Diabetes and the Eye

Diabetes and the Eye

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of your eye).  The retina is a group of cells on the back of your eye that take in light. They turn light into images that the optic nerve sends to your brain.

At first, diabetic retinopathy may cause no symptoms or only mild vision problems. However, Eventually, it can cause blindness.

If you have diabetes, it’s important for you to get a comprehensive dilated eye exam at least once a year. Diabetic retinopathy may not have any symptoms at first — but finding it early can help you take steps to protect your vision. 

Managing your diabetes — by staying physically active, eating healthy, and taking your medicine — can also help you prevent or delay vision loss.   

What are the symptoms of diabetic retinopathy?

The early stages of diabetic retinopathy usually don’t have any symptoms. Some people notice changes in their vision, like trouble reading or seeing faraway objects. These changes may come and go. 

As the condition progresses, diabetic retinopathy symptoms may include:

  • Spots or dark strings floating in your vision (floaters).
  • Blurred vision.
  • Fluctuating vision.
  • Impaired colour vision.
  • Dark or empty areas in your vision.
  • Vision loss.

Diabetic retinopathy usually affects both eyes.

In later stages of the disease, blood vessels in the retina start to bleed into the vitreous (gel-like fluid in the center of the eye). If this happens, you may see dark, floating spots or streaks that look like cobwebs. Sometimes, the spots clear up on their own — but it’s important to get treatment right away. Without treatment, the bleeding can happen again, get worse, or cause scarring.

What other problems can diabetic retinopathy cause?

Diabetic retinopathy is caused by high blood sugar due to diabetes. Over time, having too much sugar in your blood can damage your retina.

Diabetes damages blood vessels all over the body. The damage to your eyes starts when sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well. These new blood vessels can leak and/or bleed easily. 

In the early stages of diabetic retinopathy, we will probably just keep track of how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months

In later stages, it’s important to start treatment right away — especially if you experience changes in your vision. While it won’t undo any damage to your vision, treatment can stop your vision from getting worse. It’s also important to take steps to control your diabetes, blood pressure, and cholesterol. 

Diabetic retinopathy can lead to other serious eye conditions, such as:

  • Diabetic macular edema (DME). Over time, about half of people with diabetic retinopathy will develop DME. DME happens when blood vessels in the retina leak fluid, causing swelling in the macula (a part of the retina). If you have DME, your vision will become blurry because of the extra fluid in your macula.  
  • Vitreous hemorrhage. The newly formea weak blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision.
  • Neovascular glaucoma.  This makes new blood vessels grow on the iris, the coloured part of your eye. They block the normal flow of fluid and raise eye pressure. This is called rubeotic glaucoma.
  • Retinal detachment. Diabetic retinopathy can cause scars to form in the back of your eye. When the scars pull your retina away from the back of your eye, it’s called tractional retinal detachment.
  • Maculopathy. This occurs when diabetes affects the macula. The macula is the area of your retina that provides the best vision necessary for reading, driving, and other similar activities. The swelling that occurs may be easily reversible, or more serious and difficult to treat.
  • Proliferative retinopathy. It happens when cells at the back of your eye don’t get enough oxygen and new “weak” blood vessels start to grow. They’re fragile, so they can bleed and lead to a clot.
  • Diabetic Cataract. The natural internal lens of your eye allows your eye to see and focus on an image, just like a camera. When that lens gets cloudy, like a dirty or smudged window, that means a cataract has formed. Anyone can get them, but people with diabetes tend to get them earlier, and they get worse faster.

Am I at risk for diabetic retinopathy?

The condition can develop in anyone who has diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication. Anyone with type 1, type 2, and gestational diabetes (diabetes that can develop during pregnancy) can get diabetic retinopathy.

Your risk increases the longer you have diabetes. More than 2 in 5 people with diabetes have some stage of diabetic retinopathy. The good news is that you can lower your risk of developing diabetic retinopathy by controlling your diabetes.  

As a warning women with diabetes who become pregnant — or women who develop gestational diabetes — are at high risk for getting diabetic retinopathy. If you have diabetes and are pregnant, have a comprehensive dilated eye exam as soon as possible. You will need additional eye exams during your pregnancy. 

How will my eye doctor check for diabetic retinopathy?

Eye doctors can check for diabetic retinopathy as part of a dilated eye exam. The exam is simple and painless — you will be given some eye drops to dilate (widen) your pupil and then check your eyes for diabetic retinopathy and other eye problems.

If you have diabetes, it’s very important to get regular eye exams. If you do develop diabetic retinopathy, early treatment can stop the damage and prevent blindness.  Be sure to tell the doctor about all your symptoms, as well as all the medications you take.

In many cases, early treatment can correct the problem or prevent it from getting worse. If the doctor thinks you may have severe diabetic retinopathy or DME, they may do a test called a fluorescein angiogram. This test lets the doctor see pictures of the blood vessels in your retina. 

What can I do to prevent diabetic retinopathy?

Managing your diabetes is the best way to lower your risk of diabetic retinopathy. That means keeping your blood sugar levels as close to normal as possible. You can do this by getting regular physical activity, eating healthy, and carefully following your doctor’s instructions for your insulin or other diabetes medicines.  

To help control your blood sugar, you will need a special test called an HBA1c test. This test shows your average blood sugar level over a 3-month period. Talk with your physician about lowering your A1c level to help prevent or manage diabetic retinopathy.

Having high blood pressure or high cholesterol along with diabetes increases your risk for diabetic retinopathy. So, controlling your blood pressure and cholesterol can also help lower your risk for vision loss. For example, if your blood sugar is out of control, your doctor can advise you how to manage it better. However, the cause must be determined before your doctor can recommend a treatment plan.

What’s the treatment for diabetic retinopathy and DME?

  • Injections. Medicines called anti-VEGF drugs can slow down or reverse diabetic retinopathy. Other medicines, called corticosteroids, can also help.
  • Laser treatment. To reduce swelling in your retina, eye doctors can use lasers to make the blood vessels shrink and stop leaking.
  • Eye surgery. If your retina is bleeding a lot (vitreous haemorrhaging) or you have a lot of scars in your eye, your eye doctor may recommend a type of surgery called a vitrectomy.

When to see a doctor Blurry Vision

Don’t buy new glasses as soon as you notice that things look blurry. It could just be a small problem caused by high blood sugar. Your lens could swell, which changes your ability to see. To correct it, you need to get your blood sugar back into the target range (70-130 milligrams per decilitre, or mg/dL, before meals, and less than 180 mg/dL 1 to 2 hours after a meal). It may take as long as 3 months for your vision to fully get back to normal.

Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see the doctor for a yearly eye exam with dilation — even if your vision seems fine.  Do tell the doctor. He can let you know if this is a symptom of a more serious problem.

When to Call the Doctor

These symptoms can signal an emergency:

  • Black spots in your vision
  • Flashes of light
  • “Holes” in your vision
  • Blurred vision

Contact our emergency number on +2781 545 5385 right away if your vision changes suddenly or becomes blurry, spotty or hazy.

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