The eyes are a fascinating organ! In the back of the eye is a sensitive layer of cells called the retina. Many small blood vessels, called capillaries, provide the cells oxygen and nutrients. Like film in a camera, the retina receives light from outside and transmits signals to the brain to produce vision.
Unfortunately, with diabetes, one is at higher risk of complications that may threaten eyesight. These can come on with no obvious signs or symptoms.
Keeping glucose levels in your target range (Safe Zone) is one of the best ways to keep eyes healthy. Also, be sure to have an annual eye exam. This could prevent 95% of vision loss caused by diabetes.
Let’s learn more about these conditions and how they are treated.
Elevated blood sugar levels make capillaries very fragile. By clogging these tiny vessels with excess glucose molecules, they can swell, leak or close off. When areas of the retina fail to receive adequate oxygen and nutrients, new weak capillaries start to grow and block light from reaching the retina.
Signs & Symptoms
Often painless and gradual, going unnoticed at first.
- Blurred vision
- Spots or dark strings floating in your vision – otherwise known as floaters
- Fluctuating vision
- Dark or empty areas in your vision
- Vision loss
In early stages, glucose management can keep symptoms from getting worse. In more advanced stages, treatments include:
- Laser treatment – shrinks the new blood vessels to stop bleeding (stage 2 or 3 of retinopathy)
- Eye injections – treats progressive loss of central vision. Injections contain a medicine called anti-VEGF that stops the growth of new, abnormal blood vessels that would leak and bleedunder the retina.
- Eye surgery – removes blood or scar tissue
Diabetic Macular Edema (DME)
Occurs following the onset of Diabetic Retinopathy. The macula is the part of the eye where sharp and straight-ahead vision occurs. When Diabetic Retinopathy is left untreated, the damaged blood vessels in the retina can leak fluid into the center of the macula. The macula then swells causing blurred vision.
Signs & Symptoms
- Blurred vision
- Double vision
- Sudden increase in eye floaters
- Medications – block the productions of new blood vessels and limit leakage into the macula
- Focal laser - Laser light procedure used to close and destroy leaking blood vessels. It helps protect and, in some cases, improve current vision.
- Corticosteroids – steroids injected into the eye to improve vision
- Living with low vision – Low vision aids can help in their day-to-day life. Some of these items include a magnifying glass, reading lamp, and large-print reading material
Cataracts are a clouding of the lens in the eyes. This happens frequently as one ages, but can occur sooner if you have diabetes. Your risk also increases when you've had diabetes for a long period of time with blood-glucose levels that are above target range. Cataracts develop when the lens of your eyes change. They become thicker, less transparent and not as flexible. Symptoms can come on slowly until you notice clouding effects in the center of the eye. Then things can progress quickly.
Signs & Symptoms
- Cloudy vision
- Double vision in one eye
- Seeing halos around lights
- Decreased night vision
- Bright colors look faded
- Consume a diet rich in fruits and vegetables (antioxidants)
- Wear UV protective sunglasses
- Avoid smoking – increases the amount of free radicals in your eye, eventually leading to cataracts
- Cataract surgery – The clouded lens is removed and replaced with an artificial lens. Surgery is usually very successful and can result in full vision. Following surgery, patients can sometimes develop cystoid macular edema. This occurs 2-8 weeks after surgery.
Glaucoma is a disease that damages the eye’s optic nerve due to excess pressure in the eye. Your eyes are continuously making fluid which flows in and out keeping eye pressure stable. When fluid cannot drain properly, it builds up causing pressure. When this happens, the tiny nerve fibers that make up the optic nerve become damaged. This causes blind spots that often go undetected. If left untreated blindness will eventually occur.
There are several types of Glaucoma. Primary Open-Angle Glaucoma (POAG) is the most common among persons with diabetes. This happens gradually as drainage from the eye is slowed, much like that of a clogged drain. When this occurs, it is painless and there are no changes in vision at first.
Signs & Symptoms
Glaucoma is a progressive disease. This is how it slowly develops:
No warning signs or symptoms
Blind spots develop in your side vision (peripheral)
Progressive vision loss
Glaucoma cannot be reversed but there are treatments to can stop further damage
- Special eyedrops – reduce eye pressure by lowering the amount of fluid made by the eye or by helping the fluid drain from the eye
- Laser surgery – helps the fluid drain from the eye
- Drainage devices – tiny tube implanted in the eye drains to an area where it can be absorbed by nearby blood vessels
- Cataract surgery – natural lens is removed and replaced with an artificial one, creating more space for fluid to drain properly
The good news is there are ways to keep your eyes healthy. Here are some tips from the American Academy of Ophthalmology
Get a comprehensive dilated eye examination from your ophthalmologist at least one a year
Early stages of eye disease may have no symptoms. A dilated eye exam allows your ophthalmologist to examine the retina and optic nerve so treatment can begin as soon as possible.
Manage your blood glucose
Over time, high glucose levels can cause damage to the blood vessels in the eye. The good news is that managing your blood sugar prevents these side effects.
Maintain a healthy blood pressure
High blood pressure and cholesterol can increase your risk for eye disease and vision loss. Work with your physician to keep your blood pressure at an appropriate level.
Do not smoke
If you smoke, now is a great time to quit. There are resources and professionals available to help. We suggest you start with WayToQuit or join a local support group.
Stay physically active
Physical activity is beneficial for your eyes and your diabetes. Find things you enjoy doing so you can be active every day.
To learn more about other, potential complications from unmanaged diabetes, click here
“Eye Health.” Eye Health | ADA
“Prevent Diabetic Eye Disease in 5 Steps.” American Academy of Ophthalmology, 30 Sept. 2021
©Gary Scheiner MS, CDCES – Integrated Diabetes Services. May be reproduced and used for patient education, but not sold.