might be entirely unavoidable.

However, it’s still important to do all you can to reduce your risk of this complication. You can do so by:

  • Undergoing regular vision and eye health exams
  • Controlling your blood sugar levels
  • Keeping your blood pressure lower
  • Taking proactive steps if you notice any vision problem
  • Quit smoking
  • Undergo a glycosylated hemoglobin (hemoglobin A1C) test, which estimates your risk for complications based on your recent blood sugar levels

Treatment for Diabetic Retinopathy

There are some treatment options available once diabetic retinopathy develops. Treatment depends on the severity and progression of the condition, so it’s important to seek a medical evaluation as soon as you notice symptoms. 

In its earliest stages, treatment might not be necessary. You can work with your eye doctor to best manage your blood sugar levels to reduce your risk for the progression of vision problems. Managing diabetes is the best way to slow the progression of diabetic retinopathy. You’ll also want to make regular eye exams a priority.

Treatment options available for more advanced cases of diabetic retinopathy include:

Photocoagulation or Focal Laser Treatment

This is a laser treatment that seals blood vessel leaks so the liquid is slowed or stopped from seeping into the eye. It might not return your vision to normal, but it can reduce the risk of worsening macular edema. Anti-VEGF therapy has replaced focal laser as the primary treatment for diabetic macular edema.

Panretinal Photocoagulation or Scatter Laser Treatment

Also a laser treatment, this procedure shrinks abnormal blood vessels. It might result in a loss of some peripheral or night vision, but it slows or stops the damage caused by abnormal blood vessels.

Vitrectomy

This procedure removes blood and scar tissue from the middle of the eye through a small incision. 

Medication

Vascular endothelial growth factor (VEGF) inhibitors can be injected directly into the eye to prevent the growth of abnormal blood vessels. Growth inhibitor medication can be used alone or in combination with other treatments. 

Surgery 

Vitrectomy surgery might be an option to slow or stop the progression of diabetic retinopathy. Surgery is not a cure and follow-up treatment is usually needed. 


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