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Diabetes and Your Eyes

Diabetes has become much more common.  According to the International Diabetes Federation, in 2017, approximately 425 million adults live with diabetes and 352 million more are at risk of developing type 2 diabetes. By 2045 the number of people diagnosed will  rise to 629 million.

Diabetes is a leading cause of blindness as well as heart attacks, stroke, kidney failure, neuropathy (nerve damage) and lower limb amputation. In 2017, diabetes caused in 4 million deaths worldwide. Important factors in preventing complications due to diabetes include improving one's diet, physical activity and adopting a healthy lifestyle, regular medical examinations and treatment with medication when needed.

What is Diabetes?

Diabetes is a chronic (long term) disease in which there is not enough of the hormone insulin, or the insulin is not effective in being able to regulate blood sugar. When diabetes is not controlled, it leads to high blood sugar (hyperglycemia), and that is what causes the damage to many systems in the body such as the blood vessels and the nervous system.

How Does Diabetes Affect The Eyes?

Diabetic eye disease is a group of conditions which are caused, or made worse by diabetes.  This includes

  • diabetic retinopathy,
  • diabetic macular edema,
  • glaucoma and
  • cataracts.

Diabetes increases the risk of cataracts by 4 times.  It can increase dryness and reduce cornea sensation.

In diabetic retinopathy, the tiny blood vessels within the eyes become damaged.  Blood begin to leak out, and there is less oxygen circulation.  This then causes scarring of the sensitive tissue in the retina, and that then causes further cell damage and scarring.

The longer you have diabetes, and the longer your blood sugar levels remain uncontrolled, the higher the chances of developing diabetic eye disease. Diabetic eye disease is one of the main causes of vision loss in even those that are younger and are working-age.   Diabetes is not only an "older person's" problem.  These eye conditions can lead to blindness if not identified early and treated. In fact, 2.6% of blindness worldwide is due to diabetes.

Diabetic Retinopathy

As mentioned above, diabetes can result in cumulative damage to the blood vessels in the retina, the light-sensitive tissue located at the back of the eye. This is called diabetic retinopathy.

The retina is responsible for converting the light that comes in, into visual signals and sends it through the optic nerve into the brain. High blood sugar levels can cause the blood vessels in the retina to leak or hemorrhage, causing bleeding and distorting vision. In advanced stages, new blood vessels may begin to grow on the retinal surface causing scarring and further damaging cells in the retina. Diabetic retinopathy can eventually lead to blindness.

Signs and Symptoms of Diabetic Retinopathy

The early stages of diabetic retinopathy often have no symptoms.  This is why it is so important to have frequent diabetic eye exams. As it progresses you may start to notice the following symptoms:

  • Blurred or fluctuating vision or vision loss
  • Floaters (dark spots or strings that appear to float in your visual field)
  • Blind spots
  • Color vision loss

There is no pain associated with diabetic retinopathy to tell you that there is an issues. If not controlled, as retinopathy continues it can cause retinal detachment and macular edema, two other serious conditions that threaten vision. Again, there are often NO signs or symptoms until more advanced stages.

A person with diabetes can do their part to control their blood sugar level and slow the progression of diabetic retinopathy. How?  By following the physician’s medication plan, adhering to a diet, and exercising.

Retinal Detachment

A retinal detachment is when the retina pulls away from the tissue that is under it.  It can occur because of the scar tissue caused by the breaking and forming of blood vessels in advanced retinopathy.  This condition is a medical emergency and must be treated immediately. It can lead to permanent vision loss. Signs of a retinal detachment include a sudden onset of floaters or flashes in the vision.

Diabetic Macular Edema (DME)

The macula is the part of the retina responsible for clear central vision.  Diabetic macular edema occurs when the macula becomes full of fluid (edema). It is a complication of diabetic retinopathy that occurs in about half of patients, and it causes vision loss.

Treatment for Diabetic Retinopathy and Diabetic Macular Edema

Once there is vision loss, it often can't be restored.  That is why early detection is so important.  Proliferative diabetic retinopathy (when the blood vessels begin to grow abnormally) can be treated by laser surgery, injections or a procedure called vitrectomy in which the vitreous gel in the center of the eye is removed and replaced. This will treat bleeding caused by ruptured blood vessels. DME can be treated with injection therapy, laser surgery or corticosteroids.

Prevent Vision Loss from Diabetes

The best way to prevent vision loss from diabetic eye disease is early detection and treatment. There are often no symptoms in the early stages and therefore regular diabetic eye exams are critical for early diagnosis.  This is why it is so important to have regular eye exams.  Keeping diabetes under control through exercise, diet, medication and regular screenings will help to reduce the chances of vision loss and blindness from diabetes.  Your medical insurance wants to keep you healthy and reduce the many complications due to diabetes.  This then costs your medical insurance less. You need to do your part. Medical insurance monitor if patients have their eyes checked regularly.  If not, it can affect your health insurance premium rates.