American Diabetes Month: How Diabetes Affects Your Eyes

Nearly 30 million Americans are living with diabetes. It is the seventh-leading cause of death in the US and it also contributes to the leading cause of blindness in the world.

Understanding diabetes, its implications and how it affects your eyes can save your vision.

What is Diabetes?
Diabetes is a condition in which the body either does not produce insulin (type 1 diabetes) or becomes insulin resistant (type 2 diabetes). Insulin is necessary to regulate blood sugar levels and break down sugars and starches into glucose, which the insulin then carries to the cells to be used for energy.

Without proper insulin production, glucose builds up in the blood, which can lead to numerous health conditions, such as nerve damage and eye problems including diabetic eye disease, or diabetic retinopathy.

What is Diabetic Retinopathy?
Diabetic retinopathy, a condition caused by diabetes, occurs when the blood vessels in the back of the eye change. These vessels can weaken and leak fluid or abnormal vessels can grow on the surface of the retina, which may hemorrhage. Diabetic eye disease is the leading cause of blindness in the 20-64 year age group, and is one of the most frequent causes of retinal blindness in the world.

The National Eye Institute estimates that 40 to 45 percent of all Americans with diabetes have some form of diabetic retinopathy, and at least five percent of diabetics have a severe case of diabetic eye disease. The incidence of diabetic retinopathy is typically associated with the type of diabetes, how often blood sugar fluctuates, and how long one has been living with diabetes — the longer a patient has had diabetes, the greater his or her chances of developing diabetic retinopathy.

The symptoms of diabetic retinopathy range from minor symptoms such as fluctuation of vision (related to fluctuation of blood glucose levels) to severe symptoms such as bleeding in the back of the eye. In some cases, there may be no symptoms at all.

Because symptoms do not typically present until the condition is severe, it is crucial that diabetics maintain regular eye exams.

Four Stages of Diabetic Retinopathy

  • Mild Nonproliferative Retinopathy. At this stage, small areas of balloon-like swelling (called microaneurysms) occur in the retina’s blood vessels.
  • Moderate Nonproliferative Retinopathy. As the disease progresses to this stage, some blood vessels that carry vital nutrients to the retina become blocked.
  • Severe Nonproliferative Retinopathy. More blood vessels become blocked and the retina responds by sending signals to the body to grow more blood vessels.
  • Proliferative Retinopathy. Proliferative retinopathy occurs when new, fragile blood vessels develop on the retina. This condition is usually treated with laser surgery to help shrink the abnormal blood vessels. These treatments work better before the fragile new blood vessels have started to bleed. Even if bleeding has started, diabetic laser treatments may still be possible, depending on the amount of bleeding. If the bleeding is severe, you may need a surgical procedure called a vitrectomy.

Who is at risk of developing diabetic eye disease?
Diabetic retinopathy is the result of diabetes, but not all diabetics will develop the eye condition. Some diabetics are at higher risk of developing diabetic retinopathy. These risk factors include:

  • Poor management of diabetes
  • High blood pressure 
  • High cholesterol
  • Smoking
  • Lack of preventative eye care

To learn more about prevention and treatment for diabetic eye disease, click here.

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