Diabetic Eye Disease: A Leading Cause of Vision Loss

Diabetic eye disease — which refers to a group of serious eye problems among diabetics — is growing in prevalence.  As a large segment of the population ages and diabetes forges on as an epidemic fueled by poor diets, lack of physical activity and a high obesity rate, cases of diabetic eye disease also are increasing.

The most common vision problem among diabetics is “diabetic retinopathy.” This is when high blood-sugar levels cause damage to blood vessels in the retina, resulting in swelling and leaking. The swelling can also block blood from passing through. Sometimes abnormal, new blood vessels grow on the retina from this condition. All of these changes can lead to a loss of vision.

The most common reason why people with diabetes lose their vision is “macular edema.” Located in the center of the retina, the eye’s light-sensitive tissue, the macula, provides the sharp, central vision we need for seeing short and long distances, and for deciphering fine detail. When the macula swells, it is called macular edema.

“Diabetic eye disease is certainly on the rise, so much so that it is rapidly becoming one of the leading causes of blindness in senior individuals,” says Mandeep Dhalla, M.D., a retinal and macular surgeon with Retina Group of Florida and Baptist Eye Surgery Center. “We haven’t seen this much of an increase before.  While macular degeneration remains the leading culprit in senior blindness, diabetic cases are rapidly becoming much more common.”

Diabetics also have to worry about cataracts, the clouding of the eye’s natural lens which is a common and treatable condition mostly affecting adults over the age of 60. A new study examined data on 112,000 patients and found the risk for developing cataracts was more than than five-fold greater in diabetes patients aged 45 to 54 years.

Lifestyle Factors and Your Vision
The same group of lifestyle factors that drive the diabetes epidemic is propelling diabetic eye disease. Type 2 diabetes is the chronic condition in which the body fails to properly process glucose (blood sugar). That’s when the body cannot use insulin well. Over time, high blood glucose — if uncontrolled — can lead to serious problems with your heart, kidneys, nerves, and gums and teeth.

“Several organ systems, such as the kidneys, eyes, heart and brain, are affected mostly commonly in people with elevated blood sugar,” says Dr. Dhalla. “The eyes are commonly effected and often lead to active symptoms. Although one can be a diabetic and not have eye problems initially, statistically many patients will start to develop some form of diabetic retinopathy the longer they are diabetic.  This can occur even with relatively good blood sugar control and is just a function of wear-and-tear from hyperglycemia over time.”

Dr. Dhalla adds that numerous clinical studies have shown “out-of-control blood sugar, coupled with out of control blood pressure” can dramatically increase the risk of vision loss. By controlling blood sugar, you can significantly diminishes the risk of vision loss, he explains.

“High blood sugar and high blood pressure is a formula for rapid acceleration of vision loss, caused by hemorrhage, leakage, retinal detachment and a dangerous form of glaucoma resulting from neovascularization,” he said. “Damage to the eyes can be permanent in some cases, so working with your retina surgeon and the physician managing your diabetes is crucial.”

According to the American Academy of Ophthalmology, here are the top five steps you can take to help prevent diabetic eye disease:

1. Get a comprehensive dilated eye examination from your ophthalmologist at least once a year. Diabetic eye disease often has no symptoms in the early stages. A dilated eye exam allows your ophthalmologist to thoroughly examine the retina and optic nerve for signs of damage before you notice any change to your vision.
2. Control your blood sugar. When your blood sugar (glucose) is too high, it can affect the shape of your eye’s lens, causing blurry vision (it goes back to normal after your blood sugar stabilizes). High blood sugar can also damage the blood vessels in your eyes. Maintaining good control of your blood sugar helps prevent these problems.
3. Maintain healthy blood pressure and cholesterol levels. Heart disease risk factors, including high blood pressure and high cholesterol, can also put you at greater risk for eye disease and vision loss. Keeping both under control will likely help you keep your blood sugar under control as well. Preventing heart disease will not only help your eyes but your overall health.
4. Quit smoking. If you smoke, your risk for diabetic retinopathy and other diabetes-related eye diseases is higher. Giving up tobacco will help reduce that risk.
5. Exercise. Yes, exercise is good for your eyes as well. Mainly, it’s good for preventing or controlling type 2 diabetes. Staying physically active, combined with healthy eating, can help you maintain an ideal weight. Proper dieting and exercises are the necessary lifestyle modifications to control diabetes, and prevent diabetic eye disease.