How to tell if diabetes is affecting your eyes? 4 Diabetic eye diseases: Symptoms, Treatment, Preventions

There are many people around who know that they are suffering from diabetes and need treatment but they may not know that they may have condition called as Diabetic eye. Yes, there is something called as Diabetic eye, where eyes are affected by diabetes and it is common amongst diabetic patients than you think so.

There are more than 26 million people in United States itself who are suffering from diabetes and are at risk of going blind.

If you have poor vision and suffering diabetes then your diabetes can be the reason for your deteriorated vision. If your diabetic eye is left untreated then there is very high chance of you becoming blind. Hence, treatment and care are utmost important to avoid and stop your vision from further deterioration. 

Diabetic eye diseases which any diabetic patient may incur are diabetic retinopathy, diabetic macular edema, glaucoma, and cataract which is most common amongst patients. Sometimes blurry vision is also caused by diabetic eye.

Before knowing more about these eye diseases caused by diabetes, let us understand basic anatomy and functioning of eye.

Anatomy and functioning of eye

Our eyes are spherical in shape and though they may look delicate but, our eyes are quite strong enough to protect itself from some damage. 

The outer layer or first layer of an eye is cornea. It is tough clear membrane which covers frontal layer of eye. The function of cornea is to focus incoming light and also protect the eye.

Through cornea light is passed to a protective fluid and then through the pupil, it is hole in the iris. When you look into an eye, the colored circular disk you see is iris. 

From the pupil, light is focused deeper into the eye through lenses which are present in the eye. At the end there is another fluid filled section at the center of the eye through which is light is passed and then projected on retina at back of the eye.

Diabetic eye and its effects on eye

Your eyes are affected by diabetes when your blood sugar level is too high. Over the period of time if blood sugar levels are not controlled then your eyes can be damaged. 

Sometimes, people have blurry vision for days or weeks while changing their diabetes plans or medicines. Due to high sugar in fluid, there is swelling in the tissue of the eyes which are responsible for focusing the light. Swelling of these tissue causes blurred vision. Fret not, this type of blurry vision is temporary and it goes off once the sugar level is back to normal level.

If your blood sugar stays high for prolonged period of time there can be damage to blood vessels which are at the back of your eyes. This damage to tiny blood vessels can begin from early stage also known as prediabetic stage, condition when your blood sugar is high but not high enough to be diagnosed with diabetes. 

These damaged blood vessels can cause swelling and new weaker blood vessels may begin to grow and eventually rupture. This can cause bleeding in the eye which in turn can result into scarring, or can also cause to rise in pressure in the eye to highly dangerous levels.

Due to above problems which are prominently caused by diabetes, your retina is affected and such problems are called as “microvascular abnormalities”. Most of the serious diabetic eye diseases begin with these microvascular abnormalities. 

The 4 diabetic eye diseases which can severally affect your eyes are mentioned below.

Cataracts 

The cornea in your eyes acts as lenses and is responsible to focus light which helps in creating sharp vision. With age the vision can become cloudy due to clouding/fogging of the clear lenses: cornea. Person whose cornea have become cloudy/fogged is said to have cataract. 

Occurrence of cataract is common but, if you are diabetic then probability of getting cataract rises by 60 times when compared with someone who is not diabetic. It is believed by researchers that high sugar levels cause deposits on cornea of the eye and results into cataract. Thus, young adults are also prone to cataracts as diabetes plays a role in shortening the clouding of eyes.

Symptoms of Cataract

• Blurry vision
• Glary vision
• Visible clouding of eyes

Available treatments for Cataract

If you already are suffering from cataract then the most common treatment involves surgically removing the clouded lens and replacing it with new artificial lens.

Glaucoma

Glaucoma is a condition that causes damage to optic nerves in eye. It is most of the times caused by increased pressure, also known as intraocular pressure. If the damage to optic worsens then it can result into permanent vision loss within short period of few years. 

The excess pressure in the eye is created when eye is not able to remove the fluids present in the eye. This pressure causes squeezing of blood vessels in the eye which eventually starves retina and optic nerve and results into vision loss over time. 

As you age the risk of getting glaucoma is high and if you are diabetic then your risk of getting it are higher. The chances of entangled in this condition increases by 40% if you are diabetic and the chances increases with the prolonged diabetic conditions. 

Symptoms of Glaucoma

Glaucoma does not have any initial observable signs and symptoms and till the time any symptoms occur the condition has already become severe. To detect it at the earliest stage, best way is to routinely do eye checkup. When the symptoms are noticeable, it can include and appear in combination of:

• Headaches
• Eye aches
• Blurred vision
• Loss of vision/Reduced vision
• Loss/Reduced visual field
• Watering of eyes
• Halos around lights

Available treatments for Glaucoma

Most of the treatments for glaucoma involves lowering the pressure in the eyes. Pressure is lowered by removing the humor fluid present in the eye or decreasing the production of the fluid. This pressure can be lowered by:

• Medication 
• Special eye drops
• Surgery
• Laser Therapy

Glaucoma is a life-long condition so it is necessary to regularly follow up with the eye specialist. Also, it is important to know that early diagnosis is necessary to stop the damage of eyes. 

Diabetic Retinopathy

As in the name suggests diabetic retinopathy is a diabetic eye disease which is caused by damage to blood vessels connecting to retina. At early stage diabetic retinopathy may not show any symptoms of maybe some mild symptoms but, over the period of time it can cause blindness. 

Anybody with type 1 or type 2 diabetes can develop this condition and, if you are suffering from diabetes for long period of time and if you blood sugar is not in control then, it is likely for you to suffer from this eye complication.

With too much sugar in blood, it can cause blockage of the tiny blood vessels which are connected to retina. Due to this blockage of blood vessels, supply of blood and nourishment to retina is stopped. So, to avoid stopping of blood supply and nourishment, the eye tries to grow new blood vessels but, these newly developed blood vessels are not perfect like the old ones and it can leak easily. 

Diabetic retinopathy can be divided into two types:

• Early diabetic retinopathy
• Advanced diabetic retinopathy

Early Diabetic Retinopathy is also called as non-proliferative diabetic retinopathy or NPDR. In this situation new blood vessels are not being developed. 

When suffering from NPDR diabetic eye problem, the walls of the blood vessels in retina weakens. These weakened walls cause swelling of the blood vessels, this kind of swelling is called as “microaneurysms”. Due to these microaneurysms there is leakage of fluid and blood into retina.

Along with the leakage of fluid and blood, the larger retinal vessels start to dilate and can the size of the vessels become irregular. With blockage of more blood vessels, NPDR can become severe. 

Due to above causes another condition may develop where nerve fibers in retina start to swell. In some instances, the central part of retina known as “macula” starts swelling. This swelling of retina is called as “macular edema” and this condition requires treatment or else it may cause severe damage to eye and retina and, may lead to vision loss.

Advanced Diabetic Retinopathy, also called as proliferative diabetic retinopathy is severe case of diabetic retinopathy. In this type of retinopathy, the damaged blood vessels get pinched causing starvation of retina, to avoid this there is growth of new blood vessels but, these new vessels are abnormal. These new vessels can leak and release fluids which fills center of the eye known as vitreous gel.

As these new blood vessels are fragile and prone to bleeding and fluid leaks, it also causes scarring of tissues which can retinal detachment. Retinal detachment is a phenomenon where retina within the eye detaches and shifts from its original position. This detachment and shifting of retina can cause permanent vision loss.

If there is any interference from the newly developed blood vessels to the flow of fluids in the eye, it can lead to increase in the pressure within the eye. The excess pressure can damage the optic nerve and it can result into glaucoma.

Symptoms of Diabetic Retinopathy

At early stages of diabetic retinopathy there may not be any noticeable symptoms but, as the condition progresses further, you may notice symptoms like

• Spots or dark strings floating in field of vision
• Blurred vision
• Impaired vision
• Fluctuating vision
• Dark/empty spots in field of vision
• Vision loss

Note that diabetic retinopathy will not affect single eye, both eyes are affected by it.

Available treatments for Diabetic Retinopathy

Diabetic retinopathy can only be treated by surgical method or laser treatment. The treatments available are

• Photocoagulation: In this treatment an ophthalmologist will seal blood vessels which are causing damage to eyes by making tiny burns on the affected areas. This usually stops the growth of blood vessels and leakage of any blood or fluids.
• Scatter Photocoagulation/Pan-retinal Photocoagulation: In this treatment hundreds or dotted lasers are focused on eye which burns on the damaged retina. This treatment is performed to reduce the risk of blindness due to vitreous hemorrhage or retinal detachment. Vitreous hemorrhage is condition where new blood vessels bleed into clear, jelly-like substance at the center if eye. This treatment will only show result if it is performed before subsistent bleeding or detachment. Treatment usually takes place in two or more sittings.
• Vitrectomy: If there is already serious blood loss or retinal detachment then scatter photocoagulation/pan-retinal photocoagulation are not effective treatments. To stop the damage and better recovery from damage, vitrectomy is performed. It is a surgical procedure in which cloudy fluids or scarred tissues are removed from the eye. For this surgery to be a success and for the faster recovery of the patient, the operation need to take place as early as possible.

Diabetic Macular Edema

Diabetic Macular Edema or DME is a diabetic eye condition where the leakage of fluid from damaged blood vessels in retina is accumulated in macula causing its swelling. This condition mostly arises due to complications of diabetic retinopathy. 

Diabetic retinopathy and diabetic macular edema are common problems amongst diabetics and around 28% of the diabetic patients suffer from this diabetic eye disease. People who suffer from diabetic retinopathy have 50% chance of developing DME. 

DME occurs as diabetic retinopathy gets severe and complicated but, it can also occur at any stage of the disease.

DME usually occurs in two forms

• Focal DME, which occurs due to abnormalities in ocular blood vessels.
• Diffuse DME, which occurs when there is widening/swelling of retinal capillaries (thin blood vessels present on retina)

Symptoms of DME

Symptoms of DME are similar to diabetic retinopathy

• Blurred vision
• Spots or dark strings floating in field of vision or Floaters
• Double Vision
• Blindness if left untreated

Available treatments for Diabetic Macular Edema

The available treatments for focal DME and diffuse DME are different but, both of the treatments involve laser procedures. Patients suffering from focal DME are treated by focal laser treatment and to treat diffuse DME, grid laser treatment is used. Both of these treatments are aimed towards stopping of blood and fluid leakage in the macula.

How to prevent diabetic eye problems?

The best way to prevent diabetic eye disease is by controlling diabetes and blood sugar. Having good control on your blood sugar levels and blood pressure and, regular eye check-up is key to preventing diabetic eye problems.

It is also important that early intervention to any eye/vision problems can help avoid severe damage to eye and prevent vision loss.

If you are diabetic then you can reduce risk of diabetic retinopathy by following steps mentioned below:

• Control your blood sugar levels and manage diabetes: Eat healthy and involve yourself into physical activities and make it part of your daily routine. Try doing moderate aerobic exercises on daily basis and keep taking your prescribed medications as per the directions by your physician.
• Control your blood pressure and cholesterol: Same things from the first point apply when controlling blood pressure and cholesterol. Along with healthy eating and aerobic exercises, your focus should also be on shedding few extra pounds from the body. High cholesterol level and high blood pressure increases the risk of diabetic eye diseases.
• Avoid smoking: Due to smoking you raise the risks of various diabetic complications which also includes diabetic retinopathy. By avoiding smoking, you can maintain health of eyes and reduce the risk of any diabetic eye disease. If you are finding it difficult to quit smoking or tobacco, then you should see your doctor for help in quitting. There are groups and organizations which help in smoking addictions and these addictions can also be treated by medications.
• Monitor blood sugar level: If you are diabetic or someone suffering with high blood sugar then you should regularly check your blood sugar level. You can check your blood sugar level at home by using glucometer. Monitoring sugar level can help you understand few important patterns. Consult with your doctor about how frequently blood sugar needs to be checked. Another test you should consider is glycosylated hemoglobin test, this test shows average blood sugar over the period of past two to three months. The result of this test should be below 7%.
• Observe for vision changes: If you experience any sudden vision changes or you notice that your vision has become blurry, spotty or hazy or any other vision changes then, immediately consult with an ophthalmologist.

It is unfortunate that symptoms of any diabetic eye diseases are not distinctively visible at an early stage. Due to this reason, you should regularly go for eye check-up. If you are diabetic then you should get your eyes examined at least once in a year.

Regular thorough checkup for a diabetic patient involves examination of retina, optic nerve, cornea and other parts of an eye. Through this thorough checkup, ophthalmologist can diagnose any diabetic eye disease at an early stage which can save your eyes from severe damage.

If you are regular with your eye checkups then, an early diagnosis is definitely possible and the ophthalmologist can provide better treatment and ensure that your eyes remain healthy. 

The worst thing about the diabetic eye diseases like the ones mentioned in this article are that, once the damage has happened to your eyes is beyond a point then there is no coming back from it, the damage which has happened is permanent. Therefore, through this article I have insisted multiple times that regular eye checkups are crucial for healthy eyes. If diagnosed and treated early your eyes can be saved and damage can be alleviated. Today’s treatment may not be able to completely recover the eyes from serious damage but, these treatments can help you in saving your vision and with low vision aids you can continue enjoying this beautiful world.

Also, you should know that does not necessarily means there will be vision loss but, it can aggravate the causes of it. So, it is best to take diabetes seriously and do the necessary to control it. With controlled diabetic conditions you can avoid most of the complications and have a healthy life.