Diabetes is a chronic systemic condition in which one’s body is unable to regulate the level of sugar in the blood stream leading to high blood sugar. This state of high blood sugar leads to damage of the small blood vessels throughout the body. Specifically, the inner walls of small blood vessels are damaged which results in a restriction in blood supply to organs.
Diabetes does not spare the eyes. According to the American Diabetes Association, diabetes is the leading cause of new cases of blindness among adults aged 20-74. This condition can damage many aspects of the eye from the cornea (front clear part of the eye), the lens, to the retina (the light sensitive tissue inside the eyes). This article will concentrate on the retinal changes caused by diabetes.
The retina has a network of blood supply that can be damaged in diabetes. The term for diabetic damage to the retina is diabetic retinopathy. When blood vessels are damaged inside the eyes, those blood vessels leak blood and fluids into the surrounding retina. Like a sponge, the retinal tissue will soak up the blood or fluid causing swelling and possibly loss of vision. As the swelling persists, the delicate retinal tissue may become permanently damaged and vision could be irreversibly reduced.
Diabetes also causes a restriction of blood flow, ischemia, to the retina. Because the retina is a highly metabolic tissue, it needs a lot of nutrients and oxygen to function properly. When it is deprived of its blood supply, new blood vessels will grow to fill the void. This sounds like a good idea, but these new blood vessels are not the same as the original vessels. They are fragile and tend to leak blood and fluid which can cause significant scarring of the retina. In uncontrolled, advanced stages of diabetic retinopathy, significant vision loss can result from a retinal detachment and neovascularization glaucoma.
The good news is that there is treatment for certain forms of diabetic retinopathy and retinal swelling. The treatment options include injections of medications into the eyes and the use of lasers to halt the growth of the new blood vessels and reduce the swelling of the retina.
In early stages of diabetic retinopathy, you follow up with your optometrist to monitor your status. These follow ups are important because they allow the doctor to determine whether your retinopathy is stable, improving, or progressing. Your optometrist is your primary eye care provider who will be able to determine if further, more specialized care is warranted and will make the appropriate referral.
The unfortunate fact about eye problems in diabetes is that the damage can occur, initially, without obvious vision loss or pain. However, the damage can rapidly progress to severe and permanent loss of vision. Often optometrists will be the first medical professionals to uncover undiagnosed diabetes during a routine eye exam. Not all people with diabetes will develop retinopathy, but the longer you have diabetes, the more likely you are to develop these diabetic complications. In fact, the American Diabetic Association recommends those with diabetes to have a comprehensive eye exam yearly. Remember, vision loss from diabetes can be unexpected, rapid, permanent and painless. If you have diabetes, make sure you are seeing an optometrist for your diabetic eye exam once a year. Preventative measures will reduce your chances of major complications.
Dr. Nguyen is a UC Berkeley trained Optometrist who completed an Ocular Disease residency at the Veterans Affairs Hospital in Baltimore, MD. She can be reached at 760-342-6900 at her office in La Quinta, CA.