Most people are aware that diabetes can have significant effects on the kidneys, heart, feet and eyes. However, few people are aware that it can affect the eyes without causing symptoms or blurry vision. It is not uncommon for diabetic eye disease to be present when a patient is first diagnosed with diabetes. The good news is most mild eye changes are reversible with good control of blood sugar.
After your initial diagnosis of diabetes you should have your eyes examined. People with both type 1 and type 2 diabetes are at risk for diabetic eye disease and an annual dilated eye exam is necessary to examine the retina (tissue lining the back of the eye that senses light entering the eye) for signs of changes or damage, a condition known as diabetic retinopathy.
What is retinopathy?
Diabetic retinopathy is damage to the blood vessels of the retina which can result in bleeding. People with early diabetic retinopathy often have no changes in vision or only mild vision problems. If left untreated diabetic retinopathy can result in blindness.
Stages of retinopathy
Early: Nonproliferative diabetic retinopathy is an early stage of retinopathy that includes small bulges in the blood vessels (micro-aneurysms) and small areas of bleeding in the retina (dot hemorrhages). Usually no changes in vision are noted at this stage.
Advanced: Proliferative diabetic retinopathy occurs if blood sugar continues to remain high or fluctuates significantly, resulting in more damage to the delicate retinal blood vessels. This damage can lead to a decrease in oxygen to the retina. If the retina is not getting enough oxygen new blood vessels may start to grow. These blood vessels are fragile and can break and bleed easily, leading to loss of vision. Treatment is needed to prevent vision loss.
Symptoms may include:
- Spots or dark “floaters” in vision
- Blurred vision
- Fluctuating vision
- Missing areas in vision
- Vision loss
- Difficulty with color perception
Swelling in the macula – the part of the retina used for central vision – is known as macular edema. This swelling is caused by damage to the retina that allows fluid to leak. If there is swelling – macular edema – treatment is needed to prevent vision loss. One symptom of macular edema is blurred vision; however, patients may not notice any changes in their vision.
Treatment: Nonproliferative diabetic retinopathy does not usually require treatment. However, because damage has already occurred to the retina, strict control of blood sugar is needed to prevent further damage.
Treatment for proliferative retinopathy is laser surgery and is required to prevent vision loss. This surgery is performed by an ophthalmologist and will decrease the growth of new, fragile blood vessels and decrease the amount of oxygen needed by the retina.
Treatment for diabetic macular edema is typically an injection of medication directly into the eye to decrease the swelling in the macula.
Because people with diabetes are at an increased risk of developing these serious eye conditions, it’s imperative to have annual eye exams and follow the advice of your eye doctor and healthcare provider. If there is damage to the retina, eye exams may be needed every three to six months.
Diabetes also increases your risk of heart disease, stroke, blindness, kidney disease, neuropathy (nerve damage) and amputation. Ask your doctor if you are at risk for diabetes and do what you can to prevent diabetes through diet and exercise. If you have diabetes, continue working with your doctors to maintain good control of your blood sugars through diet, exercise and medication.