Diabetes is a disease that profoundly affects many areas of your body, including your eyes. It increases your risk for eye conditions, such as glaucoma and cataracts.
The main concern for eye health in people with diabetes is the development of diabetic retinopathy.
Diabetic retinopathy is a disease that develops when the blood vessels in the retina are damaged. The retina is the light-sensitive portion of the back of your eye. As the damage worsens, you may begin to lose your vision. Your vision may become blurry, less intense, and begin to disappear.
This condition can affect people with type 1 or type 2 diabetes. The longer you live with diabetes, the more likely you are to develop complications such as diabetic retinopathy. This is why making lifestyle changes and learning how to manage diabetes is so important.
Types of diabetic retinopathy
Non-proliferative diabetic retinopathy (NPDR)
NPDR is also known as background retinopathy. It is called “non-proliferative” because the eye does not make new blood vessels during the early stages of diabetic retinopathy.
During the early stages of retinopathy, damaged blood vessels often leak blood and fluid from the eye. In some cases, the center of the retina, or macula, begins to swell. This causes a condition called macular edema.
The three stages of NPDR are mild, moderate and severe, which can progress to proliferative diabetic retinopathy of another type or fourth stage.
Proliferative diabetic retinopathy (PDR)
Proliferative diabetic retinopathy, or advanced retinopathy, is the stage of retinopathy in which new blood vessels begin to grow within the retina. These new blood vessels are usually abnormal and grow in the center of the eye.
Symptoms of diabetic retinopathy
In its earliest stages, diabetic retinopathy may not cause symptoms. Initial symptoms may be barely noticeable or mild. Over time, the condition can worsen and lead to partial and then complete blindness. You should see your doctor if you experience any of these symptoms:
- Floaters, or dark dots and strings, in your field of vision.
- Dark or empty areas in your field of vision.
- Blurry vision.
- Difficulty focusing.
- Vision changes that seem to fluctuate.
- Altered color vision.
- Partial or total loss of vision.
Diabetic retinopathy most often affects both eyes at the same time and to the same extent. If you have problems with only one eye, that doesn’t mean you don’t have diabetic retinopathy. However, it could indicate another eye problem. Make an appointment to see your doctor and find an appropriate treatment plan.
Causes of diabetic retinopathy
The accumulation of excess sugar in the blood can lead to a number of health problems. In your eyes, too much glucose can damage the small vessels that supply blood to your retina. Over time, this damage can block your blood flow.
Chronic damage to the blood vessels in the retina affects your vision. When blood flow decreases, your eye tries to fix the situation by growing new blood vessels.
The process of growing new blood vessels is called neovascularization. These ships are not as effective or as strong as the originals. They may leak or tear, which can negatively affect your vision.
Diabetic retinopathy is a concern for anyone with diabetes. There are additional risk factors for developing diabetic retinopathy:
Women who are pregnant and have diabetes may experience more problems with diabetic retinopathy than women who have diabetes and who are not pregnant. Your doctor may suggest that you have additional eye exams during your pregnancy.
Time with diabetes
The longer you have diabetes, the higher your risk of complications, including diabetic retinopathy.
Poor disease management
Your risks of developing complications are higher if your diabetes is not under control. Tight glycemic control is the most effective tool to prevent diabetic retinopathy. Early detection and working closely with your doctor to manage your diabetes are important.
Other medical conditions
Other medical conditions or diseases can also increase your risk of developing retinopathy. They include high blood pressure, heart disease, and high cholesterol.
African Americans and Hispanics have a higher risk of developing diabetic retinopathy than the general population.
People with diabetes who smoke are more likely to develop retinopathy.
Diabetes and your eyes
The best way to manage diabetes-related eye problems is through early detection of retinal abnormalities, regular monitoring, and prompt treatment. Early detection and treatment usually begin with a retinal exam.
The American Diabetes Association (ADA) recommends that people with type 1 diabetes have their first eye exam within the first five years after diagnosis. If you have type 2 diabetes, the ADA recommends that you have your first eye exam soon after you are diagnosed.
This is because type 2 diabetes often goes undetected and goes undiagnosed for years. The retinopathy may have started during that time. An eye exam will help your doctor determine if you already have damage.
The ADA recommends that you get an eye exam every year after your first exam. If you wear glasses or contact lenses, you will probably need an annual eye exam to keep your prescription up to date.
During that exam, your doctor will do some minor tests to see if your vision has changed as a result of diabetes.
You may develop retinopathy and find that your symptoms do not progress or completely stagnate. If that happens, the likelihood that you will be monitoring your eyes for changes for the rest of your life is high.
If your doctor diagnoses and treats retinopathy, they may order tests several times a year. The number of eye exams you need each year will largely depend on the severity of your retinopathy.
How is diabetic retinopathy diagnosed?
The only way to diagnose diabetic retinopathy is to have a dilated eye exam. For this test, your ophthalmologist will place drops in your eyes to widen or dilate your pupils. Dilation of the pupils helps the doctor to see the inside of the eyes more easily and inspect the damage caused by retinopathy.
While your eyes are dilated, your doctor may also perform one of two diagnostic tests:
Optical coherence tomography (OCT)
OCT provides images of your eyes. These views are taken from a cross section so your doctor can see very fine details in your eyes. These images show the thickness of the retina and where fluid can leak from damaged blood vessels.
Your doctor can take pictures of the inside of your eyes while they are dilated. Then, while your eyes are still dilated, your doctor will inject a special dye into your arm. This dye will help your doctor identify which blood vessels are blocked and which vessels are leaking.
Preparing for your doctor’s appointment
Come to your appointment prepared to talk about what you have been experiencing.
Specify what you are experiencing. Write down the following details and bring them with you:
- The symptoms you are experiencing.
- When symptoms happen.
- What are your blood glucose levels at the time of the episode.
- A list of any other health problems you have besides vision problems, when they occur, and what stops them.
- Any other information that you think is important for your doctor to know.
Bring a list of questions
Your doctor will have several questions and information for you. Make sure you’re prepared with a list of questions you have about what you’ve been experiencing and what the next steps might be.
How is diabetic retinopathy treated?
Treatment for diabetic retinopathy aims to slow or stop the progression of the disease. The exact treatment depends on the type of retinopathy you have, how severe your condition is, and how well your diabetes is controlled. Possible treatments include the following:
Be sure to monitor the progress of the retinopathy
You may not need treatment yet if your retinopathy is not severe or does not cause any symptoms. However, annual eye exams are still important. Going for annual exams is the only way your doctor can monitor changes.
Maintain a healthy lifestyle
You need to manage your diabetes and control your blood glucose level to reduce the chance that your retinopathy will get worse.
Focal laser treatment
You may need focal laser treatment if you have advanced diabetic retinopathy. This treatment can stop or slow blood loss from blood vessels by burning abnormal blood vessels. This treatment should stop the symptoms and possibly reverse them.
Scattering laser treatment
This type of laser treatment can shrink and scar abnormal blood vessels, making them less likely to grow or bulge in the future.
Your doctor may suggest a minor surgery called a vitrectomy to relieve retinopathy symptoms if lifestyle or laser treatments don’t work.
During this procedure, your doctor will make a small incision in your eye to remove the blood that has leaked from the blood vessels. Your doctor will also remove the scar tissue that is pulling on your retina and affecting your vision.
Visual assistive devices
Vision problems are often corrected once treatment is complete and your eyes have had time to heal. Your doctor can treat any permanent vision changes with visual assistive devices, such as contact lenses or glasses.
What is the outlook for people with diabetic retinopathy?
Treatments for diabetic retinopathy are often very successful, but they are not a cure. Diabetes is a chronic disease, which means that you are likely to experience complications from the disease for the rest of your life. This includes vision problems.
If you develop diabetic retinopathy, you may find relief with treatment, but you will need regular eye exams to monitor problems for worsening. Eventually you may need more treatment for retinopathy.
The best way to reduce the effects of diabetes on the eyes and the rest of the body is to control blood sugar levels and maintain a healthier lifestyle.
You can do the following to help prevent vision loss and other diabetes complications:
- Go to regular appointments with your doctor to check your health, including the health of your eyes.
- Don’t skip dates just because you don’t have problems. Some of the more mundane symptoms may actually be a small sign of a bigger problem.
- Contact your doctor immediately if anything changes with your health or vision.
- Stop smoking if you smoke.
- Lose weight if you are overweight. Weight loss is important to control your blood sugar level.
- Maintain a healthy weight to help improve your insulin sensitivity and lower your blood sugar levels.
- Eat a healthy, well-balanced diet to help you achieve and maintain an ideal body weight.
Talk to your doctor if you are having trouble losing weight or quitting smoking. They can help you develop a treatment plan. Your doctor can also refer you to a dietitian who can help you develop a diet that promotes weight loss and a healthy lifestyle.