November 10, 2019

Diabetic Retinopathy: A Pound of Prevention Is Worth an Ounce of Cure

Diabetic eye disease—specifically diabetic retinopathy— is a worldwide epidemic, and one that hits close to home at Island Retina. With diabetes on the rise, we’re seeing more and more microvascular complications. That’s why this November, in honor of Diabetic Eye Disease Month, we’re taking every opportunity to educate the public about the risks of diabetic eye damage and the importance of regular eye exams in prevention.

How does diabetes damage eyes?

First of all, it’s important to understand that diabetes is the leading cause of new cases of blindness in adults. In fact, people with diabetes are 25 times more likely to suffer permanent vision loss than those without diabetes.

Diabetes can have some short-term effects on the eye. Short term blurriness can be the result of fluid that moves in and out of the eye with low or high blood sugar. This fluctuation can cause changes in the light-sensitive tissue at the back of the eye responsible for focus—as the shape of the lens changes, blurriness results. In short-term circumstances, this will resolve itself with the leveling of proper blood sugar levels, but can ultimately lead to cataract formation. Diabetics, on average, require cataract surgery 10 years sooner than nondiabetics.

And diabetics who do not get eye care are at significant risk of permanent damage to their vision and, possibly, blindness.

What is diabetic retinopathy?

Diabetic retinopathy is an eye disease that causes changes to the blood vessels in the retina (the lining at the back of your eye that changes light into images).

It afflicts more than 8 million Americans living with type 1 or 2 diabetes. Risk of developing the complication increases as a result of the duration of diabetes, inconsistent control over glucose levels, high blood pressure, high cholesterol, pregnancy, and tobacco use.

Diabetic retinopathy progresses through four stages:

  • Mild nonproliferative retinopathy: As with most serious diabetic eye diseases, diabetic retinopathy begins with blood vessel problems in the eye. Small areas of swelling will occur in the retina’s blood vessels.
  • Moderate nonproliferative retinopathy: Over time, high blood glucose can lead to the damage or blockage of small blood vessels that nourish the retina. These damaged vessels may leak fluid and cause more swelling.
  • Severe nonproliferative retinopathy: With more blood vessels becoming blocked, new, weak blood vessels begin to grow as the eye attempts to create new pathways. However, these new blood vessels don’t develop properly.
  • Proliferative retinopathy: Because these new blood vessels are abnormal, they can rupture and bleed. This can lead to scarring, retinal detachment or dangerously high pressure inside of the eye.

How does this affect your vision?

  • Vitreous hemorrhaging: If the amount of bleeding is small, small dark spots (floaters) may be seen in the line of vision. In more severe cases, blood can fill the area around the retina and block vision. Eyes with hemorrhage require laser treatment and/or intravitreal injections of a drug that will dry up the leaking blood vessels., Sometimes the vitreous hemorrhage clears by itself , but sometimes surgery is required to remove the blood.

  • Retinal detachment: The abnormal blood vessels created to provide blood to the eye, stimulate scar tissue. Scar tissue can pull the retina from the back of the eye. This can cause spots in vision, flashes of light, and even severe vision loss. This requires a surgical repair to save vision.
  • Glaucoma: Pressure can build in the eye, as newer blood vessels interfere with the normal flow of fluid out of the eye. Damage to the optic nerve that is responsible for carrying images from the eye to the brain can occur from this pressure, resulting in neovascular glaucoma. This is a very serious problem and requires extensive treatment.
  • Blindness: Untreated, diabetic retinopathy, glaucoma or both will eventually lead to complete vision loss.

Prevention

Serious diabetic eye disease that needs treatment can exist without any changes in vision. That is why it’s so important to get regular eye exams. The best way to detect a complication is through a comprehensive eye examination with dilation designed to recognize the early signs of the disease.

Careful management of diabetes and regular eye examinations are the best ways to prevent vision loss.

  • Maintain stable blood sugar, healthy blood pressure and low cholesterol.
  • Visit an eye doctor at least once per year, or as often as recommended by your healthcare professional. 
  • Keep a healthy lifestyle that includes exercising regularly, not smoking, and eating a balanced diet.
  • Pay attention to vision changes and alert your doctor to any differences.

Don’t let diabetes steal your eyesight

Diabetes doesn’t have to lead to vision loss. Taking an active role in diabetes management and early intervention eye care can prevent irreversible damage and lead to years of seeing clearly. Education is the best defense and the most important aspect of prevention.