Diabetic Eye Disease Q & A

How does diabetes damage your eyes?
Diabetes can bring with it a host of health problems, and among other things, it is known to affect our eyes. High blood sugar can lead to problems like blurry vision, cataracts, glaucoma, and retinopathy. In fact, diabetes is the primary cause of blindness in American adults ages 20 to 74. The most common diabetic eye disease is Diabetic Retinopathy, and it is estimated to affect almost 11 million Americans by 2030.

​Diabetic Retinopathy is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (the retina), and can lead to serious vision problems including:
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Vitreous hemorrhage: The new blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision. Vitreous hemorrhage by itself usually doesn't cause permanent vision loss. The blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision may return to its previous clarity.
Retinal detachment: The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in your vision, flashes of light or severe vision loss.
Cataracts: You're more likely to have cataracts, and at a younger age, if you have diabetes. The lens of the eye gets oxygen and glucose from the aqueous humor, which is the fluid that fills the front of the eye. If someone doesn't have control over their glucose levels, such as someone with diabetes, the sugar levels can rise, causing the lens to swell and consequently the early development of cataracts.
Glaucoma:  Having diabetes doubles your odds of glaucoma. New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up. This extra pressure can damage the retina and the optic nerve, the main nerve for sight that carries images from your eye to your brain, causing permanent vision loss.
Blindness: Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.

What are symptoms of diabetic eye diseases?
At first, in the early stages of diabetic eye disease, there may be no symptoms or only mild vision problems. However if gone untreated, eventually diabetic eye disease can cause blindness.
 
As the condition progresses, symptoms may include:
-Spots or dark strings floating in your vision (floaters)
-Blurred vision
-Fluctuating vision
-Impaired color vision
-Dark or empty areas in your vision
-Vision loss  

Should you get yourself screened for diabetic eye disease?
If you are 12 years or older and have been diagnosed with diabetes, it is recommended that you see your eye doctor yearly for an eye exam with dilation (even if your vision seems fine). Diabetic eye disease can develop in anyone who has type 1 or type 2 diabetes. While diabetes doesn't necessarily always lead to vision loss, taking an active role in diabetes management can go a long way toward preventing diabetic retinopathy.
The risk of developing a diabetic eye disease can increase as a result of:
-Duration of diabetes: the longer you have diabetes, the greater your risk of developing diabetic retinopathy
-Poor control of your blood sugar level
-High blood pressure
-High cholesterol
-Pregnancy
-Tobacco use
-Genetics: especially for those of African-American, Hispanic or Native American descent  
 
How are diabetic eye diseases diagnosed?
Diabetic eye disease is best diagnosed with a comprehensive dilated eye exam. For this exam, dilating drops placed in your eyes widen your pupils to allow your doctor to better view inside your eyes to check for any signs of diabetic damage.
During the exam, your eye doctor will look for:
-Abnormal blood vessels
-Swelling, blood or fatty deposits in the retina
-Growth of new blood vessels and scar tissue
-Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous)
-Retinal detachment
-Abnormalities in your optic nerve
In addition, your eye doctor may:
-Test your visual acuity
-Measure your eye pressure to test for glaucoma
-Look for evidence of cataracts
-Request an optical coherence tomography (OCT) test. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. And later, OCT exams can be used to monitor how treatment is working.  

How do you treat diabetic eye diseases?
​Treatment, which depends largely on the type of diabetic eye disease you have and how severe it is, is geared to slowing or stopping progression of the condition. If you have mild or moderate diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment. If you have advanced, or proliferative diabetic retinopathy or macular edema, you'll most likely need prompt surgical treatment by a retina specialist. Depending on the specific problems with your retina, options may include: laser treatments, surgical vitrectomy, injections, intravitreal steroids, and/or other medications.
 
Even after treatment you'll still need regular eye exams. And at some point, additional treatment may be recommended. Surgery often slows or stops the progression of diabetic eye disease, but it's not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible; thus it is imperative to work closely with your ophthalmologist, primary care doctor, and nutritionist to control your diabetes long-term.
 
Can I prevent diabetic eye diseases?
Unfortunately, we can't prevent diabetic eye disease which is why careful management of your diabetes and early intervention is the best way to prevent vision loss.

​If you have diabetes, reduce your risk of getting diabetic eye disease by doing the following:
 
Manage your diabetes: Make healthy eating and physical activity part of your daily routine. Try to get at least 150 minutes of moderate aerobic activity, such as walking, each week. Take oral diabetes medications or insulin as directed.
Monitor your blood sugar level: You may need to check and record your blood sugar level several times a day — more-frequent measurements may be required if you're ill or under stress. Ask your doctor how often you need to test your blood sugar.
Ask your doctor about a glycosylated hemoglobin test: The glycosylated hemoglobin test, or hemoglobin A1C test, reflects your average blood sugar level for the two- to three-month period before the test. For most people, the A1C goal is to be under 7 percent.
Keep your blood pressure and cholesterol under control: Eating healthy foods, exercising regularly and losing excess weight can help. Sometimes medication is needed, too.
If you smoke or use other types of tobacco, ask your doctor to help you quit: Smoking increases your risk of various diabetes complications, including diabetic retinopathy.
Pay attention to vision changes: Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy. Pregnancy may worsen diabetic retinopathy, so if you're pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy.  
 
References:
Ahdieh, H. (2018, October 30). Diabetes And Eye Disease. Retrieved October 22, 2019, from https://www.lvcenter4sight.com/diabetes-and-eye-disease/.
Diabetic retinopathy. (2018, May 30). Retrieved October 22, 2019, from https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611.