Diabetes and Visual Health
People with diabetes are at risk of losing one of the most precious of their senses: sight.
The National Eye Institute reports that about half of the people with diabetes in America have early stage diabetic retinopathy and one quarter have serious retinal disease. Each year, about 65,000 Americans progress to proliferative retinopathy, the most sight-threatening stage of the disease. As many as 25,000 people go blind each year from diabetic retinopathy.
“People unnecessarily lose their vision yearly because of diabetes complications that can often be prevented through early detection and timely treatment,” said Robert Layman, O.D. and Chair of the American Optometric Association’s Diabetes Eye Care Project Team.
Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication(s) of the disease. All can cause severe vision loss or, even, blindness.
People with diabetes are at higher risks for:
- Diabetic retinopathy, a condition occurring in persons with diabetes, which causes progressive damage to the retina, the light sensitive lining at the back of the eye.
- Cataracts, a clouding of the eye's lens, which blocks or changes how light passes into the eye.
- Glaucoma, which is an increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.
- Macular edema, a swelling of the retina causing blurred vision in the middle or to the side of the central visual field.
- Retinal detachment is one of the most common causes of blindness in diabetes which occurs when newly growing blood vessels pull the retina from the back of the eye.
According to Michael Duenas, O.D. and health scientist at the Centers for Disease Control and Prevention (CDC), Division of Diabetes Translation, “patients suffering from diabetic retinopathy may not notice any changes in their vision, especially during the early treatable stages of the disease, this fact emphasizes the importance of all individuals with diabetes having yearly dilated eye examinations by an optometrist or ophthalmologist.”
Dr. Layman concurs, “Individuals should consider an eye exam [as] the first line of detection for this serious disease and its complications. Sometimes the very first signs of diabetes can be diagnosed during a dilated eye exam in which drops are put into the eyes.”
Risk factors for diabetic eye disease
Although all people with Type 1 and Type 2 diabetes are at risk for developing diabetic eye disease, the longer a person has diabetes, the more likely they are to develop vision problems, particularly if the diabetes is poorly controlled.
· Race — Hispanic and African Americans are at greater risk for developing diabetic retinopathy.
· Medical conditions — persons with other medical conditions, such as high blood pressure and high cholesterol, are at greater risk.
· Pregnancy — pregnant women face a higher risk for developing diabetic retinopathy.
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Symptoms of diabetic eye disease
According to Prevent Blindness America, symptoms of diabetic eye disease may include:
- Blurry or clouded vision
- Floaters or dark spots in vision
- Straight lines that do not appear straight (such as flag poles, street lights, etc.)
- Difficulty seeing in dim light or at night
- Tunnel vision
- Having a dark or empty spot in the center of your vision
Early detection and treatment can limit the potential for significant vision loss from diabetic eye disease.
How does diabetes damage your vision?
In patients with diabetes, prolonged periods of high blood sugar are the primary cause of vision complications. Better control of blood sugar levels in patients with diabetes slows the onset and progression of diabetic eye disease. You can also help prevent, or slow, the development of diabetic eye disease by taking your prescribed medication, sticking to your diet, exercising regularly, controlling high blood pressure, and avoiding alcohol and smoking.
The Diabetes Control and Complications Trial (DCCT) showed that control of blood sugar levels slows the onset and progression of diabetic eye disease. Better control also reduces the need for sight-saving laser surgery.
High glucose levels affect the eyes by:
- Causing an accumulation of fluid behind the lens which changes its curvature and results in blurred vision. This blurring may subside once glucose levels are brought under control.
- Diabetic retinopathy is the result of damage to the tiny blood vessels that nourish the retina. These vessels leak blood and other fluids that cause retinal tissue to swell and cloud vision.
- Fluid can also leak into the macula, resulting in blurred vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with advanced cases of retinopathy also have macular edema.
- The eyes may attempt to improve blood circulation in the retina by forming new blood vessels on its surface. These fragile blood vessels can leak blood into the back of the eye and block vision.
- The condition usually affects both eyes.
The longer a person has diabetes, the more likely they will develop diabetic eye diseases. People with retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care. If left untreated blindness can result.
In the early stages of diabetic eye disease, regular monitoring by an eye care professional may be all the treatment that is required. Treatment for diabetic eye disease depends on the specific condition and stage of the disease. Treatment is directed at trying to slow, or stop, the progression of the disease and save vision.
Treatments may include:
· Laser surgery to seal leaking blood vessels or to discourage new leaky blood vessels from forming.
· Injections of medications into the eye to decrease inflammation or stop the formation of new blood vessels.
· In more advanced cases, a surgical procedure to remove and replace the vitreous gel-like fluid in the back of the eye may be needed.
· A retinal detachment, defined as a separation of the light-receiving lining in the back of the eye, may also require surgical repair.
What can be done if you have already lost some vision from diabetic retinopathy?
In spite of efforts to take care of your eye sight it is still possible to suffer significant vision loss or, even, blindness. If you have lost some sight from diabetic retinopathy, ask your eye care professional for a referral to a specialist in low vision.
There are many adaptive devices that may help you make the most of your remaining vision, including: telescopic and microscopic lenses, hand and stand magnifiers and video magnification systems that can be prescribed to make the most of remaining vision.
If you completely lose your vision there are additional adaptive devices available to individuals, including: talking computers, watches, audio books, Braille books, etc. to assist you retain your independence.
Many community organizations and agencies offer low vision counseling, training and other special services for people with visual impairments. A nearby school of medicine or optometry may also provide low vision services.
Resources for People with Vision Loss
Lighthouse International
For more than 100 years, Lighthouse International has been a leader in meeting the evolving needs of people who are dealing with, or are at risk for, vision loss and blindness. Through services, education, research, and advocacy, the Lighthouse enables people with low vision and blindness to enjoy safe, independent and productive lives.
Disability.gov
A federal government website that provides information on disability-related programs, services, laws and benefits. Through the site, Americans with disabilities and their families can connect to thousands of resources from federal, state and local government agencies, educational institutions and non-profit organizations.
The eye and how we see – neat little interactive video
Sources
Foundation of American Academy of Ophthalmology
American Optometric Association
Prevent Blindness
Updated May 9, 2011
