Diabetes Complications

Diabetes: Caring For Your Eyes

The eye is a complex organ. Many times, we associate health with general items like physical ability or nutrition.

Rarely considered is eye health. You may expect some vision loss as you age or an occasional eye issue to a certain degree.

Some eye issues are more serious than others and preventable. Here we will discuss why it is crucial to think about eye health at any age. 

Types of eye disease

Cataracts

The development of Cataracts is often associated with aging. Cataracts are the development of a film over the eye that causes clouding. The lens of the eye contains protein and water.

In a healthy eye, the proteins align in a way that allows light to pass through. Healthy eyes send clear communication to the brain for interpretation.

Over time, the proteins become altered. They become grainy or clumpy, and this leads to clouding. The light scatters in the protein web and appears as blurred. Blue light, the light emitted from electronic devices, becomes hard to interpret. It will appear yellowed. Some symptoms of cataracts include:

  • Halos around light

  • Double vision

  • Trouble with night vision

  • Blurry vision

Cataract surgery can remove the cataract, restoring a great part of the vision.

Glaucoma

Glaucoma is a progressive optic nerve neuropathy caused by high pressure in the eyes. Gradual death of retinal cells occurs. This is the primary cause of irreversible blindness worldwide. Glaucoma is the most common type of glaucoma in diabetic individuals, with 70 million affected worldwide.1 The swelling is also known as diabetic macular edema.

While glaucoma isn’t preventable, you can reduce your risk by completing an annual comprehensive eye exam.

Diabetic retinopathy

Diabetic eye disease is a group of concerns that can lead to poor vision and blindness. The leading cause of blindness is Diabetic retinopathy. Prompt diagnosis and treatment can reduce the chance of blindness by more than 90 percent.5

The combination of high blood sugar and high blood pressure can damage tiny blood vessels in the retina. The retina is the light-sensitive layer at the back of the eyeball. New blood vessels can develop, but they don’t grow well and leak, causing vision loss. It usually affects both eyes. If left untreated, the pulling can cause retinal detachment and blindness.7 

In severe cases, abnormal blood vessels form and spread over the retina’s surface. This causes the loss of cells, scarring, and the possibility of severe vision loss.

In Diabetic Retinopathy (DR), swelling of the eye occurs. The swelling is also known as diabetic macular edema. Symptoms people report include:

  • Eye floaters.

  • Black spots in their line of vision. 

  • Difficulty perceiving colors. 

  • Distorted vision.

What is the relationship between blood sugar control and diabetes eye problems? 

Glucose is in the foods we eat that fuel our bodies cells. The beta cells of the pancreas are responsible for making insulin. Insulin is a pancreatic hormone that allows glucose to enter the cells and tissues.

Insulin acts like the key to the cells to allow the glucose in. Diabetes is a dysfunction where the body does not produce insulin or cannot use what it makes. When the body is unable to get sugar from the blood into the cells, it leads to high blood sugar levels. 

Type 1 diabetes is an autoimmune disease often seen in the young. In this disease state, the body attacks itself. It begins to damage the pancreas’ beta cells permanently, and they cannot produce insulin. 

Type 2 diabetes is often the result of dysfunction in the body symptoms. When excess adiposity exists, the deterioration in pancreatic function increases. This, in turn, slows insulin production. In both types, excess sugar circulates, blood glucose rises, and it can cause blurry vision. 

If you experience blurry vision, it may be due to a high blood sugar level. If it occurs, this is cause to call your physician. Many people become diagnosed with diabetes following such an event. The circulating sugar causes vascular changes, including the weakening of blood vessels. Swelling and hemorrhaging can follow.

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 and blurred vision is cause for concern. As this continues, eye disease develops, and diabetic eye conditions progress. They may rupture and bleed into the surrounding areas.

There are several stages of neuropathy in the eye. In Nonproliferative Retinopathy, there are small changes in the blood vessels and hemorrhages. New blood vessel growth stops.

In Proliferative Diabetic Retinopathy, new vessels begin to grow, but they are abnormal. Treatment includes laser surgery. Swelling can occur and progress to macular edema. To help prevent retinopathy:

  • Complete a yearly diabetic eye exam.

  • Control your blood pressure and blood sugar levels~

  • Manage your cholesterol levels

Another common concern is dry eye resulting from neuropathy. The same nerve damage that causes tingling and numbness in the hands and feet can damage 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

During a regular eye exam, you will be screened for vision changes and diabetic eye problems. A dilated eye exam is a simple procedure your eye doctor conducts to check for eye disease.

In a comprehensive eye exam 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. 

The exam includes:

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

  • A 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.

  • A 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.

  • A 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 

retina specialist specializes in retinal disease and injuries. They should be consulted if any of these issues occur.

  • Retinal Tear/Break or Detachment. Retinal tears are particularly common. The patient requires urgent referral to a retina specialist for operative repair.

  • Post-Operative Cataract removal or glaucoma infiltration surgery.

  • Proliferative Diabetic Retinopathy with High-Risk Characteristics such as neovascularization and hemorrhage.

  • Diabetic patients with proliferative diabetic retinopathy carry the highest risk of severe visual loss and work with a Retinal Specialist. 

  • Significant Macular or Diabetic Macular Edema.

  • Age-Related Macular Degeneration.

  • Retinal Vein Occlusions requiring pan-retinal photocoagulation. This is a laser treatment that helps new blood vessel growth and restores color vision. 

Steps to Protect Your Vision

Getting a yearly eye exam with the same eye doctor can be beneficial. He or she will be able to identify and track any small changes in the eye.

Avoiding complications as a diabetic patient is critical to long term health. Kidney health will help prevent elevated blood pressure and resulting avoid nerve damage. Neuropathy can affect your sight as much as it affects your other body systems.

The frequency of the eye exam will depend on several factors. Items considered include your health history, disease risk, and family medical history. A comprehensive dilated eye exam should be completed every 1 to 2 years. Yearly exams are necessary if: 

  • If you over the age of 60

  • Are African American and over 40

  • Have a family history of glaucoma with diabetes or high blood pressure 

Conclusion 

By working with your specialist, eye conditions can be monitored for further development, and preventative care can be tailored for your needs. Although surgery is often recommended to a patient, there are risks, including continued disease progression or the cataract’s reformation.

Ultimately the best diabetic eye disease treatment keeps your eyes healthy and prevents oxidative stress and damage to your eye. Combining protective nutrients for eye health can reduce the risk of cataracts and disease formation. 

When diabetes is not managed well, your risks increase to several serious conditions. By eating healthfully and exercising regularly, you will help keep your weight down. By increasing cardiovascular exercise and practicing careful eating habits, you will keep your blood sugar and blood pressure near the preferred ranges. By understanding your risks, and the perceived benefits, you can protect your eyes.

Sources

  1. Diabetes and risk of glaucoma: systematic review and a Meta-analysis of prospective cohort studies, 2017)
  2. International Journal of Ophthalmology, 2017. Diabetes and risk of glaucoma: systematic review and a Meta-analysis of prospective cohort studies.
  3. National Institute of Health, 2020. Get A Dilated Eye Exam.
  4. Today’s Dietitian, 2020. Eating for Eye Health. Vol. 11 No. 9 P. 12.
  5. Christina Antonopoulos MD. (2010). Seven Reasons to Refer to a Retina Specialist.
  6. World Health Organization. (2018). Blindness and Visual Impairment. Available:
  7.  NIH. (2020). Bilberry. Available: https://www.nccih.nih.gov/health/bilberry. Last accessed 11/21/20.
  8. AOA. (2020). Diet and Nutrition Adding powerful antioxidants to your diet can improve your eye health

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