Diabetes

Diabetes affects the eyes in many ways but the most common eye problem in diabetics is diabetic retinopathy. Diabetic retinopathy is the most common cause of blindness in people of working age in the United States. Diabetes causes damage to blood vessels in the body due to the inability of the body to process blood sugar properly. The eye has many small blood vessels and these blood vessels are a common site of damage in diabetes. Essentially, diabetes damages the blood vessels and makes them become leaky. In the eye, the leaky blood vessels cause blood and fluid to deposit in the retina, where it should not be. Over time this leaking damages the retina and causes vision loss. The early stages of diabetic changes in the retina of the eye are called non-proliferative diabetic retinopathy.

As diabetic retinopathy progresses, new blood vessels form in the eye. These blood vessels are very fragile and often break open, causing blood to accumulate in the retina or the gel inside the eye and often result in sudden loss of sight. These new blood vessels can also pull the retina off the back of the eye, resulting in a retinal detachment and again, often severe loss of sight. This stage of diabetic change in the retina is called proliferative diabetic retinopathy.

Diabetic Retinopathy Symptoms

Diabetic retinopathy is more common the longer you have the disease. However, it is less common in diabetics who have excellent blood sugar control. Although every diabetic is at risk for developing diabetic retinopathy, the risk is decreased for those who control their blood sugar well. In the early stages of diabetic retinopathy there may be no changes in vision. This is why it is essential that diabetics get an annual diabetic dilated eye examination regardless of their vision. As the retinopathy increases, changes in vision are often noticed. These changes are often gradual in non-proliferative diabetic retinopathy.

In proliferative diabetic retinopathy, there may be a sudden decrease in vision. An increase in floaters and dark spots in the vision may also occur.

Other eye problems in diabetics

If diabetes affects the macula (the central part of the retina responsible for detail vision), it can lead to diabetic macular edema, which is a swelling of this central part of the retina. This swelling can cause a decrease in vision and make both reading and distance vision difficult. It can also make straight lines appear wavy or distorted.

Diabetics can also suffer from damage to the blood vessel supply to the nerves that control the eye muscles. This can cause sudden double vision when the eye muscles do not work properly. The eye affected may suddenly turn in or out.

Many diabetics suffer from variable vision throughout the day. This is usually a sign of poor blood sugar control and can make it difficult to determine the proper glasses prescription in an eye examination.

What Causes Diabetic Retinopathy?

As stated before, diabetic sugar variations damage the blood vessels in the body. The smaller blood vessels are affected more frequently and there are many small blood vessels in the eye. As the blood vessels in the eye get damaged, they leak blood and fluid into the retina and damage the retina over time. As the retina becomes damaged, vision loss results.

Diabetics need to have a yearly dilated eye examination. Once diabetic retinopathy occurs, eye examinations at more frequent intervals may be necessary. Diabetics can decrease their risk for developing diabetic retinopathy by keeping their blood sugar under good control, treating any high blood pressure or high cholesterol, exercising regularly and eating a healthy diet.

Diabetic Retinopathy Treatment

It is essential that diabetic retinopathy is monitored regularly and when needed, treated as soon as possible to reduce vision loss. In the early stages of diabetic retinopathy, better sugar control is encouraged and frequent follow-up recommended. If the retinopathy progresses, laser treatment is often necessary to preserve sight.

If you have diabetic retinopathy or macula edema you may need to have a special test called a fluorescein angiogram. This requires an injection of dye into a vein in your arm as you sit in a special microscope that takes pictures of your retinas. As the dye reaches your retinas, photos are taken to see which blood vessels are leaking. This helps the eye doctor determine how to treat the retinopathy with the laser.

Laser treatment of diabetic retinopathy is necessary when there is damage from leaking blood vessels or new blood vessel growth. The laser is used to seal off the leaking blood vessels and/or decrease the amount of new blood vessel growth.

If proliferative diabetic retinopathy causes a leaking of blood into the gel of the eye, called a vitreous hemorrhage, a sudden loss of vision often results. Depending on the type of vitreous hemorrhage, it may just be watched carefully since they often clear on their own, or a removal of the gel inside the eye, called a vitrectomy, is performed.

Diabetics are at a higher risk to develop cataracts at a younger age. Cataracts are treated by cataract surgery when the vision becomes affected. Since diabetics often have a decreased ability to heal, it is important that they are followed carefully after cataract surgery to ensure that the eye is healing normally.

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