Diabetes and your eyes - What you need to know about Diabetic Retinopathy

Diabetes is the leading cause of preventable blindness for people under the age of 74. Thankfully, if you keep up with your eye exams, a lot of the diabetes-related vision issues are easily detectable. As long as they are caught early, these issues can then be treated and managed by taking a few simple action steps.

The scary thing is that studies show many people with diabetes are not getting their annual eye exams as they should be. The statistics tell us that up to half of people with diabetes aren’t scheduling, are no-showing, or are delaying their eye exams past the recommended yearly mark.

On top of this, 20 to 40 percent of people newly diagnosed with diabetes show up with certain eye issues like retinopathy already developed. These frankly unacceptable numbers about a preventable issue give us healthcare providers something to work on when it comes to improving the health of our society-with education being step 1.

There are several vision problems that occur as a result of diabetes including diabetic retinopathy, diabetic macular edema, glaucoma, and cataracts. In this article, we’ll be discussing the most common cause of vision loss in people with diabetes–diabetic retinopathy. 

What is Diabetic Retinopathy?

Perhaps the most significant and prominent vision problem facing people with diabetes is Diabetic Retinopathy. In this condition, the tiny blood vessels in your retina become damaged. This happens because too much sugar in your blood clogs up these tiny vessels which results in the blood supply being cut off.

The eye then tries to heal itself by growing new vessels, but unfortunately, it doesn’t do a great job at it. These newly formed blood vessels develop poorly, and as a result, leak very easily.

There are two types of diabetic retinopathy: Early Diabetic Retinopathy and Advanced Diabetic Retinopathy.

In Early Diabetic Retinopathy (also known as nonproliferative diabetic retinopathy, NPDR), the eye isn’t trying to make new blood vessels yet. In this early form of the disease, the walls of the blood vessels in your retina start to weaken. These vessel walls begin to develop bulges which leak fluid and blood into the retina.

As more vessels become blocked NPDR moves from the classification of mild to severe. Also in NPDR the leaky vessels could result in swelling of the center of the retina called the macula and swelling of tiny nerve fibers of the eye. These issues frequently result in changes to your vision.

Advanced Diabetic Retinopathy (also known as proliferative diabetic retinopathy, PDR) is where the eye creates the new but weak blood vessels to replace the closed-off and damaged vessels. These new weak vessels leak into the clear, jelly-like center of the eye called the vitreous.

This becomes a problem as you may start to see dark floaters or cobweb-like structures. Even more vision threatening are scar tissues that form as a result of the growth of new blood vessels. These can cause the retina to detach from the back of the eye. This leads to severe vision loss or blindness.

Furthermore, if the new vessels block the normal flow of fluid in the eye, the increased eye pressure can damage the optic nerve. As a result, many people with uncontrolled diabetic retinopathy also develop glaucoma.

How do you prevent diabetic retinopathy?

To decrease the chances of developing diabetic retinopathy you have to manage your diabetes. Eat healthy, exercise, monitor your blood sugar, control your blood pressure, keep cholesterol at healthy levels, and if you smoke, ask your primary care provider about quitting. Of course, get your eye exam at least annually or as directed by your eye doctor.

How is diabetic retinopathy treated?

If you are in the early stages of diabetic retinopathy (NPDR), your eye doctor may want to check your eyes every 2 to 4 months. If the retinopathy progresses into the more severe stages or you are experiencing changes in your vision, treatment will be needed as soon as possible.

There are three primary treatments for diabetic retinopathy: injection medication, laser procedures, and eye surgery.

Injection medications, called anti-VEGF, work by slowing down or even reversing diabetic retinopathy. Laser procedures work by causing blood vessels to shrink and stop leaking, which in turn reduces swelling in the eye. A type of eye surgery known as a vitrectomy is performed when the retina is bleeding too much or there are a lot of scars in the eye.

When to see an eye doctor

Make sure you are always keeping up with the appointments you have with your primary care provider and your endocrinologist. These healthcare experts help you on your path to controlling and managing your diabetes.

If you have diabetes, and even if your vision seems ok, see an eye doctor for a dilated eye exam at least every year. If you have diabetes and you become pregnant, your eye doctor will likely want to see you early in your pregnancy and a few more times until one year after giving birth.

If you experience symptoms of diabetic retinopathy including floaters, blurry vision, dark spotty vision, flashes, impaired color vision, fluctuating vision, or vision loss, contact your eye doctor immediately. 

Dr. Sally Mina, the founding optometrist of Motiveyes Eye Care in Plano, TX, is proud to partner with Village Health Partners to bring you this educational article. If you would like to schedule an eye exam with her, feel free to check availability at www.motiveyes.com.