How Does DiabetesAffect Your
Eyesight?
Diabetes Support Site Website
http://diabetessupportsite.com/
How Does Diabetes Affect Your Eyesight?
A common complicationof diabetes is diabetic eyedisease. Diabetic eye
disease refers to a groupof sightthreatening eyeproblems that people withdiabetes may develop.
If you have diabetes,regular visits to your eyedoctor for regular examsare important to avoid eyeproblems. High blood
sugar (glucose) increasesthe risk of eye problemsfrom diabetes. In fact,diabetes is the leadingcause of blindness inadults ages 20 to 74.
High blood sugar in diabetes
causes the lens of the eye to
swell, which changes your
ability to see. To correct this
kind of eye problem, you
need to get your blood sugar
back into the target range
(70130 milligrams per
deciliter or mg/dL before
meals, and less than 180
mg/dL one to two hours after
a meal). It may take as long
as three months after your
blood sugar is well controlled
for your vision to fully get
back to normal.
Blurred vision can also be a
symptom of more serious eye
problem with diabetes. The
three major eye problems that
people with diabetes may
develop and should be aware
of are cataracts, glaucoma,
and retinopathy.
What is the relationship between Diabetes and Glaucoma?
The relationship betweendiabetes and openangleglaucoma (the mostcommon type of
glaucoma), has intriguedresearchers for years.
People with diabetes aretwice as likely to developglaucoma as are non
diabetics, although somecurrent research is
beginning to call this intoquestion. Similarly, thelikelihood of someone
with openangle glaucomadeveloping diabetes ishigher than that of aperson without the eye
disease.
Neovascular glaucoma,
a rare type of
glaucoma, is always
associated with other
abnormalities, diabetes
being the most
common.
In some cases of
diabetic retinopathy,
blood vessels on the
retina are damaged.
The retina
manufactures new,
abnormal blood
vessels.
Neovascular glaucoma
can occur if these new
blood vessels grow on
the iris (the colored
part of the eye), closing
off the fluid flow in the
eye and raising the eye
pressure.
Neovascular glaucoma
is a difficult disease to
treat. One option is
laser surgery to reduce
abnormal blood
vessels on the iris and
on the retinal surface.
Recent studies have
also shown some
success with the use of
drainage implants.
Glaucoma and DiabetesGlaucoma is caused by excess fluid
pressing on the nerve at the back of
the eye
Glaucoma may occur amongst
people with and without diabetes,
and can be a complication of
diabetes if retinopathy develops.
Glaucoma is caused by an excess
amount of fluid pressing on the
nerve at the back of the eye.
How does glaucoma start?
The eye produces a small amount
of fluid like water in its middle
chamber, which flows around the
lens of the eye into the front
chamber.
The fluid leaves the eye using a
drainage network and then enters
the bloodstream.
Commonly, glaucoma causes the
drainage system to become
blocked, and fluid becomes trapped
in the eye. This causes pressure to
build up in the eye and pass to the
nerve at the rear of the eye.
This nerve may become damaged
by glaucoma.
What are the Symptoms of Glaucoma?
Glaucoma has very
few symptoms in its
early stage, so
people may be
unaware that
something is wrong
with them.
As someone with
diabetes, an
optometrist or
another eye
specialist should
test you for
glaucoma at least
once each year.
How is glaucoma diagnosed?
Glaucoma may be diagnosed
by an optometrist by
measuring your eye pressure,
checking the eye at the optic
nerve, and testing the field of
your vision.
A common test these days is
a noncontact tonometry test
(NCT test) in which a brief puff
of air will be directed into the
front of your eye. The machine
you sit in front of measures
the resistance of your eye to
the puff of air without needing
to make contact with your eye.
The puff of air is noticeable
but is not painful.
Experts will quickly be able to
determine if you have
glaucoma.
How is glaucoma treated?
Glaucoma will usually be treated with eye drops to relieve pressure in the eye. Treatments include:
Beta blockers (such as betaxolol hydrochloride, levobunolol hydrochloride or timolol)
Prostaglandin analogues (such as latanoprost, bimatoprost , tafluprost or travoprost)
Carbonic anhydrase inhibitors (such as brinzolamide or dorzolamide)
Your healthcare professional will be able to advise you further on the most suitable drops for your condition.
Alternative treatments include laser treatment (laser iridotomy) and trabeculectomy surgery.
What is the worst case scenario, will I go blind?
In developed stages of
glaucoma, poor vision
starts to spread, which
can extend to include
the whole of the sight.
If the pressure of
glaucoma can be
successfully eased,
however, the condition
should not deteriorate
further. Should your
vision become
significantly impaired,
there are a number of
aids which can help
people with diabetes
who have visual
impairments.
Cataracts and DiabetesCataracts are cloudy
opacifications of the
lens of the eye
Cataracts are one of
the sightrelated
complications of
diabetes that can
cause misting or
blurring of vision.
Attending regular eye
checks as part of your
annual diabetic review
will help your health
team to identify any
signs of cataracts at an
early stage and advise
on treatment.
What are the symptoms of
cataracts?
The main signs of cataracts are:
Cloudy or misty vision
Blurred vision
Spots in your vision
Being dazzled by bright lights
Seeing a circle of light around lights
A yellowing of your vision
Early stage cataract symptoms may
barely influence the vision, and a
cataract diagnosis may come as a
genuine surprise.
Challenging visual situations such
as driving at night and bright
sunlight may cause your sight to
become hazy. Attending regular
eye checks and screenings will
make it easier for your health team
to diagnose cataracts at an early
stage.
What causes cataracts?
The lens of the eye ismade up of fluids that
contain protein.
Over time this fluid maybegin to cloud over,
causing cataracts. Age isone of the factors andother factors include:
Having diabetes
Smoking
A family history ofcataracts
Long periods of takingcorticosteroids
Does diabetes increase the risk of cataracts?Diabetes is one of the keyfactors that result in thedevelopment of cataracts.
Although the reasons whyare still not fully
understood, people withdiabetes mellitus
statistically face a 60%greater risk of developingcataracts. As with most
complications of diabetes,maintaining good controlof your blood sugar levelswill help to reduce your
risk.
In addition, research hasshown that people with
type 2 diabetes who lowertheir HbA1c level by just1% can reduce their riskof cataracts by 19%.
How are Cataracts Treated?
Cataracts treatment has advanced
considerably in recent years.
Surgery is often prescribed, with
the lens removed and replaced with
an artificial one. Cataract surgery is
widely recommended and is
commonly performed.
Your ophthalmologist will determine
whether you need cataract surgery.
Cataract surgery is generally safe,
so the point at which an operation
is undertaken depends partly on
the individual.
Cataract operations are typically
day cases, with the local
anaesthetic often sited as the most
uncomfortable part.
For people with diabetes, there is a
slightly greater risk of developing
more serious problems such as
macula oedema, diabetic
retinopathy complications, and
infections as a result of the surgery.
Diabetic MaculopathyDiabetic maculopathy may
result from retinopathy
Diabetic maculopathy is a
condition that can result from
retinopathy. Maculopathy is
damage to the macula, the
part of the eye which provides
us with our central vision.
A common from of damage is
from diabetic macular
oedema (DMO) in which fluid
builds up on the macula.
Diabetic maculopathy is often
treated by laser surgery.
A number of other treatments
are possible but there has
recently been a lot of
discussion about which
treatments are appropriate .
The macula is the part of the
eye that helps to provide us
with our central vision.
Diabetic maculopathy is when
the macula sustains some
form of damage. One such
cause of macular damage is
from diabetic macular
oedema whereby blood
vessels near to the macula
leak fluid or protein onto the
macula.
If the leakages cause the
retina to harden and exudates
(deposits of fat from the
blood) become significantly
large and close to the fovea,
then the condition is termed
as Clinically Significant
Macular Oedema (CSMO).
Symptoms of diabetic maculopathy
The symptoms of diabetic maculopathy are a blurring of one’s central vision.
This may be noticed by:
Trouble with reading
Recognising faces in the centre of your vision
How is diabetic maculopathy /
diabetic macular oedema treated?
Mild macular oedema may resolve
itself without treatment but most
people will need the first line of
diabetic maculopathy treatment
which is laser photocoagulation
treatment.
Other treatments include having
injections of what are called anti
VEGF drugs (antivascular
endothelial growth factor), such as
Lucentis or Avastin.
In December 2012, Lucentis was
approved for use in treating
diabetic macular oedema in
Scotland.
Another treatment, which is rare
because of the side effects that can
exist, is to have injections of
intravitreal steroids.
Diabetic RetinopathyRetinopathy is a
disease of the retina .
The retina is the nerve
layer that lines the back
of your eye. It is the
part of your eye that
“takes pictures” and
sends the images to
your brain.
Many people with
diabetes get
retinopathy. This kind of
retinopathy is called
diabetic retinopathy
(retinal disease caused
by diabetes).
Diabetic Retinopathy – CauseDiabetic retinopathy canlead to poor vision andeven blindness. Most ofthe time, it gets worse
over many years. At first,the blood vessels in the
eye get weak.
This can lead to bloodand other liquid leakinginto the retina from theblood vessels. This iscalled nonproliferativeretinopathy. And this isthe most common
retinopathy. If the fluidleaks into the center ofyour eye, you may have
blurry vision.
Most people withnonproliferative
retinopathy have nosymptoms.
If blood sugar levels stay high,
diabetic retinopathy will keep getting
worse. New blood vessels grow on
the retina.
This may sound good, but these
new blood vessels are weak. They
can break open very easily, even
while you are sleeping.
If they break open, blood can leak
into the middle part of your eye in
front of the retina and change your
vision.
This bleeding can also cause scar
tissue to form, which can pull on the
retina and cause the retina to move
away from the wall of the eye
(retinal detachment).
This is called proliferative
retinopathy. Sometimes people
don’t have symptoms until it is too
late to treat them. This is why
having eye exams regularly is so
important.(Get your eyes checked at
least once a year for Diabetic
Retinopathy)
Retinopathy can also cause swelling
of the macula of the eye. This is
called macular edema.
The macula is the middle of the
retina, which lets you see details.
When it swells, it can make your
vision much worse. It can even
cause legal blindness.
If you are not able to keep your
blood sugar levels in a target range,
it can cause damage to your blood
vessels.
Diabetic retinopathy happens when
high blood sugar damages the tiny
blood vessels of the retina.
When you have diabetic retinopathy,
high blood pressure can make it
worse
High blood pressure can cause
more damage to the weakened
vessels in your eye, leading to more
leaking of fluid or blood and clouding
more of your vision.
Diabetic Retinopathy – SymptomsMost of the time, there areno symptoms of diabeticretinopathy until it starts tochange your vision. Whenthis happens, diabeticretinopathy is already
severe. Having your eyeschecked regularly can finddiabetic retinopathy earlyenough to treat it and help
prevent vision loss.
If you notice problemswith your vision, call an
eye doctor(ophthalmologist) rightaway. Changes in visioncan be a sign of severedamage to your eye.These changes can
include floaters, pain inthe eye, blurry vision, or
new vision loss.
An eye exam by an eye specialist
(ophthalmologist or optometrist) is
the only way to detect diabetic
retinopathy.
Having a dilated eye exam
regularly can help find retinopathy
before it changes your vision. On
your own, you may not notice
symptoms until the disease
becomes severe.
Symptoms of diabetic retinopathy
and its complications may include:
Blurred, double, or distorted vision
or difficulty reading.
Floaters or spots in your vision.
Partial or total loss of vision or a
shadow or veil across your field of
vision.
Pain, pressure, or constant
redness of the eye.
Diabetic Retinopathy – What Increases Your RiskYour risk for diabetic retinopathy
depends largely on two things: how
long you have had diabetes and
whether or not you have kept good
control of your blood sugar.
You can control some risk factors,
which are things that may increase
your risk for diabetic retinopathy
and its complications.
Risk factors that you can control
include:
Pregnancy
Women who have diabetes are at
increased risk of developing
retinopathy during pregnancy.
In women who already have
retinopathy when they become
pregnant, the condition can become
much worse during pregnancy.
If you get pregnant, you will need to
have an eye exam sometime during
the first 3 months. You’ll also need
close followup during your
pregnancy and for 1 year after you
have your baby.
Consistently high blood sugar
High blood sugar levels increase
your risk of retinopathy.
(Hyperglycaemia) Keeping your
blood sugar levels in a target range
can reduce your risk for diabetic
retinopathy and can slow the
progression of the disease if it has
already started.
High blood pressure
In general, people with diabetes
who also have high blood pressure
are more likely to develop
complications that affect the blood
vessels in the body, including those
in the eyes.
Delayed diagnosis and treatment
Getting a dilated eye exam will not
prevent retinopathy. But it may
reduce your risk of severe vision
loss from complications of
retinopathy. By detecting it early,
you can get treatment that can
prevent vision loss and delay the
progression of the disease.
SmokingAlthough smoking has
not been proved to
increase the risk of
retinopathy, smoking
makes many of the
other health problems
faced by people with
diabetes worse,
including disease of
the small blood
vessels.Stopping
smoking has many
health benefits ,it will
reduce your chances of
getting serious diabetic
complications as well
as the financial gain
you will have more
money in your pocket
at the end of the
month.
Diabetic Retinopathy – Exams and Tests
Diabetic retinopathy canbe detected during adilated eye exam by anophthalmologist or
optometrist.
An exam by your primarydoctor, during which youreyes are not dilated, is notan adequate substitute fora full exam done by anophthalmologist. Eyeexams for people withdiabetes can include:
Visual acuity testing
Visual acuity testingmeasures the eye’s abilityto focus and to see detailsat near and far distances.It can help detect visionloss and other problems.
Ophthalmoscopy and slit lamp
exam
These tests allow your doctor
to see the back of the eye and
other structures within the eye.
They may be used to detect
clouding of the lens (cataract),
changes in the retina, and
other problems.
Gonioscopy
Gonioscopy is used to find out
whether the area where fluid
drains out of your eye (called
the drainage angle) is open or
closed.
This test is done if your doctor
thinks you may have
glaucoma, a group of eye
diseases that can cause
blindness by damaging the
optic nerve.
Tonometry
This test measures the
pressure inside the eye, which
is called intraocular pressure
(IOP).
It is used to help detect
glaucoma. Diabetes can
increase your risk of
glaucoma.
Your doctor may also do a test
called an optical coherence
tomography (OCT) to check
for fluid in your retina.
Sometimes a fluorescein
angiogram is done to check
for and locate leaking blood
vessels in the retina,
especially if you have
symptoms, such as blurred or
distorted vision, that suggest
damage to or swelling of the
retina.
Fundus PhotographyCan track changes in theeye over time in peoplewho have diabetic
retinopathy and especiallyin those who have been
treated for it.
Fundus photographyproduces accurate
pictures of the back of theeye (the fundus).
An eye doctor cancompare photographs
taken at different times towatch the progression ofthe disease and find outhow well treatment is
working.
But the photos do nottake the place of a full eye
exam.
Early DetectionEarly detection andtreatment of diabeticretinopathy can help
prevent vision loss. Forpeople in whom diabeticretinopathy has not beendiagnosed, the DiabetesAssociation recommendsthat screening be donebased on the following
guidelines:
People with type 1diabetes who are age 10and older should have adilated eye exam within 5years after diabetes is
diagnosed and then everyyear.
People with type 2diabetes should have anexam as soon as diabetesis diagnosed and then
every year.
If your eye exam
results are normal,
your doctor may
consider followup
exams less often.
For example, you
may have an exam
every 2 years. But if
you are diagnosed
with retinopathy,
you may need
frequent eye
exams.
Women who have type
1 or type 2 diabetes
and who are planning
to become pregnant
should have an exam
before becoming
pregnant, if possible,
and then once during
the first 3 months (first
trimester) of
pregnancy.
The eye doctor can
decide whether you
need further screening
for retinopathy during
pregnancy based on
the results of the first
trimester exam.
Diabetic Retinopathy – TreatmentThere is no cure for
diabetic retinopathy. Butlaser treatment
(photocoagulation) isusually very effective atpreventing vision loss if itis done before the retina
has been severelydamaged.
Surgical removal of thevitreous gel (vitrectomy)may also help improve
vision if the retina has notbeen severely damaged.
Sometimes injections ofan antiVEGF (vascularendothelial growth factor)
medicine or an antiinflammatory medicinehelp to shrink new bloodvessels in proliferativediabetic retinopathy.
Because symptoms maynot develop until the
disease becomes severe,early detection throughregular screening isimportant. The earlierretinopathy is detected,the easier it is to treat andthe more likely vision will
be preserved.
You may not needtreatment for diabetic
retinopathy unless it hasaffected the center
(macula) of the retina or,in rare cases, if your side(peripheral) vision hasbeen severely damaged.
But you do need to haveyour vision checked
regularly.
If the macula has been
damaged by macular edema,
you may need laser
treatment.
For more severe retinopathy,
you may need either laser
treatment or vitrectomy.
These procedures can help
prevent, stabilize, or slow
vision loss when they are
done before the retina has
been severely damaged.
Newer treatment includes
medicines like antiVEGF
medicine or steroids that are
injected into the eye.
Surgical removal of the
vitreous gel (vitrectomy) is
done when there is bleeding
(vitreous hemorrhage) or
retinal detachment, which are
rare in people with earlystage
retinopathy. Vitrectomy is also
done when severe scar tissue
has formed.
Diabetic Retinopathy – Treatment
Treatment for diabeticretinopathy is often veryeffective in preventing,delaying, or reducing
vision loss.
But it is not a cure for thedisease. People who havebeen treated for diabeticretinopathy need to be
monitored frequently by aneye doctor to check for
new changes in their eyes.
Many people with diabeticretinopathy need to be
treated more than once asthe condition gets worse.
Also, controlling your blood
sugar levels is always
important. This is true even if
you have been treated for
diabetic retinopathy and your
eyes are better. In fact, good
blood sugar control is
especially important in this
case so that you can help
keep your retinopathy from
getting worse.
Ideally, laser treatment should
be done early in the course of
the disease to prevent serious
vision loss rather than to try to
treat serious vision loss after
it has already developed.
People with diabetes who
have any signs of retinopathy
need to be examined as soon
as possible by an
ophthalmologist.
Diabetic Retinopathy – PreventionThere are steps you can take to
reduce your chance of vision loss
from diabetic retinopathy and its
complications:
Control your blood sugar levels.
Keep blood sugar levels in a target
range by eating a healthful diet,
frequently monitoring your blood
sugar levels, getting regular
physical exercise, and taking
insulin or medicines for type 2
diabetes if prescribed.
Control your blood pressure.
Retinopathy is more likely to
progress to the severe form and
macular edema is more likely to
occur in people who have high
blood pressure. It is not clear
whether treating high blood
pressure can directly affect long
term vision.
But in general, keeping blood
pressure levels in a target range
can reduce the risk of many
different complications of diabetes.
Have your eyes examined by an
eye specialist (ophthalmologist or
optometrist) every year
Screening for diabetic retinopathy
and other eye problems will not
prevent diabetic eye disease. But it
can help you avoid vision loss by
allowing for early detection and
treatment.
See an ophthalmologist if you have
changes in your vision. Changes in
visionsuch as floaters, pain or
pressure in the eye, blurry or
double vision, or new vision loss
may be symptoms of serious
damage to your retina. In most
cases, the sooner the problem can
be treated, the more effective the
treatment will be.
The risk for severe retinopathy and
vision loss may be even less if you:
Don’t smoke
Although smoking has not been
proved to increase the risk of
retinopathy, smoking may
aggravate many of the other health
problems faced by people with
diabetes, including disease of the
small blood vessels.
Avoid hazardous activities
Certain physical activities, like
weight lifting or some contact
sports, may trigger bleeding in
the eye through impact or
increased pressure.
Avoiding these activities when
you have diabetic retinopathy
can help reduce the risk of
damage to your vision.
Get adequate exercise
Exercise helps keep blood
sugar levels in a target range,
which can reduce the risk of
vision damage from diabetic
retinopathy.
Talk to your doctor about what
kinds of exercise are safe for
you.
Everything You Need To Know About Diabetes
Diabetes Support Site Website
http://diabetessupportsite.com
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