Diabetes can lay the groundwork for a group of eye diseases, and awareness is instrumental in protecting vision from these stealthy conditions. While none are curable, they can be managed successfully, preventing, delaying and reducing the vision loss and impairment these untreated conditions can cause.
The high sugar levels associated with diabetes can damage blood vessels in the retina, which most often leads to severe vision loss. Most people with diabetes have at least the early stage of this disease, called non-proliferative diabetic retinopathy, or NPDR. NPDR sees leaking of retinal blood vessels, which in turn engorge the tiny macula, the part of the retina that enables central vision, fine detail, and light and color reception. When the macula is damaged, it affects everything in the central view, robbing people of the ability to drive, read, watch movies, cook, even recognize faces. NPDR can also cause blood vessels in the retina to collapse or close, preventing healthy blood flow to the macula and often leading to the formation of particles that distort normal vision. NPDR causes blurred vision and is the most common cause of blindness in diabetics.
In its early stages, diabetic retinopathy often produces no symptoms. Left unmanaged, it can develop into the more advanced stage of the disease, proliferative diabetic retinopathy, or PDR. With PDR, the retina, in a failed effort to replace damaged blood vessels, begins to grow new ones, but they are malformed and weak. This process, called neovascularization, typically leads to vessels that bleed easily, damaging the vitreous, the gel-like fluid that fills the eye. Bleeding can cause blurred vision and new dark floaters to appear in one’s field of vision. Serious bleeding creates poor vision, especially at night, muted colors, and blank areas, not only in central vision but in peripheral vision as well, leading to total blindness in some cases.
Diabetic Macular Edema
Diabetic Macular Edema, or DME, occurs when diabetic retinopathy causes the macula to swell or distort, impairing central vision. DME occurs in about half of all diabetic retinopathy cases.
Treatment of Diabetic Retinopathy/DME
The good news is that early diagnosis and treatment of diabetic retinopathy/DME can reduce the risk of related blindness by as much as 95%.
Annual comprehensive eye exams can catch diabetic retinopathy before it has a chance to steal sight.
Treatment depends on what your eye doctor finds during your examination, but will definitely include steps to control your blood sugar and blood pressure to protect your vision and, in some cases, even improve your current vision quality. Keeping your numbers in check and on target can help ensure that your eye’s blood vessels perform optimally.
Other treatments include medications and corticosteroids. Anti-VEGF (vascular endothelial growth factor) injections block the VEGF protein that encourages abnormal blood vessels to form. Blocking VEGF is an effective way to reduce these vessels and excess retinal fluid. Injectable steroids can also reduce macular swelling. These are usually the first line of defense against diabetic retinopathy/DME.
Less often, patients may require macular laser surgery to seal off leaking blood vessels. Most people respond favorably after just one treatment, though some require multiple sessions. It is often combined with drug therapy.
Very serious cases of PDR may require a procedure called a vitrectomy, in which the eye’s damaged vitreous gel is removed and, when warranted, the retina surgically reattached. If needed, your eye doctor will refer you to a local recommended specialist.
Diabetes greatly increases one’s risk of developing glaucoma, specifically a type called neovascular glaucoma. Glaucoma causes damage to the optic nerve, which transmits data collected by the retina to the brain, enabling vision. In its early stages, glaucoma produces no noticeable symptoms, so, as with nearly all eye diseases, its diagnosis and successful management begin with annual comprehensive eye exams, which can also catch ocular hypertension, a common precursor of glaucoma. Any damage from glaucoma is permanent, so discovering it before it produces vision loss is crucial.
Glaucoma is most often treated with prescription eye drops and/or oral medications designed to lower pressure within the eye. In many cases, laser surgery may be required to open drainage angles and decrease fluid and pressure.
For open-angle glaucoma, Selective Laser Trabeculoplasty, or SLT, opens up the drainage channel of the eye, relieving pressure. This quick, comfortable procedure lowers eye pressure in greater than 80% of patients over the 1-3 months following surgery.
For closed-angle glaucoma, there is laser iridotomy, a procedure in which a laser is used to create a tiny drainage channel in the iris to expel excess fluid. In some cases, surgeons take advantage of standard surgical instruments to create a new drainage passage. In all cases, Lake Eye patients return home the day of surgery, so no need to stay in a hospital overnight.
People with diabetes face a significantly higher chance of developing cataracts. Changes in blood sugar can cause the lens of the eye to swell or distort, or create excess proteins that cause clouding. Diabetics are more likely to develop cataracts at a younger age as well, and because cataracts can develop without showing early symptoms (yes, this is a running theme in eye diseases), early diagnosis is paramount.
Simple Solution: Annual Eye Exams
Adults with diabetes should have a comprehensive dilated eye exam every year or more often if your doctor recommends it. Changes in eye health can happen quickly and without warning, so schedule your exams on time so your doctor can spot changes early, while vision is intact and treatment is most effective. With early treatment, nearly all cases of vision loss can be prevented.
If you have diabetes and haven’t had a complete eye exam in a year or more, call Lake Eye today. Our team of doctors is here to protect and promote your healthy vision.