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Diabetes

Diabetes is a disease that affects the way we process food for energy and growth.

With all forms of diabetes—type 1, type 2 and gestational diabetes—the body has trouble converting sugar in the blood into energy, resulting in a host of potential health problems.

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Diabetes Increases The Likelihood That Common Diabetes-Related Vision Problems Or Diseases Might Occur

  • Diabetics are prone to developing cataracts (a clouding of the eye’s lens) at an earlier age.
  • People with diabetes are almost 50% more likely to develop glaucoma, an eye disorder that damages the optic nerve often marked by an increase of internal eye pressure.
  • Macular edema (and macular degeneration) are more common in diabetics due to malfunctioning blood vessels in the middle region of the retina responsible for central, sharp vision.
  • Most notably, diabetes can result in diabetic retinopathy; an eye disease that affects the blood vessels in the all-important retina. Nearly 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy.

That’s why there’s no separating diabetes and vision. If you have diabetes, then you should understand vision problems that increase in likelihood as a result of the disease.

Diabetes Statistics

Over 2.3 million people in Canada have diabetes, with an estimated additional 6 million people have pre-diabetes they have a form of the disease. What’s more, an estimated 54 million Canadian ages 40 to 74 have prediabetes, a condition that puts them at risk for developing type 2 diabetes. According to a recent Canadian Optometric Association survey, diabetes is the leading cause of new cases of blindness among adults ages 20 to 74.

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Overview of Diabetic Retinopathy

Diabetic retinopathy involves swelling, leaking or abnormal growth of blood vessels in or near the retina. There are multiple stages to this disease, the earliest of which may not present any symptoms you can see.

Symptoms you can see include dark or black spots in your vision that increase over time, or severely blurred vision due to bleeding within the eye.

That’s why comprehensive eye exams are so important when thinking about diabetes and eye sight—both type 1 and type 2 diabetics are at risk for developing diabetic retinopathy, and the longer you have diabetes, the more likely you are to develop some form of the disease.

Treatments for diabetic retinopathy include replacement of the inner gel inside the eye (called a vitrectomy) and different kinds of laser surgery. A recent clinical trial also suggested that better control of blood sugar levels slows the onset and progression of the disease in many patients.

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Signs and Symptoms of Diabetic Retinopathy

Diabetes prohibits the body from properly using and storing sugar, leaving excessive amounts of sugar in the bloodstream which can cause damage to blood vessels and various parts of the body- including the eyes and visual system. Diabetic retinopathy is when this condition results in progressive damage to the retina at the back of the eye.  

The retina is a light-sensitive tissue that is essential for vision, so if left untreated, diabetic retinopathy will eventually cause blindness. Sadly, despite the fact that proper monitoring and treatment can successfully halt the progression of the diabetic eye disease, it is still the leading cause of new cases of blindness in adults in North America.

Symptoms of Diabetic Retinopathy

Diabetic retinopathy progressively damages the blood vessels of the retina to the point that they begin to leak blood and fluids. This leakage causes swelling in the retinal tissue which can impact your ability to focus causing vision loss and if left untreated, eventually will cause blindness. Retinopathy typically affects both eyes and often will have no symptoms in the early stages - making regular eye exams essential for anyone with diabetes. The longer an individual has had diabetes, the more likely it is that they will have some degree of retinopathy.

Symptoms include:

  • Blurred or cloudy vision
  • Seeing floaters or spots
  • Difficulty reading or seeing close objects
  • Double Vision
  • Poor Night Vision

Untreated diabetic retinopathy can also lead to a detached retina. This can happen if the disease has progressed to proliferative retinopathy in which new, fragile blood vessels grow in the retina and the vitreous at the back of the eye. The blood vessels can break, leaking fluid and causing the growth of scar tissue which can cause the retina to detach. If left untreated this can cause blindness as well.

Many of the symptoms of diabetic retinopathy, particular in the early stages of vision loss, can be reversed with proper treatment and control of blood sugar levels.  Diabetics with or without retinopathy must see an eye doctor at least once a year for a comprehensive eye exam to monitor any changes and ensure that proper treatment is prescribed.

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Causes of Diabetic Retinopathy

What are the causes of diabetic retinopathy and long-term diabetes? Changes in blood-sugar levels is the main culprit. People suffering from diabetes generally develop diabetic retinopathy after at least ten years of having the disease. Once you are diagnosed with diabetes, it is essential to have an eye exam once a year or more.

In the early stage of diabetic retinopathy, called background or non-proliferative retinopathy, high blood sugar in the retina damages blood vessels, which bleed or leak fluid. This leaking or bleeding causes swelling in the retina, which forms deposits.

In the later stage of diabetic retinopathy, called proliferative retinopathy, new blood vessels begin to grow on the retinal. These new blood vessels may break, causing bleeding into the vitreous, which is the clear gelatinous matter that fills the inside of the eye. This breakage can cause serious vision difficulties. This form of diabetic retinopathy can cause blindness, and is therefore the more serious form of the disease.

It is not hard to greatly reduce your risk of diabetic retinopathy by following some simple steps and being aware of your overall health. The most important factor you can control is maintaining your blood sugar at a healthy level. Eating a healthy diet will help greatly in controlling blood sugar levels. A regular exercise regimen is also a great help. Finally, make sure to listen to your doctor’s instructions.

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Treatment for Diabetic Retinopathy

95% of people diagnosed with diabetic retinopathy, if treated promptly, can avoid significant vision loss.

Laser photocoagulation treatment seals off blood vessels that are leaking into the eye, and stops new blood vessels from growing. This laser treatment only takes a few moments, and is painless.

Sometimes in diabetic retinopathy blood leaks into the vitreous humor in the eye, clouding vision. Some eye doctors wait before choosing treatment, as the blood may dissipate by itself. Another treatment option is a vitrectomy, which removes blood that has already leaked into the vitreous humor.

To improve the supply of blood to the core inner portion of the retina, a laser may be used to destroy tissue on the outside of the retina which is not essential for basic vision. This procedure is used to save vision.

Lucentis is a medication that is administered by an eye doctor using injections. This medication was approved by the FDA is 2015, and is the first non-laser treatment approved by the FDA. The FDA is currently reviewing several other non-laser treatments for diabetic retinopathy.