What Leading Eye Specialists Have to Say About Your Eyes and Diabetes

Diabetes affects your eyes when your blood glucose, also called blood sugar, is too high.

In the short term, you are not likely to have vision loss from high blood glucose. People sometimes have blurry vision for a few days or weeks when they’re changing their diabetes care plan or medicines. High glucose can change fluid levels or cause swelling in the tissues of your eyes that help you to focus, causing blurred vision. This type of blurry vision is temporary and goes away when your glucose level gets closer to normal.

If your blood glucose stays high over time, it can damage the tiny blood vessels in the back of your eyes. This damage can begin during prediabetes when blood glucose is higher than normal, but not high enough for you to be diagnosed with diabetes. Damaged blood vessels may leak fluid and cause swelling. New, weak blood vessels may also begin to grow. These blood vessels can bleed into the middle part of the eye, lead to scarring, or cause dangerously high pressure inside your eye.

Most serious diabetic eye diseases begin with blood vessel problems. The three eye diseases that can threaten your sight are

1. Cataract
2. Proliferative Diabetic Retinopathy
3. Glaucoma

Often, there is no early symptom of diabetic eye diseases. You may have no pain, and no vision alterations as the damage will start inside your eyes, especially with diabetic retinopathy. When symptoms occur, they might include the following:

• Fluctuating vision.
• Wavy or blurry vision.
• Dark or empty areas in your vision.
• Night vision problems.
• Vision loss.
• Impaired colour vision.
• Seeing dark strings or blackish-grey spots (floaters) that move in the direction the person looks.
• Flashes of light.

There are generally two stages of diabetic retinopathy: Nonproliferative and proliferative.

Nonproliferative diabetic retinopathy (NPDR), the most common type of diabetic retinopathy, occurs when the blood vessels in a person’s retina weaken and tiny bulges protrude from their walls. Proliferative diabetic retinopathy (PDR) is the more severe type of diabetic retinopathy and occurs with the growth of abnormal blood vessels. This may lead to bleeding or scar tissue formation, possibly causing detachment of the retina and permanent vision loss. Both NPDR and PDR can cause diabetic macular edema (DME) which can cause central vision loss.

Diabetic macular edema (DME). A consequence of diabetic retinopathy, DME is the build-up of fluid (edema) in a region of the retina called the macula. The macula is important for the sharp, straight-ahead vision that is used for reading, recognizing faces, and driving. DME is the most common cause of vision loss among people with diabetic retinopathy. About half of all people with diabetic retinopathy will develop DME. Although it is more likely to occur as diabetic retinopathy worsens, DME can happen at any stage of the disease.

Treatment options depend upon the nature of the diabetic eye disease but can include medications, laser, and sometimes surgery.

If early nonproliferative diabetic retinopathy is present, treatment of the eye may not be necessary if blood sugar is well maintained. If severe nonproliferative or proliferative diabetic retinopathy is present, laser procedures, surgeries, or injectable medications are available and may reverse, slow, or stop the progression of diabetic retinopathy. Based on your vision diagnosis during an examination, our diabetic eye care specialists will discuss with you the most appropriate treatment options.

Other than retinopathy, diabetes poses the risk of the following eye conditions:

1. Cataracts: Though the exact connection is yet to be completely comprehended, people with diabetes have a higher risk of developing cataracts that cause hazy vision and blindness in severe cases.

   You might experience the following:

   • faded colors
   • clouded or blurry vision
   • double vision, usually in just one eye
   • sensitivity to light
   • glare or halos around lights
   • vision that doesn’t improve with new glasses or a prescription that must be changed often

   Cataract surgery is recommended for people with worsening cataract conditions, e.g. highly blurred vision.

2. Eye Infections: The chances of getting conjunctivitis are higher in people with type 1 diabetes. Additionally, people with type 2 diabetes have a higher risk of developing critical eye infections, including blepharitis and styes.

3. Glaucoma: Diabetes causes pressure build-up within the eyes when the fluid drainage cannot occur in the usual manner. This can injure and damage nerves and blood vessels and cause vision alterations and blindness in severe cases. Additionally, certain types of glaucoma can also cause diabetes.

   You might experience the following symptoms:

   • loss of peripheral vision or tunnel vision
   • halos around lights
   • reddening of the eyes
   • ocular (eye) pain
   • nausea or vomiting

   There are several treatments for glaucoma. Some use drugs to reduce pressure in the eye, while others involve lasers or surgery.

You cannot always prevent diabetic retinopathy. However, doing the following may help:

• Annual eye examinations that include a glaucoma test, cataract test, and a dialated fundus examination with retinal imaging for early detection and documentation of the disease.
• Controlling blood pressure and blood sugar and cholesterol levels.
• Quit smoking.
• Eat a healthy and well-balanced diet.
• Exercise.
• Wearing UV protective shades.

If you have been diagnosed with diabetes, you can take early measures to reduce the risk of diabetic retinopathy. Some of these include:

• Managing your diabetes and monitoring your blood sugar level. You will have to check your blood sugar level several times a day. More frequent measurements can be required if you are under stress. Consult your doctor to know how often you need your blood sugar to be checked.

• Keep your cholesterol and blood pressure under control. Along with medication, following a balanced diet, exercising regularly, and losing weight can help.

• If you smoke or use tobacco, ask your physician to help you quit. Smoking increases the chances of diabetes-related complications, such as diabetic retinopathy.

• Pay attention to vision changes like spotty, blurry, or hazy vision.