Diabetic Eye Conditionscauses, symptoms and treatments

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Last updated 9/29/2019
Dr. Assil discusses how diabetes affect the eye.

How diabetes affects the eye

There are serious vision problems that can affect people with poorly managed diabetes. Diabetic eye disease causes progressive damage within your eyes resulting in poor vision or even blindness.

 

Unfortunately, there are no warning signs or changes in vision during the initial stages of diabetic eye disease. Meaning your eyes can be damaged even if you have no symptoms. That's why annual vision exams, including a dilated eye exam, are key to detecting problems early.

 

The four main eye conditions that can result from poorly managed long term diabetes include: diabetic retinopathy, diabetic macular edema, cataracts, glaucoma.

Diabetic eye conditions

When your body is unable to produce or use insulin properly, glucose (sugar) can build up in your blood and damage your blood vessels and nerves. Elevated glucose can take its toll on different parts of your eye, luckily, there are steps that you can take to prevent diabetic eye disease, or keep it from progressing, by properly managing your diabetes.

 

These eye conditions include:

 

Diabetic retinopathy

When the body is unable to produce or use insulin properly, glucose (sugar) builds up in the blood and damages blood vessels and nerves. This also damages the small blood vessels that nourish the retina (which senses light and send it to your brain for translation into images).

 

In advanced diabetes, the damaged retinal blood vessels close off, causing the retina to create new but abnormally weak blood vessels to grow on the retina. This spurt of new weak walled blood vessel is known as proliferative diabetic retinopathy.

 

 

Diabetic macular edema

Diabetes can cause swelling of the macula (the central part of your retina responsible for the sharp vision that allows you to read, see faces and drive). Prolonged macular swelling (known as diabetic macular edema or DME) can lead to eventual destruction of the macula, resulting in partial or total vision loss. In fact, DME is the most common cause of vision loss among people with diabetic retinopathy.

 

Glaucoma and diabetes

Glaucoma is a condition characterized by elevated internal eye pressure that eventually damages the optic nerve (the conduit for sending visual signals from the retina to the brain).

 

Having diabetes doubles your chances of developing glaucoma which can result in permanent vision loss. This is because diabetics are more likely to get a rare condition known as neovascular glaucoma. This involves the growth of abnormal new blood vessels on the iris (colored part of your eye) which block the normal outflow of intraocular fluid, raising eye pressure.

 

 

Diabetic cataracts

As we age, the lenses within our eyes become cloudy, causing our vision to become less sharp. This is known as cataracts and ultimately requires surgery to take out the cloudy natural lens and replace it with a clear lens. High glucose levels can cause deposits to build up on your natural lens, causing clouding. People with diabetes are two to five times more likely to develop cataracts than those without diabetes. Diabetics also develop cataracts at an earlier age than non-diabetics.

 

Diabetic eye conditions risk factors

Although anyone with diabetes can develop diabetic eye conditions, there are known risk factors associated with developing them:

  • How long you have had diabetes
  • If you have high blood glucose, blood pressure or cholesterol that is not treated
  • If you are African American, Hispanic, Native America, Native Alaskan or Pacific Islander
  • If you are diabetic and become pregnant, you can develop fast progressing eye problems (gestational diabetes, which is a temporary condition occurring only during pregnancy, doesn't usually cause eye problems)

 

Symptoms of diabetic eye conditions

The biggest challenge in managing diabetic eye disease is that there are no early symptoms. During the early stages, you do not experience pain or vision changes. As the damage to your eye progresses, you may experience any of the following symptoms:

  • Frequent changes in your vision from sharp to blurry
  • Blurry or wavy vision
  • Poor color vision
  • Areas of darkness or black holes in your vision
  • Tiny spots or fine dark strings (known as Floaters)
  • Flashes of light

 

If you experience sudden onset of any of the above symptoms, contact your eye doctor. You should also see your eye doctor right away if you experience a sensation that a curtain has been pulled over your visual field. This can be a sign of a detached retina which is a medical emergency.

 

Diagnosing diabetic eye conditions

Signs of diabetic retinopathy and DME are detected through a painless comprehensive dilated eye exam performed by your eye doctor. This includes:

  • Visual Acuity Testing: this test measures your ability to see at various distances.
  • Tonometry: this test measures the pressure inside of your eye.
  • Dilated pupil exam: after placing drops in your eyes to widen the pupil, your doctor takes a close look at your retina, macula and optic nerve to look for leaky blood vessels, swelling, or damage to your lens or nerve tissue.
  • Optical Coherence Tomography: this test uses a special computer that captures light waves to get detailed images of your retina.

 

If your doctor finds evidence of DME or severe diabetic retinopathy, a fluorescein angiogram might be recommended to look for leaking blood vessels. This simple test involves injecting fluorescent dye into your arm vein and taking pictures of the blood vessels as the dye reaches your eye.

 

Non-surgical treatments for diabetic eye conditions

Advanced diabetic eye conditions can be treated with medicine, laser treatments, surgery or a combination of them.

 

Anti-VEGF medications for diabetic eye conditions

Special medicines known as anti-VEGF medications block a protein responsible for the growth of abnormal blood vessels (called vascular endothelial growth factor, or VEGF). These medications also stop vessels from leaking.

 

Anti-VEGF medication is important in treating diabetic macular edema (swelling of the macula area of the retina). These treatments can prevent further vision loss and may even improve vision in some cases.

 

Anti-VEGF treatments are administered by injecting the medication into your eye (once it has been numbed) with a very fine needle the thickness of a human hair. This is performed in our office. Typically, you are given several treatments in the first few months, then fewer treatments over time.

 

Laser treatments for diabetic eye conditions

One treatment that is used to keep your eye disease from getting worse involves using laser energy to cauterize your leaky blood vessels in order to keep them from leaking and causing swelling. This treatment, known as Photocoagulation, can be performed in one of two ways:

  • Focal or grid laser treatment: treats a small section of the retina and is often used to treat macular edema. This treatment is sometimes combined with anti-VEGF therapy.
  • Panretinal Photocoagulation (PRP) involves treating a larger segment of the retina and is used to arrest the growth of abnormal new blood vessels (known as proliferative diabetic retinopathy). This therapy works best before new, fragile blood vessels have started to bleed.

 

 


Surgical treatment for diabetic eye conditions

Some advanced diabetic eye conditions require surgical intervention. The most common surgeries performed for diabetic eye conditions include:

 

Vitrectomy

Because diabetic retinopathy causes the growth of new leaky blood vessels, this can lead to severe bleeding and the formation of scar tissue within your eye. Scar tissue can cause the delicate retina tissue to detach from the inner wall of your eye, resulting in blindness.

 

A retinal detachment is an emergency and the eye surgeon must reattach the delicate retina tissue to your eye wall in order to preserve as much vision as possible. This first requires draining out the gel-like substance inside your eye in order for the doctor to then reattach the thin retinal tissue like wallpaper lining the eye.

 

During a vitrectomy, the gel-like fluid (known as vitreous fluid) is carefully drained from your eye and is replaced with a clear salt water solution to maintain constant pressure within your eye while the surgeon reattaches your retina or removes scar tissue from within your eye.

 

This surgery is performed in the operating room under anesthesia. Your surgeon creates water tight openings in your cornea through which microscopic instruments are inserted for removing scar tissue or repairing a detached retina. You are sent home the same day with eye drops to reduce inflammation and prevent infection.

 

 

Cataract Lens Replacement

People with diabetes are more likely to develop cataracts at an earlier age than those without diabetes because high blood glucose levels cause deposits on your eye's natural lens.

 

Cataract surgery is a same day procedure performed in our surgery center and involves removing your cloudy natural lens and replacing it with a clear artificial lens. Your vision following cataract surgery will depend not only on the new lens but also on the degree of existing diabetic retinopathy and macular edema.


How to prevent diabetic vision loss

Having an annual eye examination is important for early detection of diabetic eye conditions. Once you have been diagnosed with a diabetic eye condition, it is important to monitor your eye health closely. This may require having eye exams more than once a year in order for your eye care professional to look for the progression of damage caused by diabetes.

 

It is also important to follow-up with your primary healthcare provider to manage your diabetes by controlling your ABCs: keeping your A1c (blood sugar level) within recommended ranges, keeping your Blood pressure and Cholesterol under control and if you Smoke, it's important to quit.

 

Studies such as the Diabetes Control and Complications Trial (DCCT) have shown that controlling diabetes delays the onset and worsening of diabetic retinopathy. Study participants who kept their blood glucose as close to normal as possible were significantly less likely to develop diabetes complications like diabetic retinopathy, kidney disease and nerve disease than those with abnormally high blood sugar.

 

The AEI eye care difference

Assil Eye Institute’s dedication to providing the best eye care available is what motivates us to strive for the highest standards of excellence when it comes to your eye health.

 

AEI utilizes the most advanced surgical techniques and technology available today to offer our patients the best possible vision outcomes in the safest manner.

 

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