Locations Main Campus: Chesterfield, MO 63017   |   Locations
314-434-1500 314-434-1500   |   Contact Us

Multimedia Encyclopedia

BACK
TO
TOP
 
E-mail Form
Email Results

 
 
Print-Friendly
Bookmarks
bookmarks-menu

Diabetes and eye disease

Retinopathy - diabetic; Photocoagulation - retina; Diabetic retinopathy

 

Diabetes can harm the eyes. It can damage the small blood vessels in the retina, the back part of your eye. This condition is called diabetic retinopathy.

Diabetes also increases the chance of having glaucoma, cataracts, and other eye problems.

Causes

 

Diabetic retinopathy is caused by damage from diabetes to blood vessels of the retina. The retina is the layer of tissue at the back of the inner eye. It changes light and images that enter the eye into nerve signals, which are sent to the brain.

Diabetic retinopathy is a main cause of decreased vision or blindness in Americans 20 to 74 years old. People with type 1 or type 2 diabetes are at risk of this condition.

The chance of developing retinopathy and having a more severe form is higher when:

  • You have had diabetes for a long time
  • Your blood sugar (glucose) has been poorly controlled
  • You also smoke or you have high blood pressure

If you already have damage to the blood vessels in your eye, some types of exercise can make the problem worse. Check with your health care provider before starting an exercise program.

Other eye problems that can occur in people with diabetes include:

  • Cataract . Cloudiness of the eye lens.
  • Glaucoma . Increased pressure in the eye that can lead to blindness.
  • Macular edema. Blurry vision due to fluid leaking into the area of the retina that provides sharp central vision.
  • Retinal detachment . Scarring that may cause part of the retina to pull away from the back of your eyeball.

High blood sugar or rapid changes in blood sugar level often cause blurred vision. This is because the lens in the middle of the eye cannot change shape when it has too much sugar and water in the lens. This is not the same problem as diabetic retinopathy.

 

Symptoms

 

Most often, diabetic retinopathy has no symptoms until the damage to your eyes is severe. This is because damage to much of the retina can occur before your vision is affected.

Symptoms of diabetic retinopathy include:

  • Blurred vision and slow vision loss over time
  • Floaters
  • Shadows or missing areas of vision
  • Trouble seeing at night

Many people with early diabetic retinopathy have no symptoms before bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.

 

Exams and Tests

 

Your eye doctor will examine your eyes. You may first be asked to read an eye chart. Then you will receive eye drops to widen the pupils of your eyes. Tests you may have involve:

  • Measuring the fluid pressure inside your eyes ( tonometry )
  • Checking the structures inside your eyes ( slit lamp exam )
  • Checking and photographing your retinas ( fluorescein angiography )

If you have the early stage of diabetic retinopathy (nonproliferative), the eye doctor may see:

  • Blood vessels in the eye that are larger in certain spots (called microaneurysms)
  • Blood vessels that are blocked
  • Small amounts of bleeding (retinal hemorrhages) and fluid leaking into the retina

If you have advanced retinopathy (proliferative), the eye doctor may see:

  • New blood vessels starting to grow in the eye that are weak and can bleed
  • Small scars forming on the retina and in other parts of the eye (the vitreous)

This exam is different from going to the eye doctor (optometrist) to have your vision checked and to see whether you need new glasses. If you notice a change in vision and see an optometrist, make sure you tell the optometrist that you have diabetes.

 

Treatment

 

People with early diabetic retinopathy may not need treatment. But they should be closely followed by an eye doctor who is trained to treat diabetic eye diseases.

Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed.

Eye surgery is the main treatment for diabetic retinopathy.

  • Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking, or to shrink abnormal vessels.
  • Surgery called vitrectomy is used when there is bleeding (hemorrhage) into the eye. It may also be used to repair retinal detachment .

Medicines that are injected into the eyeball may help prevent abnormal blood vessels from growing.

Follow your eye doctor's advice on how to protect your vision. Have eye exams as often as recommended, usually once every 1 to 2 years.

If you have diabetes and your blood sugar has been very high, your doctor will give you new medicines to lower your blood sugar level. If you have diabetic retinopathy, your vision can get worse for a short time when you begin taking medicine that improves your blood sugar level.

 

Support Groups

 

Many resources can help you understand more about diabetes. You can also learn ways to manage your diabetic retinopathy.

 

Outlook (Prognosis)

 

Managing your diabetes may help slow diabetic retinopathy and other eye problems. Control your blood sugar (glucose) level by:

  • Eating healthy foods
  • Getting regular exercise
  • Checking your blood sugar as often as instructed by your diabetes provider and keeping a record of your numbers so you know the types of foods and activities that affect your blood sugar level
  • Taking medicine or insulin as instructed

Treatments can reduce vision loss. They do not cure diabetic retinopathy or reverse the changes that have already occurred.

 

Possible Complications

 

Diabetic eye disease can lead to reduced vision and blindness.

 

When to Contact a Medical Professional

 

Call for an appointment with an eye doctor (ophthalmologist) if you have diabetes and you have not seen an ophthalmologist in the past year.

Call your doctor if any of the following symptoms are new or are becoming worse:

  • You cannot see well in dim light.
  • You have blind spots.
  • You have double vision (you see two things when there is only one).
  • Your vision is hazy or blurry and you cannot focus.
  • You have pain in one of your eyes.
  • You are having headaches.
  • You see spots floating in your eyes.
  • You cannot see things on the side of your field of vision.
  • You see shadows.

 

Prevention

 

Good control of blood sugar, blood pressure, and cholesterol are very important for preventing diabetic retinopathy.

DO NOT smoke. If you need help quitting, ask your provider.

 

 

Open References

References

American Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice Pattern Guidelines. Diabetic retinopathy. 2014. www.aao.org/ppp . Accessed August 18, 2015.

American Diabetes Association. 9. Microvascular complications and foot care. Diabetes Care . 2016;39 Suppl 1:S72-S80. PMID: 26696685 www.ncbi.nlm.nih.gov/pubmed/26696685 .

Lim JI, Rosenblatt BJ, Benson WE. Diabetic retinopathy. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 6.21.

 
  • Slit-lamp exam

    Slit-lamp exam - illustration

    A slit-lamp, which is a specialized magnifying microscope, is used to examine the structures of the eye (including the cornea, iris, vitreous, and retina). The slit-lamp is used to examine, treat (with a laser), and photograph (with a camera) the eye.

    Slit-lamp exam

    illustration

  • Diabetic retinopathy

    Diabetic retinopathy - illustration

    Diabetes causes an excessive amount of glucose to remain in the blood stream which may cause damage to the blood vessels. Within the eye the damaged vessels may leak blood and fluid into the surrounding tissues and cause vision problems.

    Diabetic retinopathy

    illustration

    • Slit-lamp exam

      Slit-lamp exam - illustration

      A slit-lamp, which is a specialized magnifying microscope, is used to examine the structures of the eye (including the cornea, iris, vitreous, and retina). The slit-lamp is used to examine, treat (with a laser), and photograph (with a camera) the eye.

      Slit-lamp exam

      illustration

    • Diabetic retinopathy

      Diabetic retinopathy - illustration

      Diabetes causes an excessive amount of glucose to remain in the blood stream which may cause damage to the blood vessels. Within the eye the damaged vessels may leak blood and fluid into the surrounding tissues and cause vision problems.

      Diabetic retinopathy

      illustration

    A Closer Look

     

    Talking to your MD

     

    Self Care

     

    Tests for Diabetes and eye disease

     
     

    Review Date: 7/24/2015

    Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

    The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

     
     
     

     

     

    A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.



    Content is best viewed in IE9 or above, Firefox and Google Chrome browser.