Eye care for people with diabetes

Diabetes can lead to retinopathy, macular edema and serious vision problems. Experts recommend annual eye exams, along with careful control of the disease.

More than 30 million Americans are living with diabetes, which is a leading cause of heart disease, amputation, end-stage kidney disease and liver problems. It can also lead to negative effects on the eyes. 

A condition called diabetic retinopathy is the most common cause of vision loss among people with diabetes and can lead to blindness. Other eye problems include diabetic macular edema (DME), cataract and glaucoma. The risks rise the longer people live with the disease.

The good news is that by carefully controlling diabetes — monitoring blood sugar levels, taking medications as prescribed, staying physically active and maintaining a healthy diet — individuals can prevent or delay vision loss. Especially important are regular eye exams from an ophthalmologist or optometrist trained to care for people with diabetes.

“We know that early detection is key with retinopathy,” says Northeast Medical Group endocrinologist Mae Whelan, MD, who is affiliated with Yale New Haven Health’s Lawrence + Memorial Hospital in New London, CT. “If we catch it early and are able to reduce the progression, we can hopefully prevent vision loss. That’s why we recommend eye exams.”

Diabetic retinopathy can occur when high blood sugar levels damage the tiny blood vessels in the retina, the light-sensitive tissue that lines the back of the inner eye, potentially causing leaking of fluid or bleeding. In some people, abnormal new blood vessels grow on the surface of the retina. Those changes may result in vision loss or blindness. Between 80 to 85 percent of individuals with diabetes will develop some level of retinopathy, and those with type 1 diabetes are more likely to develop the condition.

DME can happen when the macula, a part of the retina, swells from the build-up of leaking fluid. It is the most common cause of vision loss among people with diabetic retinopathy. Cataract, a clouding of the eye’s lens, tends to develop at an earlier age in people with diabetes. Glaucoma is a group of diseases that damage the eye’s optic nerve, which connects the eye to the brain, from increased pressure. In adults, diabetes nearly doubles the risk of glaucoma.

Making matters more complicated, retinopathy typically develops without early warning signs. As it progresses, symptoms can include blurry or double vision, dark or floating spots, pain or pressure in one or both eyes, rings, flashing lights or blank spots.

Such complications are why diabetes eye exams are critical, says Dr. Whelan, who recommends that patients have what’s called a dilated eye exam at least once a year. During the procedure, drops placed on the eye’s surface dilate, or widen, the pupil, allowing for a close-up view of the retina and optic nerve to detect changes, leaking or damage.

“If you can catch retinopathy early enough,” she adds, “it’s definitely treatable and in some cases reversible.” Common treatments include laser surgery, which shrinks the abnormal blood vessels or seals the leaking ones, and vitrectomy, a procedure to remove the cloudy vitreous (clear, jelly-like substance that fills the center of the eye) and replace it with a saline solution. Another treatment involves injecting chemicals into the eye to decrease the growth of the abnormal vessels of the retina.

To help patients with diabetes avoid eye problems, Dr. Whelan suggests they coordinate with their primary care doctor to make sure that blood sugar, blood pressure, and cholesterol levels are all under control — and to schedule an annual eye exam. 

“For some patients, it’s hard to see the value if they’re not having any problems or symptoms, so that’s why we encourage regular eye exams,” she says.

Learn more about diabetes-related eye problems and how to prevent them in our online health library. 

To make an appointment with an endocrinology specialist in Northeast Medical Group or Yale Medicine, call 855-636-4637.