Health News
Health News
May 12, 2019
Diabetic Eye Disease

May is Healthy Vision Month and the physicians of Privia Medical Group North Texas (PMGNTX) are focusing on one of the more common causes of eye problems and vision loss: diabetic eye disease. 

A disorder of the metabolism, diabetes affects more than 30 million Americans, or nearly ten percent of all people in the United States.  This includes more than 12 percent of adults, according to the U.S. Centers for Disease Control and Prevention’s 2017 Diabetes Report Card.   While diabetes impacts a large percentage of our population, a sizable number of people who have diabetes – about 25 percent, or 7 million people – are not yet aware of it.  The vast majority of people who are affected have type 2 diabetes, which can occur when the body’s cells are unable to use insulin properly, resulting in abnormally high blood sugar levels.    

A precursor to type 2 diabetes is prediabetes.  People are diagnosed with prediabetes when their blood sugar levels are elevated, but not yet high enough to be classified as type 2 diabetes.  If lifestyle adjustments are not made to lower blood sugar levels, prediabetes is likely to lead to type 2 diabetes.  Prediabetes is very common: one-third of Americans, about 90 million people, have prediabetes.  For more on the causes, symptoms and prevention of diabetes and prediabetes, see our recent Diabetes Awareness article.

Diabetic eye disease is one of several conditions that can result from diabetes.  Diabetic eye disease actually encompasses several distinct eye problems:  diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma.  Diabetes is the leading cause of adult-onset blindness. 

“Annual diabetic eye screenings are absolutely essential for any person who has diabetes or has been diagnosed as pre-diabetic,” says Dr. Harry Rosenthal, Jr., a PMGNTX retinal specialist.  “With diabetic eye screenings, we are able to successfully identify problems and prevent vision loss through treatment.   It’s so important that diabetic patients be screened annually in order to detect problems before they result in permanent vision loss.” 

Not everyone who has diabetes or prediabetes will develop diabetic eye disease.  People with untreated high blood sugar or untreated high blood pressure are more likely to develop eye problems.  Additionally, high cholesterol and smoking increase risk.

Symptoms

Diabetic eye disease can be present before any symptoms occur, especially with diabetic retinopathy.  This is why diabetic eye screenings are so important – screenings can detect problems in the eyes early and allow for more effective treatment. 

When symptoms do occur, they may include:

  • Blurry or wavy vision
  • Vision loss
  • Frequently changing vision
  • Floaters, which are dark spots in the field of vision
  • Light flashes

If you experience any of these symptoms, make an appointment to see your doctor right away to have your eyes examined. 

Diagnosis

Eye exams, conducted by an ophthalmologist, are critical to early detection of diabetic eye disease and other eye problems.  A dilated eye exam is the best way to check for eye problems.  In dilation, eye drops are administered, causing the pupil to widen.  The widened pupil allows more light into the eye and provides the doctor with a better view of the back of the eye. 

Your doctor will also test your vision and measure the pressure in your eyes.  Most people who have been diagnosed with diabetes or prediabetes should have a comprehensive eye exam annually. 

Types of Diabatic Eye Disease

Diabetic Retinopathy

One of the possible consequences of both type 1 and type 2 diabetes is diabetic retinopathy, a disease which damages the blood vessels at the back of the retina.  The longer one has diabetes and the longer blood sugar is not properly managed, the more likely the patient is to develop diabetic retinopathy.

Diabetic Macular Edema

Diabetic macular edema causes swelling in the macula.  The macula is the part of the eye that enables us to read, drive and see faces.  This condition can eventually lead to partial or complete vision loss and typically presents in patients who already show signs of diabetic retinopathy. 

Cataracts

Cataracts cloud the lens of the eye, resulting in diminished vision and blindness.  People with diabetes are more likely to develop cataracts and at a younger age than those who are not diabetic. Cataracts are the most common cause of vision loss in the United States and cataract removal is the most common surgery performed in this country.  In cataract surgery, the clouded lens is removed and replaced with an artificial lens. 

Glaucoma

Diabetes doubles the likelihood of glaucoma, a set of eye diseases that damage the optic nerve and can result in vision loss and blindness.  It is generally caused by elevated pressure in the eye, brought about by an accumulation of fluids.  Damage caused by glaucoma cannot be reversed, which is why early detection through regular eye screenings is so important.  While treatment cannot undo damage caused by the disease, it can slow its progression and mitigate the effects.  Eye drops and oral medication can be prescribed to lower the pressure in the eye and in some cases, surgery is an option to treat glaucoma. 

Treatment

The most important part of managing diabetic eye disease is the same as how someone manages diabetes itself.  That means consistent monitoring of blood sugar and A1C levels, taking all prescribed medications, keeping blood pressure and cholesterol in normal ranges and maintaining a healthy diet and regular exercise routine. 

“Following the guidance of both your primary care provider and your ophthalmologist are important to managing diabetes and diabetic eye disease,” explains Dr. Rosenthal.  “Achieving and maintaining your target blood sugar/A1C levels is essential to diabetes management and is the first step to dealing with diabetic eye disease.”   

Treatment specific to diabetic eye disease includes:

  • Medication: An anti-VEGF medicine can help block the growth of abnormal blood vessels in the eye and help stop fluid leaks, as well.  This treatment may help stop vision loss and even improve vision in some patients. 
  • Laser treatment: Laser treatment can help to treat leaky blood vessels in the eyes, as well as fluid buildup, also known as edema. Laser treatment is generally done in your ophthalmologist’s office over the course of multiple visits.
  • Vitrectomy: This is a surgery sometimes used to treat diabetic retinopathy by removing the clear gel in the center of the eye that can lead to bleeding and scarring.
  • Cataract lens surgery: In this surgery, the physician removes the cloudy lens from the eye and replaces it with an artificial lens.  This usually results in improved vision. 

Get Screened – It’s Important

Because the onset of diabetic eye disease can cause loss of vision and is not reversible, early detection is essential to effective treatment.  “If you have been diagnosed as diabetic or prediabetic, you must receive a diabetic eye screening at least once a year,” advises Dr. Rosenthal.  “And you should be screened for diabetes itself on a regular basis according to your health care provider’s guidance.  It’s a simple blood test that will tell you a lot.” 

This article contains information sourced from:

The National Institute of Diabetes and Digestive and Kidney Diseases

The U.S. Centers for Disease Control and Prevention