Diabetes is a growing health crisis in North America as an estimated 29 million Americans and 3.4 million Canadians are currently living with the disease. Chances are it affects you or someone you know. November has been dedicated as a time to spread awareness about the disease, its risk factors and the effects it has on your body, your daily life and the lives of your loved ones.

Diabetes and Your Eyes

Diabetes is a systemic disease that causes fluctuations in glucose (blood sugar) levels which can affect blood vessels throughout the body including those in your eyes and visual system. People with diabetes are at higher risk for blindness than the general population, however with regular eye exams and proper care, most of the complications are minor and treatable.

Minor changes in glucose levels could result in complications such as blurred or double vision, floaters or even visual field loss. These conditions are usually quite treatable. Diabetics are also at greater risk for developing eye diseases such as glaucoma (40% increase risk) and cataracts (60% increased risk). With early detection, both of these conditions can be treated and the majority of vision restored.

Diabetic eye disease often has NO noticeable symptoms or pain, so comprehensive eye exams that include dilating the pupils are essential to detect signs of diabetes. Online vision assessments will not detect diabetic eye disease.

The condition that is the most concerning risk of diabetes is called diabetic retinopathy which can lead to blindness if not diagnosed and treated.

What You Need to Know About Diabetic Retinopathy

Diabetic retinopathy occurs when the tiny blood vessels or capillaries in the back of the eye develop weakened vessel walls. If not treated, the vessels leak fluid and become blocked. This can progress to hemorrhages in the retina, and over time the eye does not receive enough oxygen and nutrients. As a result, new fine blood vessels start to grow. These proliferating vessels leak and can cause further bleeding, scarring and potentially lead to blindness. A special zone in the central retina called the macula is especially susceptible to diabetes. Diabetic macular edema (when fluid seeps into the macula) can cause permanent vision loss if not promptly detected.

There are treatments for stopping the progression of the disease such as laser therapy or intraocular injections, although once damage to vision has occurred, it is often permanent. This is why the condition must be diagnosed and treated early on.

All diabetics should have a regular comprehensive eye exam to catch any early signs of diabetic retinopathy or other vision threatening conditions. Because risk factors vary, speak to your eye doctor about how often you should have an exam. Risk factors for diabetic retinopathy include:

• Length of time living with diabetes
• Uncontrolled blood sugar levels
• High blood pressure
• Smoking
• Alcohol consumption
• Pregnancy
• Genetics

Although blindness from diabetes is preventable it is still a leading cause of blindness among working-age adults. If you or someone you know has the disease, make sure that proper eye care is a priority.

Eye Complications of Diabetes

It’s true. Diabetics have a higher risk of blindness than those without the disease. That fact coupled with the superior prognosis of early intervention, makes it easy to understand why optometrists and doctors say routine eye care is absolutely essential. Below, we’ll discuss what your eye doctor is looking for during a diabetic eye exam.

As the incidence of diabetes increases, it is important to spread awareness about the risks and proper preventative care for diabetes patients. November is Diabetes Awareness month, so read on!

Diabetics are at greater risk of for a number of eye problems.

Diabetic Retinopathy:

Diabetic retinopathy is the term used for the disorders associated with diabetes that cause progressive damage to the retina. The longer a patient has had diabetes, the more likely it is that he will develop these conditions which can be very serious, vision-threatening complications.

There are two types of retinopathy: nonproliferative and proliferative.

Nonproliferative retinopathy, which is the most common form, is when capillaries at the back of the eye become weakened and may start to leak blood and fluids. Nonproliferative retinopathy, which often has no symptoms, can be characterized as mild, moderate or severe, depending on how many blood vessels are affected and becoming blocked. This type of retinopathy usually doesn’t require treatment and doesn’t cause vision loss, unless the leaking fluid ends up in the macula where the eye focuses – a condition called macular edema. If this happens, vision can be blurred and even lost so preventative treatment is essential.

Proliferative retinopathy is much more severe. This is when so much damage is done to the blood vessels that they begin to close off. New blood vessels begin to grow in the retina as a response to this deterioration. The new and weak vessels can leak blood, impairing vision, or can form scar tissue which can distort the retina or cause a retinal detachment.

Proliferative retinopathy requires urgent referral to an ophthalmologist for treatment. While it usually takes years to develop, some instances of proliferative retinopathy can occur within weeks or months if blood sugars are not well-controlled. Pregnancy can also accelerate proliferative retinopathy in known diabetics. Yet if detected early, treatment can be done successfully.

Like high blood pressure, there are often no warning symptoms until advanced stages of diabetes. It is best to get checked each year by an optometrist. If you experience any changes in your vision such as spots in vision, flashes of light, blurred or double vision (rarely pain), make an appointment with your eye doctor immediately. Treatments do exists for retinopathy and many of them are successful in repairing damage and sometimes even restoring vision.

Cataracts:

Cataracts are a clouding of the lens of the eye which blocks light from entering and impairs vision. While cataracts are a fairly common and treatable condition, people with diabetes are 60% more likely to develop the condition and often get them at a younger age. Those with the condition also may experience vision fluctuation which occurs from sugar levels affecting the lens of the eye. Cataracts often progress faster in diabetics as well. In serious cases of cataracts, a surgical procedure is done to remove the natural lens of the eye which can sometimes cause complications in diabetic patients that may already have symptoms of other conditions such as diabetic retinopathy.

Glaucoma:

Glaucoma is a serious condition where pressure builds up in the eye causing damage to the retina and optic nerve and eventually if left untreated, blindness. Diabetics are 40% more likely to develop glaucoma and the risk increases with age and the amount of time the individual has had diabetes. There are treatments for glaucoma including medications and surgery but early detection and treatment are essential to prevent permanent vision loss. Glaucoma is often called the “silent thief of sight” because vision loss often doesn’t occur until significant damage is done. Therefore, yearly eye exams are essential.

Cornea Alterations:

Diabetics may experience reduced sensitivity in their cornea. This means that contact lens wearers that are diabetics should be more cautious, as they develop higher tolerance if the lens irritates the eyes and may be at greater risk of infection.

Eye Muscle Disturbance:

More advanced diabetes cases can show restriction of eye muscle movement due to nerve palsy.

For diabetics, the key to early detection and treatment – and therefore preserving your vision – is to have your eye health monitored on a regular basis. Get your eyes examined every year by an optometrist and if you experience any changes in your vision such as spots, floaters, blurred vision or pain, make an appointment with your eye doctor immediately.

If you or a loved one suffers from diabetes, awareness of the threat of vision loss due to diabetic eye disease should be a top priority. Don’t wait until it is too late to learn about the risks.

Here are eight true and false questions about diabetic eye disease to test your knowledge. If you have any questions, contact your eye care professional to find out more.

1) Diabetic Retinopathy is the only eye and vision risk associated with diabetes.

FALSE: People with diabetes have a higher risk of not only losing sight through diabetic retinopathy, but also a greater chance of developing other eye diseases such as cataracts and glaucoma. People with diabetes are 40% more likely to develop glaucoma and this number increases with age and the amount of time the individual has diabetes. Diabetics are also 60% more likely to develop cataracts and at an earlier age than those without diabetes. Additionally, during the advanced stages of diabetes, people can also lose corneal sensitivity and develop double vision from eye muscle palsies.

2) Diabetic retinopathy can cause blindness.

True: In fact, diabetes is the leading cause of blindness in adults age 20 to 74.

3) With proper treatment, diabetic eye disease is reversible.

FALSE: Although early detection and timely treatment can greatly reduce the chances of vision loss from diabetic eye disease, without prompt and preventative treatment measures, diabetic eye disease can result in permanent vision loss and even blindness. Currently, there is no cure that reverses lost eyesight from diabetic retinopathy; however, there are a variety of low vision aids that can improve quality of life for those with vision loss.

4) People who have good control of their diabetes and their blood glucose levels are not at high risk for diabetic eye disease.

FALSE: While studies do show that proper management of blood sugar levels in diabetics can slow the onset and progression of diabetic retinopathy, there is a still a higher risk of developing diabetic eye disease. Age and length of the disease can be factors for eye diseases such as glaucoma and cataracts. The risk of diabetic retinopathy can be influenced by factors such as blood sugar control, blood pressure levels, how long the person has had diabetes and genetics.

5) You can always prevent diabetic eye disease by paying attention to the early warning signs

FALSE: Oftentimes there aren’t any early warning signs of diabetic eye disease and vision loss only starts to become apparent when the disease is already at an advanced and irreversible stage.

6) A yearly, dilated eye exam can help prevent vision loss through diabetic eye disease.

TRUE: Diabetics should get a dilated eye exam at least once a year. Since diabetic eye disease often has no symptoms, routine eye exams are critical for early detection and treatment. Everyone with diabetes should get an eye examination through dilated pupils every year, because it can reduce the risk of blindness from diabetic eye disease by up to 95%.

7) Both type 1 and type 2 diabetes are at risk of developing diabetic eye disease.

TRUE: Everyone with diabetes – even gestational diabetes – is at risk and should have a yearly eye exam. In fact, 40% to 45% of those diagnosed with diabetes have some stage of diabetic retinopathy.

8) Smoking increases the risk of diabetic eye disease.

TRUE: In addition to getting regular eye exams, stop smoking, partake in daily physical activity, maintain a healthy weight and control blood sugar, blood pressure and cholesterol: they all help reduce the risks of eye disease.

Whatever your score on the quiz above, the most important take-away is that if you have diabetes, even if you aren’t having any symptoms of vision loss: make an appointment for a comprehensive, dilated eye exam every year. It could save your sight.