Diabetes Management

Diabetes and Your Eyesight: How To Prevent Vision Loss

If you want to know more about diabetic eye disease, you’ve come to the right place.

Diabetes Mellitus (DM) is a metabolic disorder in which blood sugar levels remain elevated over a prolonged period. 

Diabetes is one of the common health problems that affects millions of people all over the world. 

It represents a real challenge to the health care system due to its potential short-term and long-term complications if left untreated. 

Eye problems are among some of the most frequent complications of diabetes

Diabetes and your eyes

Having prolonged high blood sugar levels can cause many severe problems to the eyesight. This can result in toxic compounds which can damage different tissues in the body, including the eye tissues. 

Since diabetes-related eye problems are one of the leading causes of blindness worldwide, it is vital to shed light on these conditions and how to prevent and treat them. 

Diabetes can cause short-term blurry vision or long-term eye problems. 

Each of these is due to high blood sugar levels. So the less controlled your diabetes is, the higher your risk of developing eye problems.

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Short-term blurry vision

Short-term blurry vision occurs due to fluctuations in blood sugar levels. 

When blood sugar levels are high for a long time, it pulls body water into the natural lens inside the eye, causing it to swell, which might affect your vision and eyeglasses prescription. 

This effect is temporary and will resolve when your blood sugar levels return to normal.

Therefore, we recommend diabetic patients not get a new eyeglasses prescription before adjusting their blood sugar level.

Long-term eye problems

These long-term diabetic eye problems are due to high blood sugar levels over many years. 

These complications are not temporary, but treatment and adequate control of blood sugar levels can slow their progression. 

4 Main Diabetic Eye Disorders

The following eye disorders are four main eye problems associated with diabetes. 

1) Diabetic retinopathy 

Diabetic retinopathy is the technical term for diabetes-related retina disorders. 

This eye condition diabetes is well known for its damaging effect on the small blood vessels that supply the back of the eye, specifically a very sensitive layer called the retina. 

The retina is one of the most important eye tissues. The harmful effect of the prolonged elevation of blood glucose levels over many years causes the retina to be dysfunctional, weak, and leaky. 

This, therefore, results in the two categories of diabetic retinopathy: nonproliferative diabetic retinopathy and proliferative diabetic retinopathy. 

Nonproliferative diabetic retinopathy

Nonproliferative diabetic retinopathy is the most common form. It is called non-proliferative because it shows no growth of abnormal blood vessels in the back of the eye. 

It is the less aggressive form of diabetic retinopathy in which the small retinal blood vessels start to get blocked and leak small amounts of blood in the back of the eye. 

As more blood vessels become blocked and leaky, non-proliferative retinopathy can move through mild, moderate, and severe stages. 

In the early stages, tight control of your blood sugar level, adopting a healthy lifestyle, and managing risk factors such as elevated blood pressure can help slow the progression of diabetic eye disease. 

Proliferative diabetic retinopathy

Suppose blood sugar level continues to be out of control over many years. In that case, non-proliferative diabetic retinopathy will eventually progress to the more severe form: proliferative diabetic retinopathy. 

In this type, the retinal blood vessels get so damaged that they finally close off. Then, new abnormal blood vessels start to grow (proliferate) as a response. 

The growth of new blood vessels does not provide normal blood flow to the retina. And the fragile new vessels can also bleed out. 

Symptoms of bleeding include floating spots/floaters in the vision. 

Suppose there is significant bleeding from these fragile new vessels into the central fluid of the eye. In that case, dramatic decline in vision can occur in these eyes. And you might need surgical intervention to remove this blood from your eye. 

The fragile, tiny blood vessels can also cause scar tissue to grow. When the scar tissue shrinks, it can distort the retina or even pull it out of place (retinal detachment). 

This is one of the worst complications of uncontrolled diabetes. It can lead to profound vision loss, which might be very difficult to fix.

Laser treatment, injection of certain medications inside the eye, and surgical intervention are the different treatment options for proliferative diabetic retinopathy. 

2) Diabetic macular edema

The macula is the part of the retina responsible for sending the highest resolution images to your brain. 

It is at the center of the retina and is essential for sharp vision. 

Early on in diabetic retinopathy, blood vessels in the retina might undergo certain changes that weaken their walls and result in leakage of fluid into the macula, which causes the macula to swell. 

This macular swelling caused by the leaked fluid from the weakened blood vessels is called  “macular edema.” 

Diabetic macular edema can make your vision get fuzzy or wavy. 

Laser treatment or injection of certain medications inside the eye is currently the main treatment for macular edema.

3) Cataracts

Age-related cataracts develop due to the gradual opaqueness of the lens of your eyes as you get older. 

An age-related cataract usually develops after the age of 60 years. 

However, diabetes can cause cataract(s) to develop and progress earlier, especially with uncontrolled and long-standing diabetes. 

Once cataracts become visually significant, doctors can only fix them through surgery. 

4) Glaucoma

Glaucoma is a group of eye disorders that can damage the optic nerve (the nerve that connects the retina to the brain), usually due to high eye pressure. 

Damage of the optic nerve results in variable degrees of vision loss that might end up with complete loss of vision if left untreated. 

Unfortunately, diabetes can cause an aggressive form of glaucoma, neovascular glaucoma. 

As described above, in proliferative diabetic retinopathy, high blood sugar levels can sometimes cause so much damage to the retina’s blood vessels that the eye has to make new ones. 

If the new blood vessels grow on the iris (the colored part of your eye), it will cause your eye pressure to increase, resulting in neovascular glaucoma, which is often very difficult to treat. 

Laser treatment, injection of certain medications inside the eye, and glaucoma surgery are all different options for treating neovascular glaucoma.

The need for eye exams in diabetic patients

All diabetic patients need to visit their eye doctors regularly to get a complete eye exam. 

Early detection of diabetic changes is vital for many reasons. 

Firstly, diabetic retinopathy progression can be a good indicator of your blood sugar level control. 

Secondly, grading the severity of diabetic retinopathy will determine the follow-up intervals and the need for more frequent visits in advanced conditions. 

Moreover, detecting specific changes in the back of the eye, such as abnormal new vessels or macular edema, warrants treatment of these conditions to prevent vision loss. 

Different approaches to treating diabetic eye disorders are currently available. These treatments can prevent vision loss in most people.

The earlier the diagnosis of diabetic retinopathy is made, the better your chances will be.

When to see an eye doctor

All diabetic patients should have annual eye exams. 

Depending on the severity of the diabetic changes in your eyes, your eye doctor might need to schedule more frequent visits to monitor you closely. 

Pregnancy is another reason for more frequent eye checks in diabetic patients as it can sometimes result in worsening of the diabetic eye changes or eye disease. 

Moreover, if you notice any vision changes or any unusual symptoms with your eyes, such as eye pain, frequent redness, double vision, or eye pressure, you should see an eye doctor as soon as possible.

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Conclusion

Uncontrolled diabetes mellitus over many years can cause serious eye problems, which represent the leading cause of vision loss among adults all over the world. 

Therefore, diabetic eye care is vital to maintain optimal eye health and prevent eye disease. 

Tight control of blood sugar, lifestyle modification, and control of other risk factors such as elevated blood pressure can prevent or slow down the progression of diabetic eye disease. 

A regular eye exam, at least annually, is essential for early detection and treatment of diabetic changes or diabetic eye diseases.

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Sources

  1. Pearce I, Simó R, Lövestam-Adrian M, Wong DT, Evans M. Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review. Diabetes Obes Metab. 2019 Mar;21(3):467-478. doi: 10.1111/dom.13550.
  2. Tumosa N. Eye disease and the older diabetic. Clin Geriatr Med. 2008 Aug;24(3):515-27, vii. doi: 10.1016/j.cger.2008.03.002.
  3. Li JQ, Welchowski T, Schmid M, Letow J, Wolpers C, Pascual-Camps I, Holz FG, Finger RP. Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis. Eur J Epidemiol. 2020 Jan;35(1):11-23. doi: 10.1007/s10654-019-00560-z.

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