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.
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:
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 sends 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 vessels is known as proliferative diabetic retinopathy.
Learn more about Diabetic Retinopathy
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 the 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 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.
Learn more about glaucoma
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.
Learn more about cataracts
Although anyone with diabetes can develop diabetic eye conditions, there are known risk factors associated with developing them:
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:
If you experience a 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.
Signs of diabetic retinopathy and DME are detected through a painless comprehensive dilated eye exam performed by your eye doctor. This includes:
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.
Advanced diabetic eye conditions can be treated with medicine, laser treatments, surgery, or a combination of them.
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 human hair. This is performed in our office. Typically, you are given several treatments in the first few months, then fewer treatments over time.
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:
Some advanced diabetic eye conditions require surgical intervention. The most common surgeries performed for diabetic eye conditions include:
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 saltwater solution to maintain constant pressure within your eye while the surgeon re-attaches your retina or removes scar tissue from within your eye.
This surgery is performed in the operating room under anesthesia. Your surgeon creates watertight 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.
Learn more about vitrectomies
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.
Learn more about cataract lens options
Having an annual eye examination is important for the 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.
Assil Gaur 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.
AGEI utilizes the most advanced surgical techniques and technology available today to offer our patients the best possible vision outcomes in the safest manner.
Dr. Gaur's training and work experience at renowned ophthalmic institutions, including Tufts Medical Center and Boston-Mass Eye and Ear Infirmary, have given her extensive experience in state-of-the-art medical, laser and surgical management of glaucoma and cataracts. It is no exaggeration to report that she has performed thousands of sucessful cataract, glaucoma and LASIK surgeries.