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Diabetic eye disease is a group of eye problems that can affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma.
Over time, diabetes can cause damage to your eyes that can lead to poor vision or even blindness. But you can take steps to prevent diabetic eye disease, or keep it from getting worse, by taking care of your diabetes.
The best ways to manage your diabetes and keep your eyes healthy are to
Photo courtesy of the National Eye Institute, NIH.
Often, there are no warning signs of diabetic eye disease or vision loss when damage first develops. A full, dilated eye exam helps your doctor find and treat eye problems earlyoften before much vision loss can occur.
Diabetes affects your eyes when your blood glucose, also called blood sugar, is too high.
In the short term, you are not likely to have vision loss from high blood glucose. People sometimes have blurry vision for a few days or weeks when theyre changing their diabetes care plan or medicines. High glucose can change fluid levels or cause swelling in the tissues of your eyes that help you to focus, causing blurred vision. This type of blurry vision is temporary and goes away when your glucose level gets closer to normal.
If your blood glucose stays high over time, it can damage the tiny blood vessels in the back of your eyes. This damage can begin during prediabetes, when blood glucose is higher than normal, but not high enough for you to be diagnosed with diabetes. Damaged blood vessels may leak fluid and cause swelling. New, weak blood vessels may also begin to grow. These blood vessels can bleed into the middle part of the eye, lead to scarring, or cause dangerously high pressure inside your eye.
Most serious diabetic eye diseases begin with blood vessel problems. The four eye diseases that can threaten your sight are
The retina is the inner lining at the back of each eye. The retina senses light and turns it into signals that your brain decodes, so you can see the world around you. Damaged blood vessels can harm the retina, causing a disease called diabetic retinopathy.
In early diabetic retinopathy, blood vessels can weaken, bulge, or leak into the retina. This stage is called nonproliferative diabetic retinopathy.
If the disease gets worse, some blood vessels close off, which causes new blood vessels to grow, or proliferate, on the surface of the retina. This stage is called proliferative diabetic retinopathy. These abnormal new blood vessels can lead to serious vision problems.
Photo courtesy of the National Eye Institute, NIH.
Photo courtesy of the National Eye Institute, NIH.
The part of your retina that you need for reading, driving, and seeing faces is called the macula. Diabetes can lead to swelling in the macula, which is called diabetic macular edema. Over time, this disease can destroy the sharp vision in this part of the eye, leading to partial vision loss or blindness. Macular edema usually develops in people who already have other signs of diabetic retinopathy.
Glaucoma is a group of eye diseases that can damage the optic nervethe bundle of nerves that connects the eye to the brain. Diabetes doubles the chances of having glaucoma, which can lead to vision loss and blindness if not treated early.
Symptoms depend on which type of glaucoma you have. Learn more about glaucoma.
Photo courtesy of the National Eye Institute, NIH.
The lenses within our eyes are clear structures that help provide sharp visionbut they tend to become cloudy as we age. People with diabetes are more likely to develop cloudy lenses, called cataracts. People with diabetes can develop cataracts at an earlier age than people without diabetes. Researchers think that high glucose levels cause deposits to build up in the lenses of your eyes.
Photo courtesy of the National Eye Institute, NIH.
About one in three people with diabetes who are older than age 40 already have some signs of diabetic retinopathy.1 Diabetic retinopathy is the most common cause of vision loss in people with diabetes. Each persons outlook for the future, however, depends in large part on regular care. Finding and treating diabetic retinopathy early can reduce the risk of blindness by 95 percent.
Your chances of developing glaucoma or cataracts are about twice that of someone without diabetes.
Anyone with diabetes can develop diabetic eye disease. Your risk is greater with
High blood cholesterol and smoking may also raise your risk for diabetic eye disease.
Some groups are affected more than others. African Americans, American Indians and Alaska Natives, Hispanics/Latinos, Pacific Islanders, and older adults are at greater risk of losing vision or going blind from diabetes.
If you have diabetes and become pregnant, you can develop eye problems very quickly during your pregnancy. If you already have some diabetic retinopathy, it can get worse during pregnancy. Changes that help your body support a growing baby may put stress on the blood vessels in your eyes. Your health care team will suggest regular eye exams during pregnancy to catch and treat problems early and protect your vision.
Diabetes that occurs only during pregnancy, called gestational diabetes, does not usually cause eye problems. Researchers aren't sure why this is the case.
Your chances of developing diabetic eye disease increase the longer you have diabetes.
Often there are no early symptoms of diabetic eye disease. You may have no pain and no change in your vision as damage begins to grow inside your eyes, particularly with diabetic retinopathy.
When symptoms do occur, they may include
Talk with your eye doctor if you have any of these symptoms.
Call a doctor right away if you notice sudden changes to your vision, including flashes of light or many more spots (floaters) than usual. You also should see a doctor right away if it looks like a curtain is pulled over your eyes. These changes in your sight can be symptoms of a detached retina, which is a medical emergency.
Having a full, dilated eye exam is the best way to check for eye problems from diabetes. Your doctor will place drops in your eyes to widen your pupils. This allows the doctor to examine a larger area at the back of each eye, using a special magnifying lens. Your vision will be blurry for a few hours after a dilated exam.
Your doctor will also
Your doctor may suggest other tests, too, depending on your health history.
Most people with diabetes should see an eye care professional once a year for a complete eye exam. Your own health care team may suggest a different plan, based on your type of diabetes and the time since you were first diagnosed.
Eye exam guidelines for diabetes 2,3,4:
Women who develop gestational diabetes dont usually need an eye exam because they dont develop diabetic eye disease during pregnancy. If you have any questions, ask your doctor.
Your doctor may recommend having eye exams more often than once a year, along with management of your diabetes. This means managing your diabetes ABCs, which include your A1c, blood pressure, and cholesterol; and quitting smoking. Ask your health care team what you can do to reach your goals.
Doctors may treat advanced eye problems with medicine, laser treatments, surgery, or a combination of these options.
Your doctor may treat your eyes with anti-VEGF medicine, such as aflibercept, bevacizumab, or ranibizumab. These medicines block the growth of abnormal blood vessels in the eye. Anti-VEGF medicines can also stop fluid leaks, which can help treat diabetic macular edema.
The doctor will inject an anti-VEGF medicine into your eyes during office visits. You'll have several treatments during the first few months, then fewer treatments after you finish the first round of therapy. Your doctor will use medicine to numb your eyes so you dont feel pain. The needle is about the thickness of a human hair.
Anti-VEGF treatments can stop further vision loss and may improve vision in some people.
Laser treatment, also called photocoagulation, creates tiny burns inside the eye with a beam of light. This method treats leaky blood vessels and extra fluid, called edema. Your doctor usually provides this treatment during several office visits, using medicine to numb your eyes. Laser treatment can keep eye disease from getting worse, which is important to prevent vision loss or blindness. But laser treatment is less likely to bring back vision youve already lost compared with anti-VEGF medicines.
There are two types of laser treatment:
Vitrectomy is a surgery to remove the clear gel that fills the center of the eye, called the vitreous gel. The procedure treats problems with severe bleeding or scar tissue caused by proliferative diabetic retinopathy. Scar tissue can force the retina to peel away from the tissue beneath it, like wallpaper peeling away from a wall. A retina that comes completely loose, or detaches, can cause blindness.
During vitrectomy, a clear salt solution is gently pumped into the eye to maintain eye pressure during surgery and to replace the removed vitreous. Vitrectomy is done in a surgery center or hospital with pain medicine.
In a surgery center or hospital visit, your doctor can remove the cloudy lens in your eye, where the cataract has grown, and replace it with an artificial lens. People who have cataract surgery generally have better vision afterward. After your eye heals, you may need a new prescription for your glasses. Your vision following cataract surgery may also depend on treating any damage from diabetic retinopathy or macular edema.
To prevent diabetic eye disease, or to keep it from getting worse, manage your diabetes ABCs: your A1c, blood pressure, and cholesterol; and quit smoking if you smoke. Read more information on how to manage diabetes.
Also, have a dilated eye exam at least once a yearor more often if recommended by your eye care professional. These actions are powerful ways to protect the health of your eyesand can prevent blindness.
The sooner you work to manage your diabetes and other health conditions, the better. And, even if youve struggled in the past to manage your health, taking better care of yourself now can protect your eyes for the future. Its never too late to begin.
Ask your eye care professional to help you find a low vision and rehabilitation clinic. Special eye care professionals can help you manage vision loss that cannot be corrected with glasses, contact lenses, medicine, or surgery. Special devices and training may help you make the most of your remaining vision so that you can continue to be active, enjoy hobbies, visit friends and family members, and live without help from others.
[1] Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.
[2] Diabetic retinopathy preferred practice pattern guidelines. American Academy of Ophthalmology website. https://www.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp. Updated January 2016. Accessed June 2, 2017.
[3] Fraser CE, DAmico DJ. Diabetic retinopathy: prevention and treatment. UpToDate website. https://www.uptodate.com/contents/diabetic-retinopathy-prevention-and-treatment. September 28, 2016. Accessed June 2, 2017.
[4] American Diabetes Association. Standards of medical care in diabetes2016 abridged for primary care providers. Clinical Diabetes. 2016 Jan;34(1):321.
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Diabetic Eye Disease | NIDDK