Diabetes and the Eyes

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Diabetes And The Eyes

Introduction

Diabetes is a condition in which the body does not properly regulate and use sugar (glucose) for its energy needs, usually because of a failure to produce enough of the hormone known as insulin.

Effects of Diabetes on Eyes

Poorly regulated and high levels of sugar in the blood can cause changes in the optics of the eye, resulting in blurred vision and changes in eyeglass prescriptions. The condition may also interfere with focusing of the eye. Control of the blood sugar level usually corrects these problems.

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Diabetes can also cause cataracts, a clouding of the lens inside the eye that blurs vision.

Diabetes can cause double vision when it affects the nerves that control the alignment and movement of the eyes. It can also cause the optic nerve to be more easily damaged by glaucoma.

Normal Fundus

Diabetic Retinopathy

Retinal Arterioles

Retinal Venules

Optic Disc

Macula

Fovea

Venous Dilation

Capillary Microaneurisms

Hemorrhages

Hard Exudates

Neovascularization

The most important cause of visual impairment in people with diabetes is diabetic retinopathy, a condition in which changes occur in the tiny blood vessels that nourish the retina (the light-sensitive tissue that lines the back of the eye and changes the light into nerve messages to be transmitted to the brain). In the early stages of diabetic retinopathy, called non-proliferative or background retinopathy, small blood vessels weaken and leak fluid or tiny amounts of blood, which distort the retina. At this stage the person may have normal vision or may note blurred or changing vision. Although 25 per cent of people with diabetes have some degree of non-proliferative retinopathy, the condition does not progress to more severe problems in most.

In a more advanced stage, blood vessels in the retina are blocked or closed completely, and areas of the retina die. Proliferative diabetic retinopathy affects about 5 per cent of people with diabetes and occurs when new, abnormal blood vessels grow to replace the old ones. These new vessels are fragile and often rupture and bleed into the eye, blocking vision. Scar tissue forms, shrinks and tears the retina, causing bleeding or detaching it from the back of the eye. This can result in severe visual loss or blindness. Fortunately, this occurs only in a small minority of people with diabetes.

The chances of having some form of diabetic retinopathy increase the longer a person has had diabetes. Retinopathy is present in 90% of those who have had the disease for more than 20 years.

Detection and Treatment

Research has shown that severe visual loss from diabetic retinopathy can be prevented or delayed by laser treatment, but only if the retinopathy is diagnosed early enough. This is why it is important for most people with diabetes, particularly those who have had the disease for five years or more, to have an annual eye examination performed by a medical doctor trained to recognize the subtle early signs of diabetic retinopathy.

Diabetic retinopathy is precisely located and documented with special photographs of the retina called fluorescent angiograms. Treatment with laser photocoagulation is aimed at sealing leaky vessels and preventing the growth of new, abnormal vessels. Laser treatment has risks and side effects, which must be weighed against the benefits for each individual patient. In more advanced retinopathy, the benefits usually outweigh the risks.

Despite treatment or for lack of it, some people with diabetes bleed massively into the eye and require a delicate, microscopic operation called a vitreotomy to remove blood and scar tissue from the eye. Others also need surgery for retinal detachment.

Research into diabetes and diabetic retinopathy is continuing and encourages the hope for prevention and better treatment.

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