Healthy eyes & diabetes

Diabetes is a chronic disease with complications involving multiple organs and your eyes are not an exception. Globally, around 93 million people with diabetes have some form of eye damage. The longer you have diabetes, the greater is your chance of having diabetic eye disease.

You may not have any symptoms of eye damage at first. Thus, an eye examination should be a part of routine diabetes check-up to find out if the process of eye damage has started and treat it before its too late. Once a diabetic loses his vision, it is rarely restored.

How diabetes affects your eye?

High blood sugar levels damage the blood vessels in the retina due to which they start to swell and leak. This condition is called diabetic retinopathy. The blood and the fluid that has oozed out cause the macula (the central, functional area of the retina) to swell up or thicken. This condition is called diabetic macular edema. This slowly deteriorates your vision and may eventually lead to blindness.

The following eye changes occur in diabetic retinopathy:

  • Formation of microaneurysms: The small bulgy areas in the retinal blood vessels have extremely fragile blood vessel wall, which can rupture and leak blood in the retina.
  • Retinal hemorrhages: Owing to leakage of the blood vessels, there are tiny spots of blood in the retina.
  • Thick exudates: Lipid molecules get deposited in the retina.
  • Abnormalities in the retinal microvasculature: The small blood vessels in the retina become dilated and start branching out abnormally.
  • Neovascularisation: There is formation of new small, blood vessels in the retina.

Symptoms & risk factors of diabetic eye disease

Symptoms of diabetic eye disease

The symptoms of eye disease vary from person to person, and some people may not have any symptoms unless the eye disease is advanced. The symptoms include:

  • Eye floaters (dark spots in the visual field)
  • Blurring of vision
  • Vision loss

Factors that increase your risk of having diabetic eye disease

The longer you have diabetes and the more severe your diabetes is, the more is your risk of having diabetic retinopathy. In addition, the following factors may further aggravate your risk:

  • High cholesterol and triglyceride levels
  • High blood pressure
  • Smoking and using other forms of tobacco
  • Pregnancy

Prevention of diabetic eye disease

You cannot prevent diabetic retinopathy, but early detection can help to prevent complications such as vision loss. Follow these measures to prevent diabetic eye disease from worsening:

Go for a dilated eye exam at-least once a year

If you smoke, please quit smoking

Opt for healthy food choices- limit consumption of sugars, oils and alcohol

Exercise on a regular basis- 150 minutes of moderate physical activity per week is ideal for maintaining good health.

Take your medications on time and at doses as prescribed by your doctor to prevent diabetes from worsening.

The Eye Exam for diabetic eye disease

Diabetic retinopathy is a very common complication and if you are a diabetic, you must have a comprehensive eye examination at-least once a year.

During your screening visit, your ophthalmologist would ask a few questions regarding your diabetes and whether you are having any visual symptoms. Following this, a visual acuity testing would be done to find out whether you have normal vision and if you are able to see clearly.

The third and the chief examination for diabetic retinopathy is the dilated eye examination. During this test, your doctor would check for

  • Blood clots in the retina
  • Abnormal blood vessels
  • Bleeding in the vitreous
  • Fatty deposits in the retina
  • Detachment of the retina
  • Abnormal changes in the optic nerve
  • Evidence of cataract

In addition, your doctor would also check for intraocular pressure (pressure within the eye) to rule out glaucoma.

Dilated eye exam

A dilated eye exam helps to detect any damage inside the eye when there are problems in vision. In this test, certain eyedrops are given which help your pupils stay open (dilated) for some time. When your pupils are dilated, it is easier to check the parts which are at the back of the eye such as the retina, the macula and the optic nerve.

Some tips for those taking the dilated eye exam

  1. Avoid driving: It usually takes around 4-5 hours for your vision to
    come back to normal after the use of those eye drops. Thus, it is
    unsafe to drive during this time.
  2. Take a time off work: With blurred vision, it is often difficult to work.
    Thus, it is advisable to go for the test after work or take a day off.
  3. Get your sunglasses: When your pupils are dilated, you become
    extra sensitive to glare. Wear sunglasses to comfort your eyes.

Treatment of diabetic eye disease

If your vision is affected due to diabetic retinopathy, you may be suggested one of the following treatments:

Laser photocoagulation:

This treatment is used to seal off the new fragile blood vessels that cause leakage of blood in the eye. This procedure often takes 40-45 minutes.

In this procedure, you would be given anesthetic drops to numb your eyes and eye drops to dilate your pupil. Laser light would be shone on your retina. This treatment is not usually painful, but you may feel a sharp prick like sensation in areas being treated.

Eye injections:

Anti VEGF injections (ranibizumab, aflibercept) help in preventing the formation of new blood vessels in the eye.

During the treatment, small clips would be used to help keep your eyes open, you would be given anesthetic eye drops to numb your eyes and the medication is injected using a fine needle. Sometimes, steroid injections can also be given if the anti-VEGF injections do not seem to work.

Vitreo-retinal surgery

Vitreo-retinal surgery may be indicated in advanced cases of diabetic retinopathy, and when there is a lot of blood in the vitreous humor, extensive scar tissue formation that may cause retinal detachment, or if laser surgery/ eye injections had not been successful in curbing the growth of new blood vessels.

The surgery, which is done under sedation and local anesthesia, involves removal of a portion of the vitreous humor of the eye.
Though these treatments are quite effective, you should have realistic expectations from these procedures. These procedures do not help to restore lost vision but do prevent from further worsening of eyesight. Early detection is the key to prevent eye problems. So, your doctor may prescribe you treatment even before your vision problems start.

Eye damage is a common complication in diabetics. It does not show any symptoms at an early phase and thus is detected at an advanced stage. In some, eye damage can lead to vision loss that cannot be restored easily. Thus, it is important to include eye examination in the routine check-ups for diabetics.