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What You Should Know About Diabetes and Eye Exams

Overview

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 primary concern for eye health in people with diabetes is the development of diabetic retinopathy.

Diabetes and blindness
Diabetes is the leading cause of blindness among people between the ages of 20 and 74 in the United States.

Diabetic retinopathy is a condition that develops when the blood vessels in your retina become damaged. The retina is the light-sensitive portion of the back of your eye. As the damage worsens, you may begin losing your vision. Your eyesight 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 like diabetic retinopathy. This is why adopting lifestyle changes and learning to manage diabetes is so important.

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Symptoms

Symptoms of diabetic retinopathy

In its earliest stages, diabetic retinopathy may cause no symptoms. The 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 dots and dark 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 vision loss

Diabetic retinopathy most often affects both eyes at the same time and in equal measure. If you’re experiencing issues with only one eye, it doesn’t mean you don’t have diabetic retinopathy. However, it might indicate another eye issue. Make an appointment to see your doctor to find an appropriate treatment plan.

Causes

Causes of diabetic retinopathy

The buildup of excess sugar in your blood can lead to a number of health issues. In your eyes, too much glucose can damage the tiny vessels that supply blood to your retina. Over time, this damage may block your blood flow.

Chronic damage to retinal blood vessels affects your vision. When your blood flow is diminished, your eye attempts to fix the situation by growing new blood vessels. The process of growing new blood vessels is called neovascularization. These vessels aren’t as effective or as strong as the original ones. They may leak or rupture, which can negatively impact your vision.

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Risk factors

Risk factors for diabetic retinopathy

Diabetic retinopathy is a concern for anyone who has diabetes. There are additional risk factors for developing diabetic retinopathy:

Pregnancy

Women who are pregnant and have diabetes may experience more issues with diabetic retinopathy than women who have diabetes and aren’t pregnant. Your doctor may suggest that you have additional eye exams during your pregnancy.

Length of time with diabetes

The longer you have diabetes, the greater your risk of complications, including diabetic retinopathy.

Poor disease management

Your risks for developing complications are higher if your diabetes isn’t under control. Strict glycemic control is the most effective tool in preventing diabetic retinopathy. Early detection and working closely with your doctor to manage your diabetes is important.

Other medical conditions

Other medical conditions or diseases may also increase your risk of developing retinopathy. They include high blood pressure, heart disease, and high cholesterol.

Ethnicity

African-Americans and Hispanics have a greater risk of developing diabetic retinopathy than the general population.

Smoking

People with diabetes who smoke are more likely to develop retinopathy.

Eye exams

Diabetes and your eyes

The best way to handle eye problems related to diabetes is through early detection of retinal abnormalities, regular monitoring, and prompt treatment. Early detection and treatment typically begin with the 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 shortly after you receive a diagnosis. This is because type 2 diabetes often goes undetected and undiagnosed for years. Retinopathy may have already begun during that time. An eye exam will help your doctor determine if you already have damage.

The ADA recommends you have an eye exam each year after your first exam. If you wear glasses or contacts, you probably need an annual eye exam to keep your prescription up to date. During that exam, your doctor will conduct a few minor tests to see if your vision has changed as a result of diabetes.

You may develop retinopathy and find that your symptoms don’t progress or stall entirely. If that happens, the likelihood you’ll be monitoring your eyes for changes for the rest of your life is high. If your doctor diagnoses you with retinopathy and treats you for it, they may request exams several times per year. The number of eye exams you need each year will depend largely on the severity of the retinopathy.

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Diagnosis

How is diabetic retinopathy diagnosed?

Preparing for dilation
Your eyes will be more sensitive to sunlight while they’re dilated. Bring sunglasses to your appointment with your eye doctor. If you need to drive to the appointment, find out if someone can drive you or wait until the dilation wears off before driving a motor vehicle.

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. Dilating your pupils helps your doctor to see inside your eyes more easily and inspect for damage caused by retinopathy.

While your eyes are dilated, your doctor may also conduct 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 of your eyes. These images show the thickness of your retina and where fluid might leak from damaged blood vessels.

Fluorescein angiography

Your doctor can take pictures of the inside of your eyes while they’re 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 have blockages and which vessels leak blood.

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Preparation

Preparing for your appointment

Come to your appointment prepared to talk about what you’ve been experiencing.

Bring details

Write down the following details and bring them with you:

  • the symptoms you’re experiencing
  • when the symptoms happen
  • what your blood glucose levels are at the time of the episode
  • a list of any other health issues you’re having in addition to the vision problems, when they happen, and what makes them stop
  • any other information you think is important for your doctor to know

Bring a list of questions

Your doctor is going to have several questions and information for you. Be sure you’re prepared with a list of questions you have about what you’ve been experiencing and what the next steps might be.

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Treatments

How is diabetic retinopathy treated?

Treatment for diabetic retinopathy aims to slow or stop the progression of the condition. The exact treatment depends on which type of retinopathy you have, how severe your condition is, and how well-controlled your diabetes is. Possible treatments include the following:

Watchful waiting

You may not yet need treatment if your retinopathy isn’t severe or causing any symptoms. Yearly eye exams are still important, though. Going to yearly exams is the only way your doctor can monitor changes.

Healthy lifestyle

You should manage your diabetes and take control of your blood glucose to reduce the likelihood that your retinopathy will become worse.

Focal laser treatment

You may need a focal laser treatment if you have advanced diabetic retinopathy. This treatment can stop or slow blood leakage from your blood vessels by burning the abnormal blood vessels. This treatment should stop symptoms and can possibly reverse them.

Scatter laser treatment

This type of laser treatment can shrink abnormal blood vessels and scar them so they’re less likely to grow or bulge in the future.

Vitrectomy

Your doctor may suggest a minor surgery called a vitrectomy to ease the symptoms of retinopathy if lifestyle or laser treatments don’t work. During this procedure, your doctor will make a tiny incision in your eye to remove blood that has leaked from your blood vessels. Your doctor will also remove scar tissue that’s pulling on your retina and impacting your vision.

Vision assistance devices

Vision issues often correct themselves once the treatment is complete and your eyes have had time to heal. Your doctor can treat any permanent vision changes with vision assistance devices, such as contacts or glasses.

Outlook

What is the outlook for people with diabetic retinopathy?

Treatments for diabetic retinopathy are often very successful, but they’re not a cure. Diabetes is a chronic condition, which means you’ll likely experience complications of the condition for the rest of your life. This includes vision problems.

If you develop diabetic retinopathy, you may find relief with treatment, but you’ll need regular eye exams to monitor for worsening issues. You may eventually need more treatment for retinopathy.

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Prevention

Prevention

The best way to reduce the effects of diabetes on your eyes and the rest of your body is to control your blood sugar levels and maintain a healthier lifestyle. You can do the following to help prevent vision loss and other complications from diabetes:

  • Attend regular appointments with your doctor to check your health, including the health of your eyes.
  • Don’t skip appointments just because you aren’t experiencing any issues. Some of the most mundane symptoms actually may be a small sign of a bigger problem.
  • Contact your doctor right away if anything changes with your health or your vision.
  • Quit smoking if smoke.
  • Lose weight if you’re overweight. Weight loss is important in controlling your blood sugar.
  • 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’re having difficulty losing weight or quitting smoking. They can help you develop a treatment plan. Your doctor may also refer you to a dietician who can help you develop a diet that promotes weight loss and a healthy lifestyle.

Learn more: The effects of diabetes on the body »

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