DIABETES AND THE EYE

HOW DOES DIABETES AFFECT THE BODY?
Too much glucose (sugar) in the blood for extended periods of time can lead to diabetic problems. The high blood glucose levels can damage many different parts of the body including the heart, blood vessels, kidneys, feet, and the eyes. Heart and blood vessels disease can lead to strokes and heart attacks. Kidney disease can lead to renal failure and the need for a kidney transplant. Disease in the feet and lower extremities can result in loss of limbs (amputation). Diabetes can also lead to blindness.

WHAT CAN I DO TO PREVENT DIABETIC PROBLEMS?
The most important thing to do is to obtain medical care on a regular basis and follow the advice of your doctors and other health care workers. It is also important to exercise on a regular basis and take your diabetic medications at the prescribed times and dosages. Also, check your blood sugar every day and keep a written record of the time the blood sugar was tested and the results.

HOW DOES DIABETES AFFECT THE EYE?
Diabetes can damage five structures within the eye:

Cornea. The cornea is the clear tissue over the colored part of the eye (iris). The function of the cornea is to protect the structures within the eye and to aid in focusing light on the retina.

Lens. The lens sits behind the iris and focuses light on the retina.

Vitreous. The vitreous is the clear jelly that fills the back of the eye.

Retina. The retina is the transparent tissue that lines the back of the eye. The retina is the "film" of the eye and senses light coming into the eye.

Optic Nerve. The optic nerve is the cord that connects the eye to the brain and transmits images that allow for vision.

HOW DOES DIABETES AFFECT THE RETINA?
The retina has many tiny blood vessels within the tissue that supply it with oxygen and nutrients. High blood sugar levels can weaken the vessels. Some vessels begin to swell and become leaky while others become clogged and do not allow enough blood to get through. The medical term for this problem is DIABETIC RETINOPATHY.

HOW DOES DAMAGE TO THE RETINA RESULT IN VISION LOSS?
As the vessels within the retina become clogged and leaky, they can damage the structures within the retina that sense light and lead to vision loss. As this process continues, new blood vessels can grow to replace the damaged vessels. These new vessels are very weak and can break easily spilling blood into the vitreous blocking light from reaching the back of the eye. These new blood vessels can also result in the retina pulling away form the back of the eye and becoming detached. This usually results in significant vision loss.

WHAT ARE THE SYMPTOMS OF DIABETIC RETINOPATHY?
In the early stages of the process, there are usually no symptoms or mild blurring of the vision. As the retinopathy worsens, the vision can become quite blurred and you may see spots floating in the vision. If the retina starts to become detached, you may see many floating spots or flashing lights. This is usually followed by the sensation that a curtain is being pulled over part of your field of vision. If the retina becomes totally detached or if bleeding occurs in the vitreous, you may have almost total darkness.

CAN DIABETIC RETINOPATHY BE TREATED?
Yes. The most common treatment is with laser. Here, a high intensity beam of light is focused on the back of your eye to close off the leaking blood vessels. The treatment may be localized to one area of the eye (Focal) or if the retinopathy is widespread, many laser burns are made throughout the retina (Panretinal photocoagulation).
If a lot of blood has leaked into the vitreous cavity or if a retinal detachment is involved, you may need a vitrectomy. A vitrectomy removes blood and fluid from the vitreous and replaces it with clear fluid.

WHAT OTHER EYE PROBLEMS DOES DIABETES CAUSE?
Diabetes can lead to other problems with the eyes. Many people have these same problems, but people with diabetes get them more often and in some cases, at a younger age.

CATARACT - A cataract is a clouding of the natural lens of the eye.

GLAUCOMA - Glaucoma is a disease of the optic nerve characterized by progressive loss of nerve tissue resulting in loss of vision.

KERATOPATY - Keratopathy is a term for disorders of the cornea such as erosions and dry eye related problems.

HOW CAN I PREVENT DIABETIC PROBLEMS FROM OCCURING IN MY EYE?
As with any other diabetic related disease, the most important form of prevention is tight control over your blood sugar levels. Try to prevent large fluctuations in glucose levels since this has been correlated with increased retinopathy. It is also important to maintain good control over blood pressure and cholesterol levels.

It is also very important to have a dilated retinal examination once a year. This is important even if you are not having any vision problems. The eye doctor will use dilating drops to make the pupil larger to obtain a clear view of the retina and other structures inside of the eye.

Often, problems with the retina or other part of the eye can be detected before they effect the vision and can be treated. Detecting problems at an early stage can reduce the chance that they will become more serious later on and thereby reduce the risk of vision loss.

HOW OFTEN SHOULD I HAVE MY EYES EXAMINED?
We recommend yearly exams for all diabetic patients. If any retinal or other problem is detected, more frequent exams may be needed.