Diabetic eye disease: retinopathy, eye exams and sight protection

Eyes are one of the parts of the body that diabetes can affect over time. The problem is that early eye disease often causes no symptoms. Regular eye checks are how most problems are found early. This article explains what the health agencies say about protecting your sight.

What is diabetic eye disease?

The NIDDK says diabetic eye disease is a group of eye conditions that can affect people with diabetes. It includes diabetic retinopathy, diabetic macular edema, cataracts and glaucoma. Over time, high blood glucose can damage the small blood vessels in the eye, which can lead to vision loss. The NHS describes diabetic retinopathy as an eye condition caused by diabetes that can lead to sight loss, and says finding and treating it early reduces the risk.

Symptoms

Early disease often causes no symptoms, according to the NIDDK and the NHS. When symptoms do occur, the NIDDK lists:

• Blurry or wavy vision
• Vision that changes from day to day
• Dark areas or vision loss
• Poor colour vision
• Floaters, which look like spots or dark strings
• Flashes of light

The NHS adds difficulty seeing in low light. These symptoms do not always mean diabetic eye disease, but they should be checked.

Who is more at risk?

The NIDDK names untreated high blood glucose and high blood pressure as the largest factors. It also lists high cholesterol, smoking and a longer time living with diabetes. Pregnancy can worsen existing retinopathy, while gestational diabetes usually does not cause eye problems, the NIDDK says.

How is it found?

The NIDDK says a full dilated eye exam is the recommended way to detect problems. Drops widen the pupils so the doctor can view the back of the eye, and the exam also includes a vision test and a check of eye pressure. Vision may stay blurry for a few hours afterwards. In the UK, the NHS says screening uses photographs of the back of the eye, and people with diabetes aged 12 or over are invited every 1 or 2 years.

How often should you be checked?

The NIDDK says most people with diabetes should have a complete eye exam once a year. For type 1 diabetes, yearly exams start within 5 years of diagnosis. For type 2 diabetes, yearly exams start right after diagnosis. For pregnancy, an exam before pregnancy or in the first 3 months is advised, with possible repeats later. Your eye doctor may suggest a different schedule.

Protecting your eyes

The NIDDK says the main steps are to manage blood glucose, blood pressure and cholesterol, to stop smoking if you smoke and to get regular dilated eye exams. The NIDDK states that finding and treating diabetic retinopathy early can reduce the risk of blindness by 95 percent.

Treatment options

An eye specialist decides the treatment. The NIDDK describes these options:

• Anti-VEGF injections that block abnormal blood vessel growth and fluid leakage
• Laser treatment that seals leaky vessels and helps prevent further vision loss, though it is less effective at restoring lost vision
• Vitrectomy, surgery for severe bleeding or scar tissue
• Cataract surgery, which replaces a cloudy lens
• Low vision rehabilitation for sight loss that glasses, medicine or surgery cannot correct

The NHS notes that sight loss from diabetic retinopathy cannot be cured, so treatment aims to stop vision getting worse. In its early stages it is usually monitored rather than treated.

When to see a doctor

Book an eye exam if you have diabetes and have not had one in the last year, or sooner if your eye doctor advises. See a doctor or optician about gradual changes such as floaters or trouble seeing in low light.

Seek urgent care for sudden vision changes, flashes of light, a sudden increase in floaters or a shadow over your vision. The NIDDK says these can signal a detached retina, which is a medical emergency. In an emergency, call your local emergency number (112 in India, 911 in the United States).

This article is for education only and does not replace advice from your own doctor.