Both Type 1 and Type 2 diabetes come with many associated health concerns. Eye health is one of the primary areas of concern.
Diabetic retinopathy is damage to the small blood vessels of the retina due to abnormally high levels of blood sugar. When these blood vessels break down, oxygen and nutrients cannot be delivered normally, and blurred vision and blindness can result.
In developed countries, diabetic retinopathy is the number one cause of new cases of blindness among adults. It currently affects 8 million Americans with diabetes. In fact, people with diabetes are an astonishing 25 times more likely to suffer vision loss than people without diabetes, according to the National Eye Institute.
The longer a patient has lived with diabetes (either Type 1 or Type 2), the more likely they are to develop diabetic retinopathy.
But length of time is not the only factor. The level of glycemic control is also a predictor: the less controlled average daily blood sugar is, the quicker a patient will develop retinopathy complications, warns the American Diabetes Association. Other risk factors include:
- Kidney disease
- High blood pressure
- High cholesterol
- Pregnancy in women with poorly controlled blood sugar levels at the time of conception
- Race, with African Americans, Hispanics, American Indians, Asian Americans and Pacific Islanders at increased risk
Studies predict that “Hispanic populations are projected to exhibit extremely high growth in diabetic retinopathy cases. Currently, 67 percent of cases are among whites and 17 percent among Hispanics. By 2050, projections are that 45 percent of diabetic retinopathy patients will be white and 35 percent will be Hispanic,” according to Prevent Blindness.
In addition, more men than women experience diabetic retinopathy, unlike other eye diseases like glaucoma, cataract, and macular degeneration. Because the rate of diabetes in increasingly steadily across the country, doctors expect cases diabetic retinopathy to increase in proportion. By the year 2050, the number of diagnoses of the eye condition will grow by over 60 percent to above 13 million Americans.
Sometimes the vision changes associated with diabetic retinopathy are the first signs a person might notice of oncoming diabetes, usually in the first of the four stages of retinopathy. Warning signs to look out for include:
- Sudden increase in eye floaters (spots and/or dark cobweb-like strands)
- Blurred vision
- Fluctuating vision
- Dark spots
- Sudden loss of vision in one eye
- Halos around lights
- Flashing lights
If left untreated, the first three stages of the disease progress through mild, moderate, and severe non-proliferative diabetic retinopathy (NPDR).
In NPDR, small blood vessels in the retina begin to bulge, leak, and become increasingly blocked.
The fourth and final stage is proliferative diabetic retinopathy (PDR), in which new blood vessels grow on the retina or optic nerve. These abnormal, fragile vessels can leak blood into the eye, causing the patient to experience dark spots or blurry vision.
Further complications can arise as a result of the leaky fluid exchange, including diabetic macular edema, retinal detachment, and glaucoma. It is very important to follow up with an ophthalmologist at the earliest stages of the disease. The doctor will perform a dilated eye exam—something not part of a general visit that simply tests for visual acuity alone. Photographs of the retina are also used to monitor the progression of the disease.
In terms of technology, there are more medical tools than ever before to treat the condition, with many having come on the market in the last decade. The American Diabetes Association says, “the widespread adoption of optical coherence tomography ... and wide-field fundus photography” and further notes that “Improvements in medications and devices for the systemic therapy of diabetes have also improved the ability of patients to optimize their metabolic control.”
While having diabetic retinopathy can be serious and eventually lead to blindness, it is important to remind patients that the disease can be prevented and slowed in its progression.
Elyse Fineman, director of Prevent Blindness Illinois, notes that “Diabetes is a very serious chronic condition that can cause damage to many parts of the body, including the eyes. The good news is that by taking the necessary steps to manage the condition, including getting an annual eye exam, we help to limit the harmful impact that diabetes may have.”
Controlling the condition involves many of the same factors that impact diabetes itself, including controlling blood sugar, lowering blood pressure and cholesterol, maintaining healthy diet and body mass index, getting regular exercise, and avoiding smoking.