Eye Complications of Diabetes and the Company They Keep

Blood vessel damage common to most disorders

By A. Paul Chous, MA, OD, FAAO
Tacoma, WA

Diabetes remains the leading cause of new blindness in Americans between the ages of 20 and 74. The major complication responsible for this terrible statistic is diabetic retinopathy (DR), damage to the light sensitive, highly vascular tissue lining the inside back wall of the eye. Most patients with diabetes will develop some degree of retinopathy over time. The key to preventing vision loss, however, is to delay the onset and retard the progression of diabetic retinopathy from less severe stages that have little or no meaningful impact on vision and quality of life to more severe stages that substantially impair vision and activities of daily living. Very often, diabetic retinopathy is associated with other blood vessel complications of diabetes and it is, I believe, useful for those of us with diabetes to be aware of the ‘bad company' that DR keeps so that we can be more proactive about both minimizing eye complications and seeking care for other problems commonly associated with DR.

For example, research shows that patients with gum (periodontal) disease are significantly more likely to have severe DR, and vice versa. Similar associations are also found between DR and diabetic kidney disease (nephropathy), nerve damage (neuropathy), and cardiovascular disease. The presence and severity of DR may double the risk of lower extremity amputations. Recently, obstructive sleep apnea – a relatively common breathing disorder especially seen in patients above ideal body weight – has been linked to DR and its worsening, as has erectile dysfunction.

Each of these diabetes complications shares at least some common biological basis. Chronic hyperglycemia damages the smallest blood vessels in the body, and there are lots of small blood vessels supplying the eyes, kidneys, nerves, and gums. Moreover, certain body tissues requiring lots of energy – notably the retina, kidney, and parts of the heart – do not require insulin to get glucose (sugar) inside of cells, a feature that ensures those cells have an energy source at all times (a good thing for cell survival). However, when glucose levels remain high, these cells can overload and become damaged over time. Of course, because diabetes is a ‘high maintenance' condition and puts extra psychological stress on both patients and families, it is not at all surprising that rates of depression and anxiety are higher in people with diabetes and are associated with poorer blood glucose control and higher risk of other complications.

The fact that eye complications often go hand in hand with other diabetes complications is disconcerting, I know. But knowledge is also power, and understanding these relationships can empower us to take better care of our condition and ask intelligent questions when working with our team of health care providers, whether they be primary care physicians, endocrinologists, dentists, pharmacists, podiatrists, mental health professionals and yes, eye doctors.

1 - Noma H, Sakamoto I, Mochizuki H, Tsukamoto H, et al. Relationship between periodontal disease and diabetic retinopathy. Diabetes Care. 2004 Feb;27(2):615
2 - Romero-Aroca P, Mendez-Marin I, Baget-Bernaldiz M, Fernndez-Ballart J, Santos-Blanco E. Review of the relationship between renal and retinal microangiopathy in diabetes mellitus patients. Curr Diabetes Rev. 2010 Mar;6(2):88-101
3 - Rosenson RS, Fioretto P, Dodson PM. Does microvascular disease predict macrovascular events in type 2 diabetes? Atherosclerosis. 2011 Jun 23.
4 - Kramer CK, Rodrigues TC, Canani LH, Gross JL, Azevedo MJ. Diabetic retinopathy predicts all-cause mortality and cardiovascular events in both type 1 and 2 diabetes: meta-analysis of observational studies. Diabetes Care. 2011 May;34(5):1238-44.
5 - Sahakyan K, Klein BE, Lee KE, Myers CE, Klein R. The 25-year cumulative incidence of lower extremity amputations in people with type 1 diabetes. Diabetes Care. 2011 Mar;34(3):649-51
6 - Kosseifi S, Bailey B, Price R, Roy TM, Byrd RP Jr, Peiris AN. The association between obstructive sleep apnea syndrome and microvascular complications in well-controlled diabetic patients. Mil Med. 2010 Nov;175(11):913-6.
7 - Hermans MP, Ahn SA, Rousseau MF. Erectile dysfunction, Microangiopathy and UKPDS risk in type 2 diabetes. Diabetes Metab. 2009 Dec;35(6):484-9
8 - de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ: Association of depression and diabetes complications: a meta-analysis. Psychosomatic Medicine 2001; 63(4):619–30.

Last Modified Date: July 01, 2013

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by Brenda Bell
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