Diabetes Eye Disease: What You Need to Know
I’ve worn glasses since middle school—long before my diabetes diagnosis. My nearsightedness is probably due to genetics. Okay, and maybe reading in low light.
But now, I take any changes to my vision very seriously. Every time my vision seems a little blurry or the bathroom light seems particularly harsh when I turn it on in the middle of the night, I notice. This is because, with diabetes, I am at higher risk of developing vision loss or blindness.
What is diabetic eye disease?
People with diabetes are at higher risk of developing vision loss or blindness because diabetes can cause damage to the blood vessels in the eye.
Chronic, high BG levels damage the blood capillaries in the eye leading to diabetic eye disease. Diabetic eye disease is not one thing, it can be any one or combination of this group of eye disorders:
Every one of these disorders can lead to vision loss or blindness.
Retinopathy happens when the blood vessels in your retina bleed or leak fluid. This causes distorted vision and can lead to blindness.
Diabetic macular edema (DME)
DME is caused when fluid builds up in the area of the retina called the macula causing swelling. This disrupts the sharpness of the image when looking straight ahead. DME follows from diabetic retinopathy. About half of people who develop diabetic retinopathy will also develop DME.
Cataracts is the clouding in the lens of the eye. People with diabetes are more likely to develop cataract at a younger age.
Glaucoma is optic nerve damage. Some forms of glaucoma are associated with elevated pressure in the eye itself, making managing blood pressure levels also important for eye health.
Symptoms of diabetic eye disease
A variety of symptoms point to eye damage due to diabetes, including:
- Blurry vision
- Distorted vision
- Vision that changes
- Colors that look different or change in appearance
- Spots or streaks floating in the vision (often called floaters)
- Dark or empty areas in the vision
Experiencing any of these symptoms, especially when blood glucose (BG) levels are high, is concerning. When this happens, it’s time to have a comprehensive dilated eye exam.
Risk factors for diabetic eye disease
The risk of developing diabetic eye disease increases with age. The CDC reports that among people with diabetes who are 40 or older one-third experience some level of diabetic retinopathy. For African Americans and Mexican Americans, the incidence is even higher.
The good news is that diabetic eye disease can often be reversed or arrested when caught early and addressed with proper treatment and follow-up. The not so good news is that these eye disorders often begin developing before any symptoms are apparent.
Chronic hyperglycemia adds to the risk
When chronic high blood glucose (BG) levels, or hyperglycemia, damages blood capillaries in they eyes this can cause vascular leaks and/or blocks. This, in turn, causes vision distortions and disruptions.
Diabetic eye exams are more comprehensive
Because diabetic eye disease affects the interior of the eye, a more comprehensive eye exam is needed. It’s not enough to test for the ability to see clearly at various distances (visual acuity).
A diabetic eye exam, in addition to testing visual acuity, also includes:
- Tonometry, to measure the pressure level inside the eye
- Pupil dilation, so that the doctor can examine the retina and optic nerve inside the eye
- Optical coherence tomography, which uses light waves to capture images of the inside of the eye
During the exam the doctor will check the retina for:
- Changes to the blood vessels
- Signs of leaking
- Macular swelling
- Changes to the eye lens
- Nerve damage
What can you do?
People with diabetes (regardless of type) have a higher risk of developing diabetic retinopathy. The NIH reports that somewhere between 40 and 45 percent of people with diabetes in the US have some stage of diabetic retinopathy. But only half of them know it.
The most important things you can do to lessen your chances of developing diabetic eye disease are:
- Have a comprehensive eye exam that includes pupil dilation every year
- Do your best to manage your BG levels on a daily basis
- Do your best to manage your blood pressure on a daily basis
Together, these three things put you in the best position for early detection, timely treatment, and effective follow-up which can limit the loss of vision and maybe even reverse diabetic eye disease.
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