Preventing Diabetes-Related Vision Loss

Affecting about one in three people with diabetes, this eye disease can cause irreversible vision loss and blindness. The good news is that early detection and treatment can prevent or minimize vision loss, and keeping diabetes under control can reduce your risk of developing diabetic retinopathy altogether.
08/04/2016 11:09 am ET Updated Dec 06, 2017

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Meenakashi Gupta, MD
Vitreoretinal Surgeon
Assistant Professor of Ophthalmology
New York Eye and Ear Infirmary of Mount Sinai

Preventing Diabetes-Related Vision Loss

Diabetes is a growing problem in the United States and worldwide. The number of Americans with this chronic disease is expected to double in the next 20 years to more than 44 million. This means more and more people will face related complications, such as diabetic retinopathy. Affecting about one in three people with diabetes, this eye disease can cause irreversible vision loss and blindness. The good news is that early detection and treatment can prevent or minimize vision loss, and keeping diabetes under control can reduce your risk of developing diabetic retinopathy altogether.

What Causes Diabetic Retinopathy?

Diabetic retinopathy is caused by excess sugar molecules that damage the blood vessels in the retina, the light-sensitive tissue at the back of the eye. In the disease's early stages, blood vessel walls start to weaken and develop little pouch-like bulges called microaneurysms. These may begin to leak, leading to swelling in the macula, the central portion of the retina that provides our sharpest vision.

As the disease progresses, this swelling, or macular edema, decreases the amount of blood delivered to the retina. In response, the retina may start to grow additional--but very abnormal--blood vessels, creating a condition called proliferative diabetic retinopathy.

These abnormal vessels sometimes cause a vitreous hemorrhage, or bleeding inside the eye, and can also lead to scarring there. Eventually, scar tissue may pull the retina from the back of the eye, resulting in retinal detachment, which can cause significant, permanent vision loss and often requires surgical repair.

Risk Factors and Prevention

People with any type of diabetes are at risk for diabetic retinopathy. The longer you have had diabetes and the more uncontrolled your blood sugar is, the more likely you are to develop it. People with diabetes and uncontrolled high blood pressure or cholesterol are also at increased risk.

That's why managing your diabetes and staying healthy overall is the foundation for preventing diabetic retinopathy and related vision loss. It is important to work with your primary care doctor or endocrinologist and follow their prescribed regimen for controlling the "ABCs" of diabetes:

• Aᅡᆲ ᅡᆲ- A1c.
Hemoglobin A1c is a type of blood protein to which sugar molecules are attached. A hemoglobin A1c blood test indicates how well you have been controlling your blood sugar level over the previous three months.
• B - Blood pressure.
• C - Cholesterol.

Symptoms, and When to Seek Care

In the early stages, patients may have no symptoms. Therefore, it is very important for people with diabetes to be seen every year by an ophthalmologist (eye MD) for a complete, dilated eye examination. During the dilated examination, eye drops are used to enlarge the pupils, the opening in the center of the iris (colored portion of the eye). Dilation allows the doctor to evaluate the health of the tissues in the back of your eyes, including the retina and optic nerve.

In later stages of the disease, patients may develop the following symptoms, which call for an immediate visit to an ophthalmologist:

• Floaters (little specks or "strings" floating through your field of vision);
• Wavy or blurred vision;
• Empty spots in your field of vision;
• Decreased vision.

The earlier your doctor detects changes from diabetic retinopathy, the better the visual outcome will be. When the disease is treated very early on, mild damage may be reversible in some instances. Left untreated, diabetic retinopathy can advance to irreversible vision loss, including complete blindness in some cases.

Treatment for Diabetic Retinopathy

Several different treatments are available:

Controlling Your ABCs. Though important in prevention, controlling your ABCs can also play a part in treatment. When diagnosed in its very early stages, patients may be able to manage diabetic retinopathy and reduce the risk of vision loss by controlling their blood sugar, blood pressure, and cholesterol.

Laser Treatment and Eye Injections. In later stages, patients may require different types of laser treatment or periodic (usually monthly) injections of medication directly into the eye to decrease swelling in the retina and/or control the growth of abnormal blood vessels. These treatments are done with anesthesia, so they are usually painless.

Treatment that reduces swelling can improve lost vision in some cases. Treatment for controlling the growth of blood vessels helps stabilize the vision and stop it from getting worse.

Surgery. Two subgroups of patients often end up requiring surgery: those who develop a retinal detachment and those who experience a vitreous hemorrhage that does not go away on its own.

Treatment for both involves vitrectomy surgery, where small instruments are inserted into the eye and the vitreous gel (gel-like fluid in the middle of the eye) is removed.

In the case of vitreous hemorrhage, this allows blood to be removed from the back of the eye. For retinal detachment, this provides better access to the back of the eye, where the surgeon carefully dissects the scarred membranes off the retina to flatten it. Laser treatment is often applied during this procedure, and a gas bubble is put into some patients' eyes to help press the retina into place.

Don't Be a Stranger

It bears repeating that people with diabetes should see their ophthalmologist annually to be checked for diabetic retinopathy, and immediately whenever they notice any symptoms of this potentially devastating eye disease.

I recently operated on a young woman whose diabetic retinopathy had progressed to the point that she developed a retinal detachment. Following surgery, she was so happy her vision had improved. She told me, "Prior to the operation, my vision was so bad I didn't know my flip-flops had ladybugs printed on them, and I can see them now!"

Visit us early and often. We may be able to help restore your eyesight