There are many things you can do to prevent, reduce, and manage the signs of diabetes-related eye complications.
In this article, we look at how to prevent eye complications, what to expect during your annual eye exam, the most common diabetes-related eye complications, and the treatments currently available.
Preventing eye complications due to diabetes
The first thing people with diabetes can do to prevent eye complications of diabetes is to manage their blood sugar levels as effectively as possible.
This is easier said than done, but when blood sugar levels are high, damage to the small but important blood vessels in the eye can lead to a variety of symptoms, including severe vision loss and blindness.
The American Diabetes Association’s (ADA) HbA1c guidelines recommend keeping your A1c (a measure of blood sugar control over the past two to three months) below 7.0 percent to prevent as many diabetes-related eye complications as possible.
A 2021 research study also showed that lower A1c levels are associated with a lower risk of developing retinopathy.
You can also talk to your health care team about taking vitamin supplements, including lutein and vitamins A, E, and C, which support healthy eye function. However, be aware that vitamin supplements cannot protect your eyes from nerve damage caused by sustained high blood sugar levels.
Annual diabetic eye exam
There’s an eye problem here. These common diabetic eye complications can very easily develop and worsen without becoming apparent in daily life until it’s too late.
However, the American Optometric Association (AOA) says there are some important signs that diabetics should schedule an appointment with an optometrist or eye doctor right away, including:
- Sudden blur or double vision
- Difficulty reading or concentrating near work
- eye pain or pressure
- A noticeable aura or dark ring around a light or illuminated object
- Images of dark spots or flashing lights visible in your vision
Having a thorough eye exam by an ophthalmologist every year is critical to diagnosing and treating diabetes-related eye symptoms in their early stages, protecting and protecting your eyes. keep your eyesight.
Let’s take a closer look at the four tests performed during your annual eye exam.
vision test
This eye chart test measures your ability to see clearly at various distances. There’s probably nothing you didn’t do every year to the pediatrician as a child.
This test requires reading characters from a chart placed typically 20 feet away. This test assesses how well you can see details in text and helps determine the clarity of your vision.
This is especially important for people managing diabetes, as it can help detect changes in vision that may indicate early signs of diabetes-related eye symptoms.
intraocular pressure measurement
This test measures the pressure inside the eye, known as intraocular pressure (IOP). For people with diabetes, monitoring IOP is very important because high intraocular pressure can worsen existing retinal damage caused by diabetic retinopathy.
External stresses that increase intraocular pressure, such as weight lifting or childbirth, can also pose additional risks to the already damaged blood vessels in diabetic eyes.
However, if your eyes are normally healthy and you do not have retinal disease, normal activities that temporarily increase intraocular pressure are usually not a cause for concern.
Optical coherence tomography (OCT)
This technology is similar to ultrasound, but uses light waves instead of sound waves to take images of tissues inside the body. OCT provides detailed images of tissues through which light passes, such as the eye.
OCT is particularly valuable in eye care because it allows high-resolution imaging of the retina and provides information about its structure and health.
This is important for the diagnosis and monitoring of conditions such as diabetic retinopathy, where early detection of retinal changes can have a significant impact on treatment outcomes.
Dilation may sound scary, but it’s actually painless and definitely essential for thoroughly examining the most important areas of your eye.
At some point during your consultation, after a vision test, your doctor will give you a few drops of tropicamide in your eyes.
This simply dilates or dilates the pupil, allowing the doctor to see more detail of the internal structures of the eye, particularly the retina, including the optic nerve and macula (the central part of the retina responsible for clear direct vision).
You will then be asked to wait approximately 15 minutes for your eyes to fully open before proceeding with the next test.
Once dilated, your optometrist will examine your eyes for:
- blood vessel changes
- If there are signs of blood vessel leakage
- Macular swelling (diabetic macular edema)
- If the lens has been changed
- damage to the optic nerve
By the way, don’t forget your sunglasses when you visit! It may take several hours for the effects of the dilator to wear off, so you should wear it when you go out. When your pupils dilate, you feel like you’re standing 7 feet in front of the sun. Too bright!
For women considering pregnancy or currently pregnant
For women with diabetes who are considering pregnancy, a dilated eye exam should be performed to check for existing signs of retinopathy. This is important because hormonal changes and increased blood volume during pregnancy can worsen existing retinopathy.
This does not mean that women with retinopathy should not seek pregnancy, but careful management and regular monitoring are essential. It is recommended that you visit your eye doctor regularly during pregnancy to address any changes in your condition.
While concerns about vaginal delivery due to pressure on the blood vessels in the eye are understandable, the delivery method should be determined in consultation with both your obstetrician and ophthalmologist, based on the severity of your retinopathy and your overall health.
Even if your pregnancy was unplanned, it’s important to schedule an appointment with your eye doctor as soon as you find out you’re pregnant to assess and monitor your eye health.
Common diabetic eye complications
These diabetes-related eye diseases have a common theme: blood sugar control.
Although not all conditions are necessarily the result of persistently high blood sugar levels (hyperglycemia), even people with very healthy blood sugar levels can develop diabetic retinopathy. Glycemic control undoubtedly plays an important role in the development and progression of diabetic ocular complications.
The most common diabetes-related eye complications are:
- diabetic retinopathy
- diabetic macular edema
- glaucoma
- cataract
- dry eye syndrome
Let’s take a closer look at each of these conditions and how to treat them.
What is diabetic retinopathy?
The most common cause of vision loss in people with diabetes is retinopathy, and it’s also probably the one you’ve heard of most.
There are actually four stages of diabetic retinopathy, and of course, the earlier you catch it, the more likely you are to halt its progression and prevent further damage to eye health and function.
The four stages of diabetic retinopathy defined by the National Eye Institute (NEI) are:
Stage 1 — Mild Nonproliferative Retinopathy (NPDR)
This early DR is identified by “small, balloon-shaped areas in small blood vessels in the retina called microaneurysms,” the NEI explains. Fluid from these microaneurysms can leak into the retina of the eye.
This early stage of DR can be detected during an annual visit to the eye doctor, making it a very good reason to have your eyes dilated and thoroughly examined every year.
Stage 2 — Moderate non-proliferative retinopathy (NPDR)
The second stage of DR is when blood vessels, which are key to “feeding” the retina, begin to swell and distort, NEI explains.
“They may also lose their ability to transport blood. Both conditions cause characteristic changes in the appearance of the retina and may contribute to diabetic macular edema.”
Stage 3 — Severe Nonproliferative Retinopathy (NPDR)
In the next stage of DR, a significant number of blood vessels in the retina become “occluded.” This means that the retina is significantly deprived of an adequate blood supply.
This ischemia (lack of blood supply) causes the retina to release growth factors that stimulate the formation of new blood vessels.
Additionally, fluid leaking from microaneurysms continues to accumulate, worsening the condition and increasing the risk of further complications such as diabetic macular edema.
Stage 4 — Proliferative diabetic retinopathy (PDR)
“At this advanced stage, growth factors secreted by the retina trigger the growth of new blood vessels that grow along the inner surface of the retina and into the vitreous gel, the fluid that fills the eye,” the NEI explains.
However, these new blood vessels are highly damaged and fragile, making them highly vulnerable to leaking and bleeding, even though they are new.
Additionally, ongoing scar tissue that develops from multiple microaneurysms can cause shrinkage and detachment of the retina, known as “retinal detachment.” Retinal detachment requires immediate treatment (usually surgery) and can lead to permanent vision loss if it cannot be repaired.
Vision loss associated with diabetic retinopathy
For many people, vision loss from diabetic retinopathy is irreversible, but the NEI says early detection and appropriate treatment can reduce the risk of vision loss by 95 percent.
Additionally, people with pre-existing retinopathy may need to see an optometrist or ophthalmologist multiple times a year.
Diabetic Retinopathy Signs and Symptoms
of only The way to catch retinopathy in its early stages is to see your eye doctor for an annual exam.
Otherwise, like most diabetic eye complications, there are no obvious signs or symptoms that let you know that retinopathy is developing and progressing during daily life.
At certain points in its progression, long after it is discovered during an eye exam, bleeding from blood vessels in the retina can cause floating spots, or “floators,” to move within the visual field.
These floaters are caused by bleeding from abnormal blood vessels in the retina. Although they may seem to be resolving from time to time, their presence indicates ongoing damage that needs to be addressed.
The longer these symptoms are ignored and left untreated, the more likely it is that your vision will worsen and you will experience permanent vision loss. As diabetic retinopathy progresses, it may lead to complications such as DME.
treatment options
“Today’s treatment options for retinopathy continue to improve and are constantly evolving,” explains Angela Bevels, OD.
“Retinopathy should be treated by a retinal specialist,” says Dr. Bevels. Because the overall problem of retinopathy can lead to irreversible vision loss and each stage of retinopathy must be treated with great care.
Most importantly, new treatments for retinopathy can often halt the progression of retinopathy and preserve vision. Therefore, it is very important to detect retinopathy early through annual eye exams.
Currently, there are several treatments for retinopathy depending on the stage of progression and eye condition.
anti-VEGF injection
Anti-VEGF injections, which are also used to treat DME, work by blocking a specific protein called “vascular endothelial growth factor” (VEGF). This protein plays an important role in stimulating abnormal blood vessel growth and fluid leakage, leading to DME and retinopathy.
These injections reverse abnormal blood vessel growth and also reduce fluid within the retina. Although anti-VEGF injections may sound intimidating and uncomfortable, they are highly effective and are considered a first-line treatment for people diagnosed with retinopathy.
FDA-approved brands of anti-VEGF injections include Lucentis (ranibizumab), Avastin (bevacizumab), and Eylea (aflibercept).
scattering laser surgery
“For decades, PDR has been treated with diffuse laser surgery (sometimes called panretinal laser surgery or panretinal photocoagulation),” the NEI explains.
“Treatment involves making 1,000 to 2,000 small laser burns in the area of the retina away from the macula. These laser burns are intended to constrict abnormal blood vessels.”
Surprisingly, this laser treatment can be completed in one session, although some patients may require more than one session depending on the severity of their retinopathy.
The NEI also explains that while this treatment can preserve central vision, it can actually result in varying degrees of loss of peripheral vision, color vision, and night vision.
vitrectomy
“Vitrectomy is the surgical removal of the vitreous gel in the center of the eye,” the NEI explains. “This procedure is used to treat severe bleeding into the vitreous and is performed under local or general anesthesia.”
The NEI explains that during surgery, “ports (temporary waterproof openings) are placed in the eye to allow the surgeon to insert and remove instruments, such as small lights and a small vacuum called a vitrector.”
Clear saline solution is gently pumped into the eye through one of the ports to maintain intraocular pressure and replace the removed vitreous during surgery. The same instruments used during vitrectomy may also be used to remove scar tissue and repair a detached retina. ”
For some people, this is an outpatient procedure, but for those who need additional postoperative observation and support, an overnight stay in the hospital may be required.
“After treatment, your eyes may become patchy, red, and sore for several days to weeks,” the NEI explains. “Drops may be placed in the eye to reduce the risk of inflammation and infection. If vitrectomy is required in both eyes, treatment for the second eye is usually performed after the first eye has recovered.”
corticosteroid injection
Corticosteroid injections are another treatment option for DR, especially when anti-VEGF therapy is not effective or appropriate. These injections reduce inflammation and reduce retinal leakage by stabilizing the blood-retinal barrier.
However, using corticosteroids in the eye can have potential side effects, such as increased intraocular pressure and cataract formation, and must be carefully managed.
Because of these risks, corticosteroid treatment is generally considered when other treatment options fail to achieve the desired results or are contraindicated (use is not recommended).
Commonly used corticosteroids include triamcinolone, dexamethasone (often delivered via a sustained-release implant), and fluocinolone. The choice of steroid and how it is administered is based on the individual’s specific needs and the severity of the symptoms.
What is diabetic macular edema?
DME is a serious complication of diabetic retinopathy. It occurs when fluid builds up within the macula.
This fluid buildup causes swelling and thickening of the macula, which negatively affects its function. The macula is essential for tasks that require detailed vision, such as reading, driving, and recognizing faces.
DME can cause significant vision loss and is the main cause of blindness in patients with diabetic retinopathy, but is not limited to later stages of retinopathy.
DME can develop at any stage of diabetic retinopathy, highlighting the need for early and continuous monitoring of eye health in patients with diabetes.
Diabetic macular edema signs and symptoms
Like retinopathy, diabetic macular edema is most easily detected during an annual eye exam.
Common signs and symptoms of this condition include:
- Vision is blurry or distorted
- Difficulty reading or seeing details
- decreased central vision
- Spots and floaters are visible
- Changes in color perception
Vision problems can be a sign of DME, but waiting until obvious symptoms appear only reduces the chances of successful treatment and preventing progression. Regular eye exams are essential to stop DME.
Treatment options for diabetic macular edema
anti-VEGF injection
As mentioned earlier in the discussion of retinopathy treatment, anti-VEGF injections are also considered the main treatment for DME.
These work by blocking a specific protein called ‘vascular endothelial growth factor’ (VEGF). This protein plays an important role in stimulating abnormal blood vessel growth and fluid leakage, leading to DME and retinopathy.
FDA-approved brands of anti-VEGF injections include Lucentis (ranibizumab), Avastin (bevacizumab), and Eylea (aflibercept).
Focal/grid macular laser surgery
This surgery involves making several or hundreds of small laser burns in blood vessels leaking fluid near the edema. These laser burns rapidly slow fluid leakage and reduce retinal swelling.
“Typically, this procedure is completed in one session. However, some people may require multiple treatments. The focal/grid laser may be applied before the anti-VEGF injection, on the same day or several days after the anti-VEGF injection, and may be applied only if DME does not improve sufficiently after six months of anti-VEGF therapy,” the NEI explains.
corticosteroid
These steroids are injected or actually implanted into the eye and can be used alone or in combination with other treatment options.
“The Ozurdex (dexamethasone) implant is for short-term use, while the Iluvian (fluocinolone acetonide) implant lasts longer,” the NEI explains. “Both are biodegradable and release corticosteroids in a sustained manner to inhibit DME.”
However, using this type of steroid in the eyes increases the risk of developing cataracts and glaucoma. This means that DME patients using corticosteroids should also be closely monitored for signs of increased intraocular pressure or signs of glaucoma.
What is glaucoma?
“Glaucoma is a group of diseases that can damage the optic nerve of the eye and cause vision loss and blindness,” the NEI explains. “It is one of the leading causes of blindness in the United States. However, early treatment can often protect the eyes from serious vision loss.”
In other words, getting a proper annual exam with an optometrist or ophthalmologist can protect your vision if it means catching and treating glaucoma before it gets too advanced.
The Centers for Disease Control and Prevention (CDC) states that people with diabetes are twice as likely to develop glaucoma as people without diabetes.
The most common types of glaucoma are “open-angle glaucoma” and “acute-angle glaucoma.”
Doreen Fazio, MD, of the Glaucoma Research Foundation (GRF) added, “You are at increased risk of developing glaucoma if you have a parent or sibling with glaucoma, if you are African American or Latino, and if you may have diabetes or cardiovascular disease.” “The risk of glaucoma increases with age.”
Glaucoma signs and symptoms
For many people, glaucoma does not show obvious symptoms until it is too late. For others, later stages of the disease can cause blurred vision, distortion, or varying degrees of vision loss.
“Open-angle glaucoma usually has no early warning signs or symptoms,” GRF explains. “It develops slowly, and in some cases there may be no noticeable vision loss for years.”
“Most people with open-angle glaucoma feel well and do not notice changes in their vision at first, because the initial vision loss is in side or peripheral vision, and vision and clarity of vision are maintained until later in the disease.”
The less common symptoms of acute angle glaucoma, according to the GRF, include:
- Blurred or blurred vision
- A rainbow-colored circle appears around the bright light
- severe pain in the eyes and head
- Nausea or vomiting (with severe eye pain)
- sudden loss of vision
Glaucoma treatment options
“Currently, eye drops are often the first line of treatment for patients in the United States,” GRF explains. “For many people, a combination of medications and laser therapy can safely control eye pressure for many years.”
Eye drops used to treat glaucoma lower intraocular pressure by draining excess fluid from the eye and reducing the amount of fluid produced by the eye.
The types of eye drops to treat glaucoma are:
- Prostaglandin analogs
- beta blocker
- alpha agonist
- Carbonic anhydrase inhibitor (CAI)
- Rho kinase inhibitor
Many people need a combination of medications to manage their glaucoma.
“Glaucoma is a treatable, if not cured, eye disease,” Bevels explains. “The best advice is to use prescribed eye drops to control intraocular pressure as directed by your eye care provider. There’s nothing scary about eye drops, but they can be problematic for older patients who have dexterity issues, and in some cases surgery is the best option.”
What is a cataract?
Cataracts are caused by clouding of the eye’s lens. They can be small and only slightly obstruct your vision, but they can also be large and their interference with your vision is significant and cannot be ignored.
People with diabetes, especially those who smoke, are at increased risk of developing cataracts, but even healthy people can develop cataracts.
“Cataracts most often occur in people over the age of 55, but they can sometimes be seen in younger people, including newborns,” explains the AOA.
Cataract signs and symptoms
Unlike many other diabetic eye complications, cataracts have notable symptoms, including:
- “Cloudy” or opaque areas visible when you look at your eyes in the mirror
- Blurred vision or cloudy spots that affect part of your vision
- Double vision (diplopia), perceiving two images instead of a single object.
- Improved sensitivity to light and glare
- Having trouble seeing at night or needing more light to read or do other activities
- Perceiving normally bright colors as washed out or less vibrant
Cataract treatment options
Some cataracts may not get bad enough to require treatment. However, for many people, surgery is essential to improve and restore vision.
“If your cataract has progressed to the point where it interferes with your daily life, you will be referred to an eye surgeon who will recommend surgical removal of the cataract,” the AOA says.
Although surgery may sound scary, cataract surgery is relatively simple and can often be performed in a short outpatient procedure at a surgeon’s office rather than in a hospital operating room.
“The surgeon uses a small incision to remove the clouded lens and, in most cases, replaces it with an intraocular lens implant,” the AOA explains. “Medication is usually put into the eye after surgery, and a patch may be placed on the eye.”
What is dry eye syndrome?
Dry eye syndrome (DES), also known as dry eye disease (DED) or “keratoconjunctivitis sicca,” is a condition found in more than 50% of diabetic patients and is a common diabetic eye complication.
“Many patients are asymptomatic, but they still have the disease or are in the early stages of developing the disease,” Bevels says.
“Chronic use of topical eye medications can lead to a diagnosis of dry eye,” she added.
This means people who require long-term medication for their eyes should be aware of the signs of dry eye syndrome, seek a proper diagnosis, and proceed with treatment promptly to prevent further complications.
Dry eye syndrome signs and symptoms
The most common ones are:
- A burning, stinging, itching, or prickling sensation in or around the eyes
- Presence of thin mucus around the eyes
- The whites of the eyes often turn red
- Increased sensitivity to light (photophobia)
- Feeling like something is in your eye (foreign body sensation)
- Blurred vision, especially after concentrating for a long time on tasks such as reading or using a computer
Treatment options for dry eye syndrome
For some people, using artificial tears daily and improving blood sugar levels is enough to manage dry eye syndrome.
However, Bevels explains that people with more advanced stages of retinopathy or DME may need a meibomian gland analysis (examination of the glands in the eyelids that produce the oil layer of tears) and consistent treatment to prevent loss of the outermost oil layer.
One effective approach to addressing meibomian gland dysfunction is intense pulsed light (IPL) therapy. This technique uses broad-spectrum light to target and treat the affected area, stimulating the glands to promote production of the oily layer of the tear film.
“Some patients may suffer from evaporative dry eye disease, which may require ‘punctal plug’ treatment, autologous tears, and possibly prescribed anti-inflammatory eye drops, depending on the severity of the patient’s symptoms and the overall condition of the eye,” added Dr. Bevels.
Take care of your eyes – you need them!
Since our eyes are essential to our daily lives, it is essential to take good care of our eyes, which means taking good care of our diabetes.
“Other simple things you can do to protect your eyes are to wear UV-protected sunglasses when outdoors and consider eye supplements that contain high levels of zinc, lutein, and carotenes,” Bevels adds.
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