DIABETES AND VISION
WHAT IS DIABETES? AND HOW DOES IT AFFECT VISION?
Diabetes is a serious chronic illness that affect 537 million people globally and that continuous to affect more and more people every year. It is a result of the organ called pancreas not being able to produce enough insulin to regulate blood sugar or when the body cannot effectively use the insulin it produces.
In cases of uncontrolled diabetes, raised blood sugar (hyperglycaemia) over time leads to serious damage to different parts of body's systems, especially the nerves and blood vessels.
Not only are diabetics two to three times more likely to suffer from heart attacks or strokes (1) but are more likely to experience reduced vision or bindless as a result of damage to the blood vessels in the retina (the posterior part of the eyes). It is estimated that close to 1 million people are blind due to diabetes (2).
Diabetes can lead to vision loss in different ways. Two of the most common problems that can occur are macular edema and retinopathy. Furthermore, diabetes can also make you more likely to have other eye conditions, such as cataracts and glaucoma.
To understand exactly how diabetes affects the eyes, thinks of the eye as a camera where the light passes through the transparent lenses to display an image in back wall of the eye. This wall, called the retina, is filled with light-sensitive cells that are dependent on tiny blood vessels for nourishment. When one has diabetes, these tiny blood vessels supplying nourishment to the retinal tissue can become damaged, resulting in damage to the retinal tissue as well.
This damage can either result in the blood vessels becoming “leaky” and fluid will leak out of the blood vessels into the retinal tissue. This fluid leakage causes the retina to thicken and swell and creates blurry vision. This condition is called macular edema.
In retinopathy, blood vessels are damaged from elevated blood sugar (hyperglycemia) over time. When retinal tissue is starved from nourishment from damaged blood vessels it will try to create new blood vessels at the surface of the retina. This process is called proliferative retinopathy.
These new blood vessels unfortunately break and bleed easily , causing scar tissue to form. Over time this scar tissue will build up and stretch the retina, separating it from the wall of the eye. When the retinal tissue is separated from blood supply it will die, causing blindness in the affected areas. This can process can happen suddenly or slowly over time.
When you are diabetic it is important to schedule an annual dilated eye exam as you might not necessarily have any notable symptoms and even perfect vision until serious damage has already occurred. However, some of the early signs may include:
Trouble seeing at night
Blurry vision in only one eye
Redness or pain in your eye
Seeing floaters, spots or “flies”
Loss of middle or peripheral vision
Please note that if you suddenly start seeing floaters, spots /”flies” or experience sudden loss of middle or peripheral vision (patients often describe it as a dark curtain in the middle or on the side of their visual field), this indicates a possible retinal detachment. Retinal detachment must be treated as soon as possible to avoid vision loss/ blindness.
ANNUALS EYE CHECK-UPS ARE A MUST
In addition to managing and controlling your diabetes through a healthy diet, medication and exercise, it is you should schedule a dilated eye exams at least once a year or more often if you have a problem.
Here at our clinic we offer all patients an full encompassing exam to screen for both common and rare diseases and conditions. Most exam takes approximately 50 minutes, but may last up to 90 minutes if there are any serious findings.
To properly exam the retina, the doctor will give you eye drops to dilate your pupils when you arrive and take about 20-30 min to work.
We will also check for changes to your glasses or contact lens prescription, eye pressure, and if you suffer from dry eye we can test your tear production.
WHAT TREATMENTS OPTIONS ARE THERE?
There are several treatments that can help manage and restore vision caused by diabetes.
Anti-VEGF (vascular endothelial growth factor) therapy, which involves injecting drugs into the eye to stop the leaking of the blood vessels
Steroids to reduce retinal swelling
Photocoagulation (laser therapy) to seal the blood vessels
Vitrectomy, a surgery to remove scar tissue and cloudy fluid from inside the eye
Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio et al. Lancet. 2010; 26;375:2215-2222.
(2) Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study GBD 2019 Blindness and Vision Impairment Collaborators* on behalf of the Vision Loss Expert Group of the Global Burden of Disease Study† Lancet Global Health 2021;9:e141-e160.