Diabetes Complications

Blurry Vision and Diabetes: What’s the Connection?

Diabetes mellitus is a dysfunction where the body does not produce insulin or cannot use what it makes.

When any of these things happen, the body cannot get sugar from the blood into the cells. That leads to high blood sugar levels. 

Uncontrolled diabetes can result in several complications, including affecting eye sight. Over time, diabetes can cause damage to your eyes that can lead to poor vision or even blindness.

Diabetes and blurred vision: Causes

Fluid leaking into your eyes is what causes diabetic blurry vision. As your lens swells, it changes shape, making vision skewed.

At first, it may be hard for your eyes to focus, then items in your vision appear blurry. The loss of sharpness of vision is a cause for concern.

It can happen in one eye or both. It is often one of the first signs of elevated blood sugar and further eye issues. If it occurs, this is cause to call your physician.

Hypoglycemia

Visual disturbances can also occur in individuals with diabetes during hypoglycemia. Decreases in blood glucose levels have been associated with diplopia, dimness of vision, blurred vision, and loss of contrast sensitivity.1 Visual disturbance can occur in both people with and without diabetes when in a hypoglycemic state. The degree of disruption is greater in the group with diabetes.1

Neuropathy

Neuropathy can cause numbness and tingle in your feet. When excess blood sugar circulates in your system, blood vessels become weakened. They may rupture and bleed into the surrounding areas. As this continues, eye disease develops. A diabetic eye disease is a group of concerns that can lead to poor vision and blindness. Here we will learn about the group of diseases.

Diabetic retinopathy

According to the CDC’s s National Diabetes Statistics Report: “About one in three people with diabetes who are older than age 40, already have some signs of diabetic retinopathy” 7. It is the most common eye disease among diabetics. In diabetic retinopathy (DR), swelling of the eye occurs due to elevated blood sugar levels.

The swelling is also known as macular edema. People will often experience eye floaters or black spots in their line of vision. Also experienced is Difficulty perceiving colors. In Diabetic retinopathy, there is also a distorted vision. In severe casesabnormal blood vessels form and spread over the retina’s surface. This causes the loss of cells and even scarring. 

The occurrence of blindness is increasing.” “The number of persons with visual impairment due to DR worldwide is rising and represents an increasing proportion of all blindness.”4 Retinopathy is a very common diabetes complication. It is the leading cause of blindness in American adults. Prompt diagnosis and treatment can reduce the chance of blindness by more than 90 percent.5

High blood sugar

Over time, high blood sugar levels and high blood pressure can damage small blood vessels in the retina (the light-sensitive layer at the back of the eyeball). New blood vessels can develop, but they do not grow well and leak, causing vision loss. It usually affects both eyes. If left untreated, the pulling can cause retinal detachment and blindness.7

Cataracts

People of all ages with diabetes are at the risk of developing a cataract. Cataracts are the development of a film over the eye that causes clouding. Laser surgery can remove the cataract, restoring a great part of the vision. Diabetics are also more likely to develop glaucoma. This a group of diseases that damage the optic nerve. 

Glaucoma

Glaucoma is a progressive optic disease caused by high pressure in the eyes. The gradual death of retinal cells occurs. This is a type of Optic nerve neuropathy.” This eye disease, which is a leading cause of irreversible blindness worldwide, has generated a major public health problem. Glaucoma is the most common type of glaucoma in a diabetic individual, with nearly 70 million affected worldwide.1

Proliferative diabetic macular degeneration

Proliferative diabetic macular degeneration occurs in the retina. The retina in the back of the eye suffers damaged from high blood sugar levels. The tiny blood vessels located here are delicate and bleed. Bleeding will cause scar tissue that pulls at the retina. If this is not corrected by laser treatment, the result is blindness.

The retina is the only area of the eye that grows new blood vessels. In proliferative retinopathy, cells create a hormone that inhibits new blood vessel growth. Treatment includes laser surgery. During surgery, blood vessels are burned. This improves blood circulation and promotes healthy vessel growth.

Diabetic macular edema

Diabetic macular edema (DME) is a byproduct of diabetic retinopathy. In DME, fluid accumulates in the macula and causes it to swell. The macula is a tiny point at the center of the retina that enables sharp, clear vision. This swelling can affect the sensitive bundle of cells, called the fovea, at the macula’ ss center. The loss of vision resulting from DME can worsen over a span of months, leaving a patient unable to focus.

According to the advocacy organization, Prevent Blindness, as many as 10 percent of people with diabetes will develop DME. People with both Type 1 and Type 2 diabetes are subject to developing DME.7

Symptoms 

Blurry vision can be the first sign that you are experiencing high blood sugar. Some of the other symptoms you may experience include:

  • Increased thirst

  • Fatigue

  • Frequent urination

  • Shortness of breath

  • Nausea and vomiting

  • A very dry mouth

  • Stomach pain

  • Fruity breath odor 

  • A rapid heartbeat

Your kidneys regulate your blood pressure. Eye disease directly correlates to damage to your kidneys. Because of the excess calcium and phosphatase in your system, you may develop dry eye. Controlling these levels helps regulate the moisture in your eyes. 

Dry eye can also result from autonomic neuropathy. The same nerve damage that causes tingling and numbness in the hands and feet can cause damage in the eye. Nerves control the tear duct. When elevated blood sugars persist, tear flow diminishes. Artificial tears in eye drops can lessen the symptoms. 

Diagnosis

dilated eye exam is a simple procedure your eye doctor (ophthalmologist) conducts to check for eye disease. The frequency for the eye exam will depend upon your health history, disease risk, and family medical history. In the procedure, eye drops dilate the eye.

They cause pupils to widen, allowing in more light and giving your doctor a better view of the back of your eye. Early diagnosis can happen in common diseases and conditions. They include:

The exam includes: 

visual acuity test to check how clearly you see. Your doctor will ask you to read letters that are up close and far away.

visual field test to check your peripheral (side) vision. Your doctor will test how well you can see objects off to the sides of your vision without moving your eyes.

An eye muscle function test to check for problems with the muscles around your eyeballs. Your doctor will move an object around and ask you to follow it with your eyes.

pupil response test to check how light enters your eyes. Your doctor will shine a small flashlight into your eyes and check how your pupils react to the light.

tonometry test to measure the pressure in your eyes. Your doctor will use a machine to blow a quick puff of air onto your eye or touch your eye with a special tool. 

Dilation to check for problems with the inner parts of your eye. Your doctor will give you some eye drops to dilate (widen) your pupil. This helps the doctor see inside your eye.5

Treatment

Pan retinal photocoagulation is a laser procedure used to treat proliferative neuropathy. The procedure helps new blood vessel growth and restores color vision.

A study conducted in 2014, published by the Journal of Diabetes Research, also came to a surprising synopsis about diabetic’s post-operative attitudes towards self-care.” “In our study, we came to an interesting observation that previous argon laser photocoagulation in patients with diabetes is positively related to their glycemic control” 6

This led researchers to believe that patients were more likely to keep tighter blood sugar control following a major medical procedure. Other treatment includes the eye drops mentioned above.

When to see a doctor

If you are experiencing the following:

  • Blurred vision

  • Floaters in your eye (black spots blocking your vision)

  • Flashes of light

  • Halos around lights 

If you experience any eye problems, you should consult an ophthalmologist.

Self-management

Diabetic patients are at a disadvantage for disease development. Understanding your risks and taking part in prevention is key.

Self-management means making small sustainable changes that make a positive impact. Be in control of your diabetes and other disease processes by learning self-care skills. Elevated blood sugar levels should be monitored. Further complications like diabetic retinopathy can be reduced with tight control.

To avoid complications from diabetes, it is important to keep your kidneys healthy and avoid nerve damage. Over time, high blood sugar can cause neuropathy throughout your body. 

  • Stay in your target blood sugar range as much as possible, and keep your blood pressure below 140/90 mm Hg 

  • Make sure to take any prescribed medicines as instructed by your doctor.

  • Keep your blood sugar level as close to your target levels as possible.

  • Get regular physical activity.

  • Lose weight if you’re overweight.

  • Limit or avoid alcohol.

  • Stop smoking.

  • Visit your eye doctor for a dilated eye exam at least once a year.

You may not even have any symptoms until you start to lose your vision, so regular eye exams are necessary. The earlier detection and treatment, the better off your eyesight will be.

For better eye health, you can make dietary changes:

  • Eat more fresh fruits and vegetables. Include dark, leafy greens such as spinach, kale, and collard greens. 

  • Increase the amount of Omega-3 fatty acids in your diet. This is effective in increasing the quantity and quality of tears. It will also lower the risk of cardiovascular disease. Foods highest in Omega3’s are salmon, tuna, herring, and nuts.

  • A study published in the Archives of Ophthalmology found an 18 % reduction in the risk of cataracts when foods rich in lutein and zeaxanthin were consumed. These carotenoids are in spinach, kale, turnip greens, collards, broccoli, pumpkin, and corn.2

Conclusion

In public health terms, the primary concern is the prevention of disease before it occurs. Secondary prevention is early detection and management. Rehabilitation is a tertiary step. With an emphasis on the first two, it is less of a financial burden and responsibility on the public as a whole. 

Diabetes self-management skills are important. Keeping track of your blood sugar levels is imperative. When blood glucose readings fall out of your desired range, it is helpful to identify why it may be as such.

As we have learned before in A guide to diabetes Medications, we know that diabetes in itself is a stress to the body. Taking a holistic approach to healthcare that includes stress management is vital. The early diagnosis and treatment of eye conditions is the most significant factor guarding against decreased vision and blindness. Diabetic patients need to have life-long awareness and advocacy skills to work with their health care providers. 

Sources

  1. International Journal of Ophthalmology, 2017. Diabetes and risk of glaucoma: systematic review and a Meta-analysis of prospective cohort studies.
  1. Today’s Dietitian, 2020. Eating for Eye Health. Vol. 11 No. 9 P. 12.
  1. Khan, M., Barlow, R. and Weinstock, R., 2011. Acute hypoglycemia decreases central retinal function in the human eye. Vision Research, 51(14), pp.1623-1626.
  2. Leasher, J., Bourne, R., Flaxman, S., Jonas, J., Keeffe, J., Naidoo, K., Pesudovs, K., Price, H., White, R., Wong, T., Resnikoff, S. and Taylor, H., 2016. Global Estimates on the Number of People Blind or Visually Impaired by Diabetic Retinopathy: A Meta-analysis From 1990 to 2010. Diabetes Care, 39(9), pp.1643-1649.
  1. National Institute of Health, 2020. Get A Dilated Eye Exam
  2. Praidou, A., Androudi, S., Brazitikos, P., Karakiulakis, G., Papakonstantinou, E., Tsinopoulos, I. and Dimitrakos, S., 2014. Diabetic Retinopathy Treated with Laser Photocoagulation and the Indirect Effect on Glycaemic Control. Journal of Diabetes Research, 2014, pp.1-3.
  3. Cdc.gov. 2020. Prevent Complications | Living With Diabetes | Diabetes | CDC. [online] Available at: <https://www.cdc.gov/diabetes/managing/problems.html> [Accessed 7 October 2020].
  4. [1] Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014, 2020. .
  5. Prevent Blindness. 2020. DME – Prevent Blindness. [online] Available at: <https://preventblindness.org/?s=DME> [Accessed 13 October 2020].

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