For the public health experts at the CDC, it may not come as a surprise — but chances are, most people don’t know that diabetic retinopathy is now the top cause of blindness among working-age adults.
But just like most diabetes complications, diabetes vision loss can be prevented. No matter the age you first got diagnosed with diabetes, the key to preventing vision loss lies in frequent check-ups and stable blood sugar levels.
Easier said than done, right? How easy is it for diabetes to damage your retina, anyway? Let’s look at the different eye conditions that can result from high blood sugar levels, how to spot them, and how to prevent them as part of a wider preventative health plan.
How many are going blind from diabetes?
Perhaps the day’s more impressive question, given the title: how strong is the link between diabetes and vision loss? Pretty strong, as it turns out.
According to the National Health Interview Survey, over 4 million people in the U.S. — or about 40% of all patients with type 1 and type 2 diabetes — currently have diabetic retinopathy. Out of this group, nearly 900,000 have vision-threatening retinopathy: damage severe enough to qualify as being legally blind.
Around the world, the increased prevalence of lifestyle diseases has created a “worldwide epidemic” of preventable vision problems. And as 1-in-3 adults may develop diabetes by 2050, we can only expect these numbers to rise.
What is diabetic retinopathy?
Diabetic retinopathy is a progressive eye condition where the blood vessels around the retina get progressively damaged by high blood sugar levels.
The retina is a special layer of tissue at the back of the eyes, responsible for detecting light. It is surrounded by tiny blood vessels that connect it to the brain. In patients with poorly-controlled diabetes, circulating blood glucose can block or stretch out blood vessels around the body. Over the years, this can cut off some of the blood flow in the area and damage the delicate structures of the eye.
Diabetes retinopathy stages
Naturally, there are usually a few decades between the first time the retina leaks fluid and the point when blurry vision becomes blindness.
Experts have identified two distinct stages of diabetic retinopathy.
First, there’s the nonproliferative stage, which is when the blood vessels first weaken, forming tiny pouches or bulges that leak fluid. This will cause the macula to swell, creating a condition known as macular edema.
It may be hard to spot any eye problems at such early stages. Vision may distort a little, but this usually develops slowly enough to go unnoticed. During blood sugar spikes, some patients may experience temporarily blurred vision — but this often goes away as soon as glucose levels return to normal.
Advanced diabetic retinopathy is also called the proliferative stage. At this stage, the continuous swelling of the retina has given way to new blood vessels – a process known as revascularization. However, these new abnormal blood vessels will be weaker and bleed more easily. Then, they leave behind scar tissue, which builds up inside the vitreous and further increases eye pressure.
Although the condition is usually discovered earlier during a routine eye exam, the damage caused by proliferative diabetic retinopathy is usually much more noticeable. This includes:
- permanently blurry vision
- “floaters” or small white spots floating in the eye
- dark spots
- loss of peripheral vision
- trouble seeing colors or under poor light
What other eye diseases does diabetes cause?
Both diabetic retinopathy and diabetes can cause a handful of other eye problems that radically increase the risk of blindness among diabetic patients. People with diabetes also have a higher risk of:
- Glaucoma — a condition where the optic nerve is damaged due to increased pressure inside the eye.
- Cataracts — the lenses within the eye become clouded, resulting in blurry vision.
- Diabetic macular edema — damages the part of your retina used for fine vision, such as reading.
- Retinal detachment — a serious condition where the retina separates from the back of the eye, and that can result in permanent, total blindness
Are you at risk of diabetic eye disease?
If you have been diagnosed with any type of diabetes — type 2, type 1, or gestational diabetes — then you are already at some risk for diabetic retinopathy. However, this is not the only risk factor. Other circumstances to watch out for include:
- frequent spikes in blood sugar levels
- high blood pressure (hypertension)
- high levels of blood cholesterol
- smoking tobacco
- being of Native American, Hispanic, or Pacific Islander descent
Finally, the longer you have had diabetes, the higher your risk of developing diabetes complications — whether on your nervous system, kidneys, or any part of the eye. This means that if you only had gestational diabetes once, and it resolved after the pregnancy, you’ll be at less risk than someone diagnosed with type 1 diabetes at a young age.
Am I going blind from diabetes?
Ultimately, only an ophthalmologist can diagnose diabetic retinopathy, as many of its symptoms can also indicate glaucoma or other types of degenerative eye disease. If you notice any of the following symptoms, it’s time for a thorough eye exam:
- gradually blurrier vision
- temporary “flashes” where you momentarily get a blind spot
- frequent redness in the eyes
- frequent floaters, especially when looking at light-colored walls
- worsening issues seeing in half-light
If caught early, diabetic retinopathy can be monitored closely, preventing permanent blindness or serious visual impairment. As a result, the American Diabetes Association recommends all diabetes patients to have regular eye exams: adults with type 2 diabetes should have an eye check-up as soon as they’re diagnosed and once a year after that.
For those with type 1 diabetes, the age of your first check-up will depend on your age of diagnosis, but it’s best not to wait more than five years.
What can I expect during an eye exam for diabetic eye disease?
Diagnosing diabetic retinopathy requires a dilated eye exam. For this, we will apply a couple of drops that will widen your pupils and allow us to get a closer look at the back of your eye. In this way, we can check the retina’s health and if there are any signs of fluid buildup or damage to the surrounding blood vessels.
Then, we will check your visual acuity (how well you see at different distances), your field of vision, and the pressure inside your eyes.
The eye drops we use for this will blur your vision for a few hours, and you may also feel discomfort when under direct light. So, it’s best if you come with someone to drive you back, and if it’s a sunny day, bring a pair of sunglasses.
Preventing and treating diabetic retinopathy
The direct cause of diabetic retinopathy is chronically high blood sugar levels. Therefore, to prevent this condition, you’ll have to work closely with your endocrinologist and nutritionist.
Still, ophthalmology has a lot to offer after the initial diagnosis. If we catch it early, an eye doctor can help you monitor your eye health and coordinate with your other doctors to ensure the damage doesn’t progress. If you keep your blood sugar stable, your LDL (or “bad”) cholesterol levels low, and your blood pressure under control, we can delay retinopathy’s progress indefinitely.
However, once diabetic retinopathy reaches its later stages, we will need more aggressive treatments to prevent further damage. There are three main options here:
- Anti-VEGF injections. This type of medication slows down the growth of abnormal blood vessels in your eyes.
- Laser therapy or photocoagulation. This can help us treat the leaky blood vessels around the retina and prevent their regrowth.
- A vitrectomy. This is a surgical procedure in which we will remove some of the gel and blood building up inside the eye.
Do you have diabetes and want to preserve your eye health? Come to Assil Gaur Eye Institute
At Assil Gaur Eye Institute, we understand the deep links between eye health, general healthcare, and holistic wellness. Our team of ophthalmologists, optometrists, and eye surgeons is proficient in both preventative care and high-tech procedures.
When working with diabetic patients, we can design a long-term management plan and are happy to coordinate with the rest of your care team. We specialize in innovative therapies, laser treatments, and precision surgery, which can all help you treat retinopathy or other types of diabetic eye disease.
Please call 866-945-2745 or make an appointment online. At Assil Gaur Eye Institute, we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations to minimize the spread of the coronavirus. Masks are required in our institutes at all times.
We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
Dr. Harris continued her education at Pennsylvania College of Optometry where she received another bachelor’s degree in vision sciences and then a doctorate of Optometry. While at the college, she served as an ambassador to the school and a tutor for her fellow professional colleagues. Her clinical and classroom work yielded academic achievement awards and bid her membership in the Beta Sigma Kappa Honor Society.
She completed clinical rotations during her fourth year at a few private practices in addition to the William Feinbloom Low Vision Rehabilitation Center and Hahneman Hospital in Philadelphia.
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