Dr Ben Wild
Overview |
Diabetes is a disorder that leads to elevated levels of glucose (sugar) in the blood. This excess sugar can damage the blood vessels of the body and lead to heart damage, kidney damage, nerve damage and many eye issues.
A frontal view of a healthy retina and optic nerve.
When it comes to the eyes, diabetes can lead to blindness several different ways. Common changes to the eye include rapidly changing prescriptions (dependent on blood glucose levels), thinning of the iris (loss of iris color), and retinopathy (damage to the retina). Other less common issues include styes, xanthelasma, early cataracts, glaucoma, optic nerve swelling and nerve palsies.
A frontal view of a retina showing neovascularization (growth of small blood vessels), retinal hemorrhaging (areas of bleeding in the retina), cholesterol plaques (yellow plaques in the retina), and a swollen optic nerve.
Diabetic retinopathy can be seen in up to 40% of all diabetics at some point in their lives and is sight threatening 10% of the time.
Diabetic papillopathy refers to a diabetic state where the optic nerves are no longer receiving enough oxygen and start to swell. This is unilateral (in one eye) 50% of the time. This is a very poorly understood condition.
Signs and Symptoms |
Signs
Diabetic retinopathy | Bleeding in the retina, aneurysms of retinal blood vessels, swelling, cholesterol plaques, neovascularization (growth of fragile leaky blood vessels), retinal detachment, etc. |
Diabetic papillopathy | Red optic nerves, swollen blood vessels around the optic nerves, swollen nerves. |
Symptoms
Diabetic retinopathy | Blurry vision, blind spots, black spots in vision. |
Diabetic papillopathy | Can be asymptomatic, can show mild blurry vision. |
Causes and Risk Factors |
Causes
Progressive damage to small blood vessels due to elevated blood glucose.
Risk Factors (for developing eye complications from diabetes)
Longer duration of diabetes, poor blood glucose control, pregnancy (can make retinopathy temporarily worse), high blood pressure, nerve damage, high cholesterol, smoking, obesity, previous cataract surgery.
Prevention and Treatment |
Prevention
Maintaining a healthy lifestyle with a balanced and nutritious diet.
Treatments
· Manage diabetes:
o Review current management to improve blood glucose stability.
o Treat high blood pressure and high cholesterol if present.
o Stop smoking.
· Treat diabetic eye disease:
o Anti-VEGF injections.
o Steroid injections.
o Laser photocoagulation.
Prognosis |
The younger a person is when they get diabetes the worse the outcomes become for not just their eyes but their entire body. For example, proliferative diabetic retinopathy (when small, fragile, blood vessels start growing into the retina) is a late stage of diabetic eye disease and signifies vision loss is likely in the near future. Only about 5% of diabetic retinopathy cases are considered to be proliferative. Unfortunately, up to 90% of people who have had diabetes for 30+ years are likely to have signs of proliferative diabetic retinopathy. Therefore, living a healthy lifestyle for as long as possible is key to preserving vision. If diabetes is diagnosed but no eye damage is seen, treating the elevated blood glucose, high blood pressure and high cholesterol, quitting smoking, and losing weight, can dramatically increase the amount of years the diabetes will take to damage the eyes. Current treatments can further prolong good vision but cannot stop the eventual damage from occurring.
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