Diabetes and the Eye

Overview

Diabetes is one of the major causes of blindness in the United States. The incidence of diabetic eye disease rises slowly in the first 10 years. 80% of people with diabetes for over 15 years have some diabetic retinopathy. Retinopathy may be present when diabetes is first diagnosed. Early diagnosis and treatment of diabetic eye diseases is important. There may be no symptoms. Yearly eye exams can identify problems so they may be treated early and help prevent vision loss.

Diabetic Retinopathy
Diabetic retinopathy occurs when abnormal material is deposited in the walls of capillaries or small blood vessels in the retina. This causes narrowing, and weakness in the wall of the blood vessel. The blood vessel may bulge causing a microaneurysm, which may leak fluid and fatty material (hard exudates) or rupture causing hemorrhages. This leakage of fluid may lead to macular edema or swelling of the area of central vision. This may cause reduction in vision. Damaged blood vessels can also reduce the amount of blood nourishing the retina. This reduced blood flow causes fragile new capillaries to grow. These new capillaries (called neovascularization) bleed easily causing large hemorrhages in the vitreous gel, and sudden vision loss. Neovascularization may also cause traction on the retina, scar tissue, and/or retinal detachment, destroying the retina and impairing the vision further.

prevention

Careful control of the diabetes with diet, oral medications and sometimes insulin can help prevent or delay the onset of diabetic retinopathy. Controlling blood pressure and cholesterol may also help prevent diabetic retinopathy. Yearly eye examinations are very important to identify early eye disease as there may be no symptoms of diabetic retinopathy until it is advanced.

Treatment

Treatment, if begun early, can help reduce vision loss. The most common form of treatment is photocoagulation or laser treatment. This uses a bright beam of light to treat the retina. Treatment may focus on the macula to reduce leakage and macular edema (swelling) – focal laser photocoagulation. It may also be used to treat the more peripheral retina (pan retinal photocoagulation) to reduce neovascularization. Vitrectomy surgery is used to treat advanced diabetic retinopathy. Vitrectomy removes the vitreous gel, hemorrhage and sometimes scar tissue. Newer treatments, such as injections of steroid medications may also be used to treat diabetic retinopathy.

Vision Changes
Changes in blood sugar may temporarily change vision, especially when the blood sugar is elevated. Increase in blood sugar causes the lens in the eye to swell, resulting in blurry vision. This resolves when the blood sugar returns to normal. The first symptom of diabetes may include blurry vision and the need to change glasses. The blood sugar should be under control for at least one month before new glasses are prescribed.

Cataracts
Diabetes may lead to cataract formation. Cataracts cause blurry vision, often impairing reading or the ability to see distant objects and glare, especially at night. Cataracts can be removed with surgery to help restore vision.

If you have diabetes or questions, please call us
at 847-328-2300 or 800-653-EYES.

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