Vision

Diabetic retinopathy is the most common serious visual complication associated with diabetes. It occurs when the blood vessels leading to the retina of the eye become blocked and/or leak fluid or blood (hemorrhage) into the eye. According to the National Institutes of Health, diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. Although most people with type 1 and type 2 diabetes will experience some degree of retinopathy eventually, early diagnosis and treatment can dramatically lower the chances of vision loss. The American Diabetes Association recommends that people with diabetes get a dilated eye exam at least annually to detect signs of eye disease early and to learn about the latest advances in eye disease prevention.

Other eye diseases associated with diabetes include:

• Macular edema. A complication of retinopathy characterized by swelling of the macula, the central part of the retina allowing detailed and color vision; Diabetic Macular Edema (DME) is a leading cause of permanent vision loss due to diabetes.
• Glaucoma. A potentially blinding eye disease caused by fluid build up and high pressure inside the eye that damages the optic nerve, causing abnormal blind spots to develop; most patients with glaucoma have no symptoms until significant nerve damage and vision loss have occurred.
• Cataracts. A clouding of the lens inside the eye that results in fuzzy vision and glare. People with diabetes are twice as likely to develop cataracts than the general population, and tend to develop them at an earlier age.
• Dry Eye. Diabetes often results in less production of tears that are necessary to moisturize the surface of the eye. In addition, diabetes lessens the quality of tears, leading to symptoms of burning, scratchiness, light sensitivity, reduced visual clarity and over-production of lower quality ‘crying tears’ that make the eyes water.

Treatment for eye complications of diabetes depends upon the particular problem. For diabetic retinopathy (including macular edema), it includes laser treatment and vitrectomy (a surgical procedure that involves replacing the vitreous fluid of the eye with another solution), as well as placement of medications inside the eye. For glaucoma, it includes eye drop medications to lower eye pressure, laser treatment and, sometimes, glaucoma surgery. For cataract, treatment is surgical removal of the cloudy lens. For dry eye, treatment includes use of artificial tears, medications to reduce inflammation and increase the eye’s production of tears, blocking the tear drainage ducts thereby increasing the amount of moisture on the eye and, more recently, use of nutritional strategies to increase the quantity and quality of tears. 

Other positive health changes such as smoking cessation, controlling blood pressure, maintaining healthy blood cholesterol levels, and staying in control of your diabetes by keeping your A1c down also help lower the risk of all eye complications associated with diabetes.

Reviewed by Dr. A. Paul Chous, MA OD, FAAO. 4/12