Diabetes is a chronic disease. Left uncontrolled, it can cause various complications, including eye and vision problems. Diabetic retinopathy is the most common eye disease related to the condition and is one of the leading causes of blindness in the U.S. It is primarily caused by changes in the retina’s blood vessels, which may occur in varying ways.
Diabetic Retinopathy: Causes and Symptoms
Diabetes results in high blood sugar. Over time, this damages the tiny blood vessels in the retina. In patients with diabetic retinopathy, retinal blood vessels leak fluid or bleed, causing distorted vision. In advanced stages, new blood vessels abnormally develop and multiply on the retina’s surface, which can lead to scarring, cell loss and, eventually, blindness.
Diabetic retinopathy doesn’t cause any obvious symptoms in the early stages, but there are still signs you can look out for, especially if you have been diagnosed with diabetes. These include:
- Blurry or double vision
- Appearance of a ring or flashing lights
- Blank spots, dark spots and/or floating spots
- Pain or sense of pressure in one or both eyes
- Difficulty seeing out of the corners of the eyes
DIABETIC RETINOPATHY: There are several diabetes-related eye diseases, but diabetic retinopathy is the most common.
Four Stages of Diabetic Retinopathy
Diabetic retinopathy typically progresses through these four stages:
Mild Nonproliferative Retinopathy
In this stage, small balloon-like swelling called microaneurysms develop in the retina’s tiny blood vessels. These can lead to leaking of retinal fluid, distorting vision.
Moderate Nonproliferative Retinopathy
As diabetic retinopathy progresses, the blood vessels that nourish the retina can swell and become distorted, as well as lose their ability to transport blood.
Severe Nonproliferative Retinopathy
In this stage, more blood vessels become blocked, depriving the retina of its blood supply. Because of this, the retina will try to compensate by growing new blood vessels.
Proliferative Diabetic Retinopathy
In the most advanced stage of the disease, growth factors released by the retina signal the development and proliferation of new blood vessels. These grow along the retina’s inner surface and into the vitreous gel, or the fluid in the eye. These new blood vessels are fragile, doing the eye more harm than good. They are susceptible to leaking, bleeding and scarring. And scar tissues contract, they can give rise to eventual retinal detachment, with the retina pulling away from underlying tissues and leading to permanent loss of vision.
Other Diabetes-Related Eye Problems
People with diabetes can also experience other eye problems, such as:
- Cataracts: Adults with diabetes are at least two times more likely than those without the disease to develop cataracts, or clouding of the eye’s lense. Cataracts also tend to appear at a younger age in diabetics.
- Glaucoma: This group of diseases occurs when the eye’s optic nerve, the bundle of nerve fibers connecting the eye to the brain, gets damaged due to an elevated pressure inside the eye. Having diabetes can double one’s risk of developing glaucoma.
- Diabetic Macular Edema (DME): This condition is actually a complication of diabetic retinopathy. It is caused by fluid accumulation in the macula, which is located in the center of the retina. When the macula swells due to fluid accumulation, the cells responsible for providing sharp central vision are compromised, leading to compromised central vision.
A SERIES OF TESTS: Different types of tests may be performed to help your eye doctor determine the exact condition of your eyes.
Diagnosing Diabetic Eye Diseases
The only way to determine if a patient has diabetes-related eye disease is through a comprehensive eye exam, which will likely involve the following:
- Visual Acuity Test: Uses an eye chart to measure a patient’s ability to see objects at different distances.
- Tonometry: Measures pressure inside the eye.
- Optical Coherence Tomography (OCT): Similar to an ultrasound, it captures images of tissues inside the eye using light waves.
- Pupil Dilation: With the use of special eye drops, the eye’s surface will dilate or widen, allowing the eye doctor to check for the following:
- Changes to blood vessels
- Leaking blood vessels
- Macular swelling
- Changes in the lens
- Damage to nerve tissues
- Fluorescein Angiogram: In this test, fluorescent dye is injected into the bloodstream. Photos of retinal blood vessels will then be taken as the dye highlights them.
Treating Diabetic Eye Diseases: Is Laser Eye Surgery Right for You?
Diabetic retinopathy, cataracts, and glaucoma can be treated with laser surgery. Diabetic macular edema, on the other hand, may be treated with an injection depending on the level of swelling present.
Diabetes presents added risk of complications, which is why some patients may be turned away by eye clinics, especially those not fitted with up-to-date eye laser technology. Seek the help of an expert eye surgeon with access to the latest and safest technologies, however, and it’s entirely possible to undergo laser eye surgery to correct vision and eye problems despite having diabetes.
Turning to a reliable eye surgeon helps ensure your laser eye surgery is a success. However, it still pays to understand what complications can get in the way of achieving the desired outcome.
Possible complications that can affect your suitability for laser eye surgery include:
- Unstable Blood Sugar Levels: Your eye surgeon may require a letter or certification from a general practitioner indicating your blood sugar levels, which need to be stable enough to yield accurate results.
- Slower Healing: Speed of recovery is a primary concern for anyone undergoing any kind of surgery. The cornea naturally heals quickly, but high levels of blood sugar can affect nerves and blood circulation, which may slow down the healing process. This is another reason why an eye surgeon will need certification from a GP regarding your blood sugar levels.
- Varying Prescriptions: To be eligible for laser eye surgery, your eyeglasses or contacts prescription should not have changed within the last year. Unfortunately, a diabetic’s prescription may vary from time to time due to fluctuating blood sugar levels. This reduces the effectiveness of laser eye surgery.
LASER TREATMENT SUITABILITY: Diabetes complications may affect one’s suitability for laser eye surgery, but access to the latest technologies can help lower risks.
All surgical procedures have risks, but as long as you work with your eye surgeon and general practitioner, you’re sure to receive expert care. Depending on your specific circumstances, laser surgery may well be an excellent solution for you even if you have diabetes.
Dr. Alan Glazier is the owner and founder of Shady Grove Eye & Vision Care. A long-standing member of the Maryland Optometric Association, American Optometric Association, American Academy of Optometry and American Board of Optometry, he has built an impeccable reputation, continuing to improve his craft by specializing in various eye treatments for different conditions. When not busy in his clinic, he finds time writing informative articles to educate people on how to take better care of their eyes. Check out the company blog for updates from Dr. Glazier!