OHSU

Diabetes

Eye Diseases Commonly Associated With Diabetes

Diabetic eye disease refers to a group of eye problems experienced by people with diabetes, which can cause severe vision loss or even blindness. However, diabetic eye diseases can often be treated before vision loss occurs. We recommend that anyone diagnosed with diabetes have an eye examination, with the eyes dilated to check the back of the eye, at least once a year.

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Diabetic Eye Diseases Include:

  • Diabetic retinopathy (the most common eye disease in people with diabetes)
  • Cataract
  • Glaucoma

What is diabetic retinopathy?

Diabetic retinopathy is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid, while in others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

Diabetic retinopathy cannot be completely avoided, but the risk can be greatly reduced. Better control of blood sugar levels slows the onset and progression of retinopathy, and lessens the need for laser surgery for severe retinopathy.

What are the symptoms of diabetic retinopathy?

There may be no symptoms or pain in the early stages of diabetic retinopathy, and vision may not change until the disease progresses.

A condition called macular edema may occur when the macula, a part of the retina, swells from the leaking fluid and causes blurred vision. When new vessels grow on the surface of the retina, they can bleed (hemorrhage) into the eye, blocking vision.

Who is at risk for diabetic retinopathy?

Anyone with diabetes is at risk. The longer a person has diabetes, the more likely that he or she will develop diabetic retinopathy.

Can diabetic retinopathy be prevented?

Although diabetic retinopathy cannot be prevented, the risk can be reduced by:

  • Dilated eye examinations once a year
  • Strictly managing diabetes by:
    • Taking medications as directed
    • Using insulin as directed
    • Eating appropriate foods to manage blood sugar level
    • Exercising to lower and help the body use blood sugar
    • Testing blood sugar levels regularly
    • Testing urine for ketone levels regularly

How is diabetic retinopathy diagnosed?

In addition to a complete medical history and eye examination, your eye care professional may perform the following tests to diagnose diabetic retinopathy:

  • Visual acuity test - the common eye chart test, which measures vision ability at various distances.
  • Pupil dilation - the pupil is widened with eye drops to allow a close-up examination of the eye's retina.
  • Tonometry – a standard test to determine the fluid pressure inside the eye.
  • Ophthalmoscopy - a doctor performs a detailed examination of the retina using a special magnifying glass.

Treatment for diabetic retinopathy

Specific treatment will be determined by your doctor based on:

  • Your age, overall health and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

According to the National Eye Institute, part of the United States National Institutes of Health, even people with advanced retinopathy have a 90% chance of keeping their vision if they seek treatment before the retina is severely damaged. Treatment may include:

Laser surgery

Often used to treat macular edema and proliferative retinopathy; involves shrinking the abnormal blood vessels or sealing the leaking ones.

Vitrectomy

A procedure that involves removing the cloudy vitreous (the clear gel that fills the center of the eye) and replacing it with a salt solution. Vitrectomies are particularly effective in persons with insulin-dependent diabetes, who may be at a greater risk of blindness due to a hemorrhage in the eye.