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What to Know About Diabetic Eye Health

Although there has been a consistent push for healthier lifestyles throughout the country, the rate of diabetes has been increasing year after year. While most can manage this chronic problem, diabetes is the 7th leading cause of death in the US, taking more lives than AIDS and breast cancer combined. It’s also the leading cause of blindness, kidney failure, amputations, heart failure, and stroke. Other common health issues include heart disease, dental disease, and nerve damage.

Diabetes Quick Stats

  • In 2015, 30.3 million people had diabetes, but almost a quarter of them didn’t know.
  • About 25% of patients are diagnosed with diabetes by an eye care professional.
  • The number of people with diabetes has doubled in the last 10 years.
  • 34% of the US has prediabetes.
  • It affects ¼ of the population who is 65 years old and up.
  • It’s most prevalent in African American, Alaska Native, American Indian, and Hispanic ethnicities.

Symptoms of Diabetes

  • Increased thirst, hunger, and/or urination
  • Fatigue
  • Blurred vision
  • Numbness or tingling in the feet or hands
  • Sores that won’t heal
  • Unexplained weight loss

Type 1

The first type of diabetes is Type 1. Caused by genetics and environmental factors like viruses, Type 1 is when the immune system attacks the cells in the pancreas that produce insulin. This type usually has a quick onset of symptoms in the younger years of life, but it can arise at any time.

Type 2

The most common form of diabetes is referred to as Type 2. Caused by factors like genetics, family history, obesity, or physical inactivity, about 95% of cases diagnosed are Type 2 diabetes. The symptoms of this type usually develop over several years and may not be noticed by patients until they experience a related health problem.

Other Types of Diabetes

A few lesser-known forms of diabetes include gestational, monogenetic, and cystic fibrosis-related diabetes. Gestational diabetes is developed during pregnancy and usually goes away once the baby is born. Monogenetic diabetes occurs when a single gene has an abnormality that causes diabetes, and cystic fibrosis-related diabetes is caused by scarring on the pancreas, preventing normal amounts of insulin production.

Diabetes-Related Eye Health

Eye health risks that can increase with diabetes include glaucoma, cataracts, and retinopathy. Diabetic retinopathy (DR) affects 1 in 3 people with diabetes, and it threatens 1 in 10 people’s vision. In fact, DR is the leading cause of preventable blindness among working-aged adults.

Early diagnosis and good blood sugar, pressure, and lipid control can help keep the patient’s diabetes from progressing into retinopathy, but it doesn’t ensure they will never develop it. The longer a patient has diabetes, the higher their chance of the disease affecting their sight. Smoking and genetics also increase a patient’s chances of losing his or her sight. There are 2 types of DR: nonproliferative and proliferative retinopathy.

Nonproliferative Retinopathy

Nonproliferative diabetic retinopathy (NPDR) is categorized when the small blood vessels in the back of the eye expand and form little pockets. This is the most common type of DR, and it can be diagnosed in 3 stages – mild, moderate, and severe. The earlier this condition is identified, the better the outcome for the patient, but patients with NPDR often have no symptoms.

Macular Edema

eye chart

Although nonproliferative retinopathy isn’t likely to cause visual impairment, the blood vessel walls may become more permeable. As more substances can pass between the blood and the retina, fluid can seep into the macula and cause swelling. This condition known as macular edema causes extremely blurry vision and even total loss of sight.

Proliferative Retinopathy

When patients have proliferative diabetic retinopathy (PDR), their retinal blood vessels constrict and close. In an effort to heal itself, the body produces more blood vessels, but they are often weak. Like macular edema, these weak-walled vessels leak, impairing vision and even completely obstructing it. The new blood vessels also create scar tissue, and as this tissue shrinks, it distorts the retina. In the worst cases, the scar tissue pulls the retina out of place, causing retinal detachment. Even though this form of DR is more severe, patients often have no symptoms until the damage is irreversible.

Diabetic Eye Health Treatment

Treatment isn’t typically necessary for NPDR, but immediate action must be taken for macular edema and PDR. Luckily, most of the following methods are successful in reducing leaking and new vessel growth, preventing and even regressing vision loss:

  1. Photocoagulation – cauterizing blood vessels with either focal or scattered lasers.
  2. Anti-VEGF – injecting medications directly into the eye that inhibit the protein that accelerates abnormal blood vessel growth.
  3. Vitrectomy – eye surgery to remove scar tissue and fluid, usually with the intention to remove blood leakage or reattach the retina. Removing fluid is typically successful, but retinal reattachment is only effective half the time.

Overall Diabetes Care

Diabetes takes a toll on all aspects of patients’ lives, impacting their physical, emotional, and social well-being. Aside from continuously checking blood sugar levels and avoiding certain foods, the stress of possible vision loss can be a burden. Knowing that patients’ eyes can be severely damaged before any visual changes occur, patients with diabetes or prediabetes must have routine eye exams.

The severity of a patient’s case determines how often he or she comes into the office. The International Council of Ophthalmology created a guide of what they consider the standard of diabetic eye care that includes tables with the optimal frequency of practice visits depending on the patient’s eye health state.

Diabetes is a growing problem, and it can cause severe vision loss if not properly cared for.

Certain forms of diabetes are preventable, but with any type, there’s an even greater chance of preventing diabetic retinopathy. Early detection of DR decreases the likelihood of blindness by 95%. Though proactive care is imperative to protecting patients’ vision, having good blood sugar and pressure control is the most important aspect of living with diabetes. Working with your patient’s primary care physician can give them the best all-around care possible.

You know nutrition is an important factor for patients with diabetes, but how can it impact diabetic eye health?

 

 

SOURCES

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017.
  2. “Cystic Fibrosis-Related Diabetes.” Cystic Fibrosis Foundation, Cystic Fibrosis Foundation, 10 Aug. 2016, www.cff.org/Life-With-CF/Daily-Life/Cystic-Fibrosis-Related-Diabetes/.
  3.  “Eye Complications.” American Diabetes Association, American Diabetes Association, 1 Nov. 2013, www.diabetes.org/living-with-diabetes/complications/eye-complications/.
  4. “ICO Guidelines for Diabetic Eye Care.” International Council of Ophthalmology, Jan. 2017.
  5. “Symptoms & Causes of Diabetes.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Nov. 2016, www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes.
  6. Solomon, Sharon D., et al. “Diabetic Retinopathy: A Position Statement by the American Diabetes Association.” Diabetes Care, American Diabetes Association, 1 Mar. 2017, care.diabetesjournals.org/content/40/3/412.
  7. “What Is Diabetes?” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Nov. 2016, www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes.
  8. “What Is Diabetes?”, Diabetes Research Institute Foundation, 2016, www.diabetesresearch.org/what-is-diabetes.
  9. “A Snapshot: Diabetes in the United States.” Center for Disease Control and Prevention, 7 Nov. 2017.
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