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Diabetes and Blindness: Manage Your Risk

Q&A With an Expert

Diabetes can affect your whole body – including your eyes. Diabetic retinopathy is the leading cause of blindness in American adults, but it can be prevented. With the incidence of diabetes expected to double or even triple in the next several decades, it’s important to be aware of the effects of diabetes on eye health.

Northwestern Medicine Ophthalmologist Paul J. Bryar, MD, answers some common questions about diabetic eye disease.

How does diabetes affect eye health?

Diabetes can affect the small blood vessels anywhere in the body. The retina, located at the back of the eye, is responsible for sending signals from your eye to your brain. It has many small blood vessels and is susceptible to the effects of diabetes. Having high blood sugar over long periods of time can damage blood vessels, which can cause swelling and bleeding in the retina. Certain individuals are more susceptible to eye disease, even if they have the same blood sugar level as others.

How long after diagnosis should I get tested for diabetic eye disease?

Type 1 diabetes can occur at any age, but typically is diagnosed in children and young adults. Symptoms usually present at the onset of the disease, so Type 1 diabetes is often diagnosed early in the disease process. In Type 1 diabetes, diabetic retinopathy, if it occurs, usually takes at least five years to develop. Your physician will be able to determine an appropriate schedule for monitoring your eye health.

On the other hand, Type 2 diabetes symptoms are not always obvious, so it’s possible that someone may have diabetes for many years before they are diagnosed. For this reason, the American Academy of Ophthalmology recommends an eye exam at the time of diagnosis and yearly eye screening after that.

Are certain individuals more likely to get diabetic eye disease?

Dr. Bryar says the incidence of diabetic eye disease is higher in patients who have poor diabetic control and higher blood sugar. “The closer your blood sugar levels are to normal, with medications, diet and exercise, the less chance you’ll have of having issues,” he explains.

What are the different types of diabetic eye disease?

The most common diabetic eye disease is a mild form called non-proliferative diabetic retinopathy (NPDR). Depending on the severity, your ophthalmologist might recommend yearly or more frequent exams to monitor or detect changes.

Two more severe types of diabetic eye disease include:

  • Proliferative diabetic retinopathy (PDR). A condition where new blood vessels start to grow in the retina. This can cause bleeding and retinal detachment, damaging your eyes and your vision.
  • Diabetic macular edema (DME). A condition where there is a build-up of fluid, or swelling, in the retina, caused by damaged blood vessels. This can lead to vision loss.

What are the symptoms of diabetic eye disease?

Whether mild or severe, diabetic eye diseases may cause no symptoms or generalized symptoms like blurred vision. “A patient should not try to judge their risk or the severity by how well they see,” cautions Dr. Bryar. Instead, he stresses the importance of following screening guidelines, even if you’re seeing well. “These conditions can exist at any level, with good or poor vision.”

Are cataracts a diabetic eye disease?

While cataracts can affect anyone, they may occur at a higher rate in individuals with diabetes. Fortunately, says Dr. Bryar, “Individuals with diabetes can have the same cataract surgery as those without diabetes, and the vast majority do very well with cataract surgery.”

Can blindness be prevented?

“Diabetic eye disease is the leading cause of blindness in adults, but in most cases vision loss can be prevented with regular eye exams and early detection,” says Dr. Bryar. Blindness can occur at end stages of disease. If blindness occurs suddenly, it may be the result of sudden bleeding or swelling, and may still respond to treatment. Seek medical attention immediately.

What are the treatment options?

Some recent advances in treatment include medications that have the potential to improve vision by targeting new blood vessel growth and, in some cases, completely eliminating new blood vessels. Other options include laser treatment or surgery.

The bottom line

Remember, when it comes to your eye health, early detection of diabetic eye disease is key. “If you have diabetes, even if you are not exhibiting symptoms, you should continue to follow up at your physician’s recommended frequency. For most patients with diabetes, unless recommended more frequently by their eye care provider, yearly eye exams are recommended,” says Dr. Bryar.