How Diabetes Affects Your Eyes

Diabetic eye disease (DED) covers a group of issues that can affect the eyes of diabetic patients. Conditions that fall under DED include diabetic retinopathy, glaucoma, cataracts, and diabetic macular edema.

Though you may experience vision impairment due to diabetes, modern medical treatment can mitigate damage and preserve eyesight in most cases. 

What Is Diabetic Eye Disease?

Diabetic eye disease is a term that encompasses several different eye conditions that can result from diabetes. These conditions include the following:

• Diabetic retinopathy
• Diabetic macular edema
• Glaucoma
• Cataracts

Diabetes involves the body’s inability to use or manage glucose levels, and these high levels of uncontrolled glucose can damage various parts of the body, including the eyes. Having diabetes doesn’t mean you are destined to have vision loss, however. Uncontrolled diabetes is what causes problems.

If you manage your diabetes and get regular eye exams, you can moderate much of the damage that diabetic eye disease can cause. An eye doctor can detect the early signs of problems in the eyes related to diabetes, so it’s incredibly important to stay on top of your regular appointments.

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How Diabetes Can Affect Your Eyes 

High levels of sugar in the blood due to diabetes can result in any of the following eye conditions:

Diabetic Retinopathy

Diabetic retinopathy is the most common eye illness that affects diabetic individuals. 

Diabetic retinopathy is caused by damage to the blood vessels in the retina. It can occur in both a non-proliferative (background retinopathy) and a proliferative form. Although the exact pathology is not understood, elevated levels in blood galactose are the likeliest cause. 

In non-proliferative retinopathy, your blood vessels are damaged, but your vision is not badly impaired. In proliferative retinopathy, new blood vessels grow behind your eyes. However, these blood vessels are fragile and can leak blood and other fluids into your eyes, impairing your vision greatly. 

If you have background retinopathy, it’s very important to manage your diabetes so the condition does not worsen. If your retinopathy is proliferative, medical management is needed as early as possible to best preserve vision. 

Diabetic Macular Edema 

Macular edema (ME) is a complication of diabetic retinopathy. ME occurs due to the accumulation of fluids in the eye. These fluids cause swelling in your retina, creating strain and pressure on nerves and vessels at the back of your eye. 

This pressure often results in blurred vision that can hamper simple tasks like driving or reading. As macular edema progresses, fluids may begin leaking into the eyes.  

Glaucoma 

Glaucoma results from damage to the retina. Fluid buildup in the eye’s optic nerves impairs vision, and it may eventually cause blindness if treatment is not sought. 

Although the mechanism is not completely understood, it’s thought that diabetes is a risk factor for developing glaucoma.   

Cataracts 

A cataract occurs due to a hardening of the eye lens that leads to the formation of a milky film-like covering. This hardening of the eye lens may occur naturally due to age, but in diabetic patients, increased blood glucose levels may accelerate this event.

Symptoms of Diabetes in the Eyes

These are early symptoms of diabetic eye disease: 

• Darkened or blurry vision
• Eye floaters (stringy or blotchy substances in the eye)
• Difficulty perceiving colors

Because diabetic retinopathy and diabetic macular edema have no specific early warning signs, they can be difficult to detect. With non-proliferative diabetic retinopathy, you may not show any symptoms. If you have diabetes, it’s incredibly important to get regular eye exams to catch these conditions in their early stages. 

Proliferative diabetic retinopathy is the advanced form of the condition, and the damage from it can be significant. New blood vessels grow in the eye due to the damage to the old ones, and these new growths are abnormal. Pressure can build in the eye, resulting in damage to the optic nerve. Scar tissue growth can cause retinal detachment. 

Seek emergency medical attention if you notice any of the following:

• Black spots in your vision 
• Flashes of light 
• Holes or gaps in your vision 

Prevalence of Diabetic Eye Disease

Diabetes is the leading cause of blindness in adults. Each person with diabetes is at risk of developing some form of diabetic eye disease. 

The earlier diabetic retinopathy or any other type of diabetic eye disease is addressed, the lesser the chances of vision loss or sustained damage.

Risk Factors

Anyone with diabetes is at risk for diabetic eye disease, but these additional risk factors increase a person’s probability of developing DED.

• High cholesterol
• High blood pressure
• Uncontrolled blood sugar levels
• Having diabetes for a long time
• Smoking or other forms of tobacco use
• Being pregnant
• Being Native American, Black, or Hispanic

These risk factors don’t mean you will certainly develop DED, but they do increase your overall likelihood.

Diagnosis of Diabetic Eye Disease

A DED diagnosis should be given by a qualified eye care professional. 

Diabetic retinopathy can be diagnosed via a dilated eye exam. This test enlarges the pupil and allows the doctor to check for signs of eye damage. 

Similarly, early signs of macular edema, glaucoma, and cataracts can be detected in comprehensive eye exams.

An eye doctor may use the following additional tests:  

• Optical coherence tomography (OCT): This is a laser-based test that provides imagery to compare the thickness and size of the retina. It can be useful for checking for abnormalities and seeing how treatment is progressing. 
• Visual acuity test: This will often be administered as part of a comprehensive eye exam, and it can be useful in detecting vision loss.
• Fluorescein angiography (FFA): This imaging technique uses special dyes to check for abnormalities in the veins and nerves of the eye.

Treatment of Diabetic Eye Disease

Moderate or mild diabetic retinopathy can be treated with proper management of blood sugar levels. Patients will be advised to control their cholesterol, blood pressure, and glucose levels.  

Your treatment plan will often be developed by your primary care physician, though your ophthalmologist may also be involved. 

For those with advanced DED, there are three main treatments utilized today. 

• Medications: Some medications like Lucentis can be injected into the eye with mild anesthesia. These medications halt the growth of new blood vessels in the eye and reduce fluid buildup, resulting in less pressure in the eye.
• Laser treatments: Also known as photocoagulation, this laser treatment can burn away excess fluid in the eye and seal leaking blood vessels. It can effectively stop the progression of diabetic macular edema.
• Surgery: A surgical procedure like vitrectomy can remove fluid and blood from the eye that is causing damage there.

The Importance of Eye Exams

If you have diabetes, regular eye exams must be part of your life. 

Comprehensive annual eye exams are key to identifying the early signs of diabetic eye disease. Since DED can often be managed, lessening the long-term effects on vision, it’s vital that any issues are diagnosed early.

See a doctor immediately if you notice any sudden changes in vision, including these:

• Flashes of light
• Blurry vision
• Vision loss 

Prevention of Diabetic Eye Issues 

Good diabetes management is the most important tool for the prevention of diabetic eye disease. 

Work with your doctor to craft a balanced diet and lifestyle plan to manage your blood sugar levels. A crucial step to managing your diabetes, and therefore preventing DED, is controlling cholesterol, blood sugar, and blood pressure. Devices like blood glucose meters and blood pressure monitors can be useful.

Regular exercise aids in managing your blood sugar levels and also makes your body more responsive to insulin. Talk to your doctor about the best way to incorporate exercise into your life.

Take all prescribed medications, including insulin, as instructed. Never attempt to adjust medication dosages without your doctor’s explicit instructions. 

Though diabetes can have a significant effect on the eyes and vision, it doesn’t have to. If you manage your diabetes well and work closely with your doctors, you can reduce damage to your eyes from diabetes. 

Diabetes & the Eyes FAQs

How can you tell diabetes is affecting your eyesight?

If you are diabetic and notice any changes to your vision (such as blurry vision or loss of vision), diabetes is potentially affecting your eyesight. See an eye doctor as soon as possible to identify the issue.

Can your eyesight recover from diabetes?

Depending on the extent of damage, your eyes may be able to recover from damage related to diabetes. However, some forms of damage are not reversible. 

With proper treatment and management of diabetes, you can prevent any further damage to your eyesight.  Medications may help improve or eliminate mild symptoms such as blurred vision. Advanced medical procedures like surgery and laser treatments can restore vision in a high number of more severe cases. 

Does blurred vision from diabetes go away? 

If your blurred vision is due to spikes in blood sugar levels, your vision should return to normal once you get your blood sugar under control. Depending on your condition, this process can be long, and it sometimes takes months for your vision to stabilize. 

Talk to your eye doctor about your specific symptoms and the path to correct them as much as possible.

How can I learn if diabetes has damaged my eyes?

You need a comprehensive dilated eye exam to assess the extent of damage to your eyes from diabetes.

References

1. Diabetic Retinopathy: Current Understanding, Mechanisms, and Treatment Strategies. (July 2017). JCI Insight.

2. Global Prevalence of Diabetic Retinopathy: Protocol For A Systematic Review and Meta-Analysis. (March 2019). BMJ Open.

3. Diabetic Eye Disease. (October 2021). American Academy of Ophthalmology.

4. How Diabetes Affects Your Eye Care. (October 2021). American Academy of Ophthalmology.

5. Diabetic Retinopathy. (July 2022). National Eye Institute.

6. Macular Edema. (August 2022). National Eye Institute.

7. Diabetes and Your Eyesight. Glaucoma Research Foundation.

8. Screening and Prevention of Diabetic Blindness. (2000). Acta Ophthalmologica Scandinavica.

9. Mechanisms of Macular Edema: Beyond The Surface. (March 2018). Progress In Retinal And Eye Research.

10. Pathogenesis Of Diabetic Retinopathy. (1989). American Diabetes Association.

11. 4 Steps to Manage Your Diabetes for Life. (January 2016). National Institute of Diabetes and Digestive and Kidney Diseases.

12. Diabetes Eye Exams. (August 2020). National Library of Medicine.

13. Diabetic Retinopathy. Centers for Disease Control and Prevention.

14. Prevalence and Progression of Visual Impairment in Patients Newly Diagnosed With Clinical Type 2 Diabetes: A 6-Year Follow Up Study. (February 2011). BMC Public Health.

15. Ranibizumab in Diabetic Macular Edema. (December 2015). World Journal of Diabetes.

16. Optical Quality of the Diabetic Eye: A Review. (November 2014). Eye.

17. The Diabetes Epidemic and Its Implications for Eye Health. (2015). Community Eye Health Journal.