Diabetes and eye disease
Diabetes can harm your eyes. It can damage the small blood vessels in your retina, the back part of your eye. This is called diabetic retinopathy.
Diabetes also increases your risk of having glaucoma, cataracts, and other eye problems.
Retinopathy - diabetic; Photocoagulation - retina; Diabetic retinopathy
Causes, incidence, and risk factors
Diabetic retinopathy is caused by damage to blood vessels of the retina. The retina is the layer of tissue at the back of the inner eye. It changes light and images that enter the eye into nerve signals that are sent to the brain.
Diabetic retinopathy is the leading cause of blindness in working-age Americans. People with type 1
and type 2 diabetes
are at risk for this condition.
Diabetes - retinal conditions
There are two stages of diabetic retinopathy:
The chance of getting retinopathy and having a more severe form is greater when:
- You have had diabetes for a long time
- Your diabetes has been poorly controlled
Other problems that may develop are:
-- cloudiness of the eye lens
-- increased pressure in the eye that can lead to blindness
- Macular edema -- blurry vision due to fluid leaking into the area of the retina that provides sharp central vision
- Retinal detachment
-- scarring that may cause part of the retina to pull away from the back of your eyeball
Most often, diabetic retinopathy has no symptoms until the damage to your eyes is severe.
Symptoms of diabetic retinopathy include:
Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.
Signs and tests
The health care provider can diagnose diabetic retinopathy by dilating your pupils with eye drops and then carefully examining the retina. A retinal photography
or fluorescein angiography
test may also be used.
You may not know there is any damage to your eyes until the problem is very bad. Your doctor can catch problems early if you get regular exams. You will need to see an eye doctor who is trained to find and treat diabetic retinopathy.
Everyone with diabetes should have regular diabetic eye exams
by an eye doctor who is skilled in the treatment of diabetic retinopathy.
If you have the early stage of diabetic retinopathy (nonproliferative), your health care provider may see:
Blood vessels in the eye that are larger in certain spots (called microaneurysms)
Blood vessels that are blocked
Small amounts of bleeding (retinal hemorrhages) and fluid leaking into the retina
If you have more advanced retinopathy (proliferative), your health care provider may see:
People with the earlier form (nonproliferative) of diabetic retinopathy may not need treatment. However, they should be closely followed by an eye doctor who is trained to treat diabetic eye diseases.
Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed.
Several procedures or surgeries are the main treatment for diabetic retinopathy.
Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking or to get rid of abnormal, fragile vessels.
A surgical procedure called vitrectomy is used when there is bleeding (hemorrhage) into the eye. It may also be used to repair retinal detachment
Drugs that prevent abnormal blood vessels from growing, and steroid drugs injected into the eyeball are possible new treatments for diabetic retinopathy.
If you cannot see well:
Make sure your home is safe so you do not fall
Organize your home so that you can easily find what you need
Get help to make sure you are taking your medicines correctly
You can improve your outcome by keeping good control over your blood sugar and blood pressure.
Treatments can reduce vision loss. They do not cure diabetic retinopathy or reverse the changes that have already occurred.
Other problems that may develop are:
Calling your health care provider
Call for an appointment with an eye doctor (ophthalmologist) if you have diabetes
and you have not seen an ophthalmologist in the past year.
Call your doctor if any of the following symptoms are new or are becoming worse:
You cannot see well in dim light.
You have blind spots.
You have double vision (you see two things when there is only one).
Your vision is hazy or blurry and you cannot focus.
You have pain in one of your eyes.
You are having headaches.
You see spots floating in your eyes.
You cannot see things on the side of your field of vision.
You see shadows.
Tight control of blood sugar, blood pressure, and cholesterol is very important for preventing diabetic retinopathy.
Do not smoke. If you need help quitting, ask your doctor or nurse.
American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2012 Jan;35 Suppl 1:S11-63.
O'Doherty M, Dooley I, Hickey-Dwyer M. Interventions for diabetic macular oedema: a systematic review of the literature. Br J Opthalmol. 2008;92:1581-1590.
Diabetic Retinopathy Clinical Research Network (DRCR.net), Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol. 2009;127:245-251.
Shehzad Topiwala, MD, Chief Consultant Endocrinologist, Premier Medical Associates, The Villages, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.