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A study finds 1 in 4 people with diabetes have diabetic retinopathy. Azman Jaka/Getty Images
  • A new study finds a quarter of people with diabetes have retinopathy.
  • Diabetic retinopathy is when the blood vessels in the retina are damaged.
  • About 9.6 million people in the U.S. have diabetic retinopathy.

​​Diabetes is a medical condition that impacts 37.3 million Americans, or about 1 in 10 people according to the CDC.

However, the impact of diabetes doesn’t stop with just poor blood sugar control. It can also affect many other organs in the body including the eyes, resulting in a condition called diabetic retinopathy.

Diabetic retinopathy is when blood vessels in the retina are damaged and can result in blindness or vision loss.

Newly released data published in the journal JAMA Ophthalmology shows that past estimates were incorrect and the prevalence of this vision loss condition is much higher than previously believed.

The researchers in this study used data from the CDC’s Vision and Eye Health Surveillance System as well as data from the US Census Bureau.

For 2021, the research team estimated that approximately 9.6 million people had diabetic retinopathy. This makes up 26.43% of all individuals who have diabetes.

Of the 9.6 million people with diabetic retinopathy, they estimate that approximately 5%, or 1.84 million people, have vision-threatening forms of diabetic retinopathy.

The experts also found that those who were of Hispanic and black descent had a higher prevalence of vision-threatening diabetic retinopathy.

The research team also notes that the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy increased substantially with age, it decreased in older age groups. Researchers relate this to people with more severe diabetes who tend to have earlier mortality.

“Uncontrolled or poorly controlled diabetes in the main factor responsible for development and progression of diabetic retinopathy. Lack of screening until advanced changes have occurred can lead to visual impairment and even blindness among young patients in the peak working age of their career,” said Dr. Sapna Gangaputra, an assistant professor of Ophthalmology & Visual Science at the Vanderbilt University Medical Center in Nashville, Tenn.

Diabetes is a chronic condition that affects how your body changes food into energy.

In people who do not have diabetes, when the body breaks down food it turns some of it into sugar, or glucose. This glucose is then released into the bloodstream and the pancreas creates insulin to regulate the amount of sugar you have in your body.

However, in people with diabetes, the body does not use insulin efficiently, or in some situations, the body doesn’t make enough insulin. When the sugar levels get too high in the body, it can have life-threatening complications such as increasing one’s risk of heart attacks, strokes, kidney disease, and even vision loss.

When blood sugar levels are too high or uncontrolled, it can damage the eyes in a condition called diabetic retinopathy.

“Diabetic retinopathy is changes are caused due to changes in the microscopic blood vessels of the eye,” said Gangaputra.

In this condition, the blood vessels and nerves that go to the retina of the eye are affected. It causes the blood vessels to sometimes swell or even leak blood or fluid into the eye.

There are two major forms of diabetic retinopathy.

Non-proliferative retinopathy is the early stage of this condition where the swelling and leaking of blood vessels cause swelling of the retina. This results in some vision loss or blurriness but tends to be treatable, particularly in the early stages of the disease.

Proliferative retinopathy is a more advanced stage where because of the lack of blood flow, new blood vessels begin to form. Unfortunately, these new blood vessels often bleed resulting in either the sensation of seeing ‘floaters’ if it is a mild case, or complete vision loss if it is a more severe case of bleeding.

Diabetes has increased in prevalence amongst US adults age 18 and older. In 2019 to 2000, approximately 9.8% of adults had diabetes. Between 2017 and 2018, that number increased to 14.3% according to the research.

The research team believes that by the year 2060 approximately 60.6 million US adults, or 17.9% of the adult population, will have diabetes. Similarly, the complications related to diabetes, including diabetic retinopathy, will likely increase as well.

“At the time of diagnosis of diabetes, it is very unlikely that the patient will have signs of diabetic retinopathy; however, they should be educated on the complications that come with long-term diabetes including diabetic retinopathy,” says Dr. Hogan Knox, an assistant professor in the University of Alabama at Birmingham Department of Ophthalmology and Visual Sciences.

Not all individuals with diabetic retinopathy know they have this condition.

“Complications such as diabetic retinopathy can present with well controlled diabetes after decades; however, this is much more likely to happen with poor blood sugar control. Patients need to understand the importance of control at time of diagnosis to decrease their chances of complications later on in their life,” Knox tells Healthline.

Oftentimes, in the early stages, there are no symptoms at all. It is is recommended that people with diabetes get routine eye testing to ensure the health of their vision.

“Early changes do not affect vision; however they can be used as a marker to advise the patient and primary care provider or endocrinologist so they can modify the diabetes regimen and better control blood sugar,” Gangaputra told Healthline.

According to the American Academy of Ophthalmology, there can be an array of symptoms. Those individuals with diabetic retinopathy often complain of blurry vision, vision changing between blurry and clear, seeing an increased number of floaters, poor night vision, having vision that seems faded or even washed out, or even losing their vision entirely.

Ophthalmologists are trained in understanding and evaluating diabetic retinopathy. When you get tested, physicians use eye drops to dilate your pupils and look within the eye. By looking at the retina and performing various testing on it, clinicians can understand the thickness, the swelling throughout the eye, and even what is happening with the blood vessels associated with the retina as well.

Gangaputra encourages routine eye exams if you are experiencing any visual symptoms.

“All diabetes patients with vision abnormalities should definitely seek assessment with their eye care provider, as we have treatment options that can save the patient from losing vision.”

While diabetic retinopathy can be permanent in some situations when the retina is severely damaged, so early detection is important for treatment.

“Once findings of diabetic retinopathy are present, they are not reversible. However, there are varying complications that can present within the diabetic retinopathy spectrum that can reverse with treatment,” said Knox.

Experts say that prevention is the best measure for diabetic retinopathy. Controlling one’s blood sugar levels as well as blood pressure can help stop and prevent vision loss.

“Prevention hinges on early diagnosis of systemic diabetes and good consistent blood sugar control, and diet and exercise can play an important role in some cases, but medical treatments typically are required by primary care physicians and endocrinologists,” Knox tells Healthline.

Medication is also available to help reduce the swelling of the macula thereby slowing vision loss and possibly improving vision. Another medication is steroids which can also help reduce inflammation of the eye as well. These medications are directly inoculated into the eye through injections.

Laser therapy is an option for some individuals to help control more advanced forms of proliferative diabetic retinopathy. These help shrink blood vessels and prevent them from growing.

In some situations, surgery may be required. A vitrectomy is when the ophthalmologist removes gel and blood from the leaking vessels within the eye. This allows for light to pass through and vision to return.

Diabetes is a condition that affects millions of people each year, and the number does not seem to be slowing down anytime soon. Experts recommend that routine eye testing be performed, not only to prevent diabetic retinopathy but also other vision-threatening illnesses.

Dr. Rajiv Bahl, MBA, MS, is an emergency medicine physician, board member of the Florida College of Emergency Physicians, and health writer. You can find him at RajivBahlMD.