Diabetic eye disorders

It’s estimated that 90% of diabetics will have some form of diabetic eye disorder over the course of their life. Vision care experts at Atrium Health Floyd and Harbin Clinic have extensive experience in identifying such disorders, and they’ll develop an individualized care plan for you.

What are diabetic eye disorders?

Having Type 1 or Type 2 diabetes can cause damage to your eyes and your vision. When you have diabetes, you have high levels of glucose in your blood and that affects different parts of your body in different ways.

People who develop gestational diabetes during pregnancy don’t tend to develop diabetic eye disorders.

How diabetic eye disorders affect the eye

There are four parts of the eye that can be affected by diabetes:

• Retina: The retina is the tissue that lines the back of your eye. The retina converts light coming into your eye into visual messages that travel through the optic nerve to your brain. The retina can be affected by diabetic retinopathy or diabetic macular edema.
• Lens: The lens of your eye is clear and is located behind the iris, the colored part of your eye. The lens helps to focus light, or an image, on the retina. Lenses tend to become cloudy with aging, leading to cataracts. People with diabetes are twice as likely to develop cataracts.
• Vitreous gel: The vitreous gel is a clear, colorless mass that fills the part of your eye between the retina and lens. Diabetic retinopathy can damage the vitreous gel.
• Optic nerve: The optic nerve, at the back of your eye, is your eye’s largest sensory nerve. The optic nerve connects your eye to your brain, carries visual messages from the retina to your brain, and sends messages between your brain and your eye muscles. Damage to the optic nerve can result in glaucoma and people with diabetes are twice as likely to develop it.

What is diabetic retinopathy?

Diabetic retinopathy is a complication of diabetes that causes damage to your retinas over time. It’s the most common diabetic eye disorder and it usually affects both eyes.

Diabetic retinopathy is the leading cause of blindness among American adults. About 25% of people with diabetes have some form of diabetic retinopathy.

Even though the development of diabetic retinopathy cannot be prevented, only a small percentage of those developing diabetic retinopathy have serious vision problems and an even smaller percentage become blind.

Nonproliferative diabetic retinopathy

Having high blood glucose levels from diabetes or prediabetes can damage the tiny blood vessels on the retinas and cause them to swell. These vessels weaken, leak fluid and blood, and fail to provide nutrients necessary for good health in the retinas. The damaged blood vessels may also leak fats and proteins which form deposits in the eye. This stage is called nonproliferative retinopathy.

Sight may not be seriously affected during this stage, particularly if the damage happens on the outer edges of the retina. And the condition doesn’t get worse in about 80% of people.

Proliferative diabetic retinopathy

Proliferative retinopathy is the stage where eye damage worsens – when the tiny blood vessels become blocked and cut off the retinas’ oxygen supply. In response, new, weak blood vessels form on the retinas and may grow into the clear vitreous gel. These blood vessels break easily and leak blood into the vitreous gel. The leaking blood keeps light from reaching the retinas and causes blurry vision.

Retinal detachment sometimes happens, where the retina is pulled away from underlying structures.

Proliferative diabetic retinopathy affects about 5% of all diabetics and becomes more likely the longer they have diabetes. If left untreated, proliferative diabetic retinopathy can lead to blindness.

Diabetic macular edema

Diabetic macular edema usually affects people who already have diabetic retinopathy. Swelling happens in the macula, which is the part of the retina you use for things like reading and driving. Developing this condition can lead to vision loss or blindness.

What are the symptoms of diabetic eye disorders?

You may not notice damage from diabetic eye disorders at first. As your condition progresses, symptoms may include:

• Blurry or double vision
• Dark or empty areas in your vision
• Pain or pressure in one or both of your eyes
• Rings, flashing lights or blank spots
• Spots or dark strings floating in your vision (floaters)
• Trouble seeing things out of the corners of your eyes
• Fluctuating vision or loss of vision
• Impaired color vision

Diagnosis of diabetic eye disorders

Your eye doctor can tell whether you have eye problems related to diabetes during a comprehensive eye exam including a dilated eye exam. In a dilated eye exam, your eye doctor will use eye drops to enlarge your pupils. Your pupil is the opening at the center of the iris.

Enlarging your pupils allows your eye doctor to see more of the inside of your eyes to check for signs of disease.

At the time of your dilated eye exam, your eye doctor also will conduct other tests to measure:

• Pressure in your eyes
• Your side, or peripheral, vision
• How well you see at various distances

If you have blood vessel leakage in your eye, a test called fluorescein angiography may be performed to find out how much blood is leaking.

Prevention of diabetic eye problems

Regular exams can prevent most instances of severe vision loss or blindness from diabetic eye problems such as diabetic retinopathy. You should have a dilated eye exam once a year even if you don’t notice vision problems because regular eye exams protect against progression of diabetic retinopathy.

You can improve your overall health and your diabetes eye problems by controlling your:

• Blood glucose
• Blood pressure
• Cholesterol and triglycerides (types of blood fat)

If you smoke, quitting smoking can help keep your eyes healthy.

Treatment of diabetic eye disorders

Treatment of diabetic eye disorders is based on the location of the disease and degree of damage to the eye. Treatment options may vary and can range from careful monitoring to laser treatments and injections – or a combination of these treatments.