Understanding Diabetic Eye Disease

What Is Diabetic Eye Disease?

Diabetic eye disease, also known as diabetic retinopathy, is an eye condition that can affect people with diabetes. It is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). Over time, diabetes can weaken and cause changes in these tiny blood vessels.

The retina is crucial for vision, as it converts light images into nerve signals that are sent to the brain. Damage to the retina directly impacts your sight.

Over time, high blood sugar levels can weaken and damage blood vessels throughout the body, including those in the eyes. The damaged vessels can leak fluid or bleed, causing swelling or distortion of the retinal tissue. In response to ischemia (lack of blood flow), the eye attempts to grow new vessels, which are abnormal and problematic.

Stages Of Diabetic Eye Disease

The retina needs a constant supply of blood, which it receives through a network of tiny blood vessels. Over time, a persistently high blood sugar level can damage these blood vessels in 3 main stages:

1. Background retinopathy: Tiny bulges develop in the blood vessels, which may bleed slightly but do not usually affect your vision. At this stage, your sight isn’t affected, but you are at a higher risk of developing vision problems in the future. You may not need urgent treatment, but you will need to be careful so that things don’t get worse.
2. Pre-proliferative retinopathy: More severe and widespread changes affect the blood vessels, including more significant bleeding into the eye. At this stage, there’s a high risk that your vision could eventually be affected. You will usually be advised to have more frequent screening appointments to monitor your eyes.
3. Proliferative retinopathy: Here, the damage is so severe that the retina starts growing new, abnormal blood vessels. This can lead to clouded vision or even retinal detachment. Treatment will be offered to salvage as much of your vision as possible, although it won’t be possible to restore any vision you’ve already lost.

Symptoms Of Diabetic Eye Disease

You won’t usually notice diabetic eye disease in the early stages, as there aren’t many obvious symptoms that spring up until the condition is more advanced.

However, here are some signs to watch out for:

1. Blurred vision
2. Floaters (dark spots or strings floating in your vision)
3. Eye pain or redness
4. Dark or empty areas in your vision
5. Vision loss

These symptoms would usually surface as the disease reaches its advanced stages, so regular eye testing is important to detect these warning signals early enough.

Risk Factors

Anyone with Type 1 diabetes or Type 2 diabetes is potentially at risk of developing diabetic eye disease.

You are at a greater risk if:

1. You have had diabetes for a long time.
2. You have a persistently high blood sugar level.
3. You struggle with high blood pressure.
4. Your cholesterol level is very high.
5. You are pregnant.

Diagnosis And Treatment

Diabetic eye disease is one of the leading causes of sight loss and blindness in the UK, particularly among working-age people, according to the Royal National Institute of Blind People.

If untreated, diabetic eye disease can lead to blindness. However, with timely treatment, vision loss can often be minimised or prevented. The key to effective treatment and management is early detection through eye exams where an ophthalmologist looks out for changes in the retina.

Diabetic eye disease can be treated through the following methods:

1. Laser Treatment: This is used to treat new blood vessels at the back of the eyes in the advanced stages of diabetic eye disease. It is done because the new blood vessels tend to be very weak and often cause bleeding into the eye. Treatment can help stabilise the changes in your eyes caused by your diabetes and stop your vision getting any worse, although it will not usually improve your sight.
2. Medication: Injections of a medicine called anti-VEGF may be administered directly into your eyes to prevent new blood vessels forming at the back of the eyes. These can help stop the problems in your eyes from getting worse, and may also lead to an improvement in your vision. Alternatively, you may be offered an eye implant called an intravitreal implant. This reduces swelling in your eye, and can help to improve your eyesight.
3. Surgery: A procedure may be carried out to remove some of the vitreous humour (the transparent, jelly-like substance that fills the space behind the lens of the eye). The operation, known as vitreoretinal surgery, may be needed if a large amount of blood has collected in your eye, or if there's extensive scar tissue that's likely to cause retinal detachment.

Preventive Measures

Understanding diabetic eye disease involves recognising it as a microvascular complication of diabetes, where the health of the eyes mirrors the overall metabolic control of the disease. Regular monitoring and proactive management are necessary for diabetic patients when it comes to protecting vision.

Here are a few management and preventive measures that could stem the tide:

1. Blood sugar control: Keeping blood sugar levels within a healthy range can significantly reduce the risk or slow the progression. If you check your blood sugar level at home, it should be 4 to 7mmol/l. The level can vary throughout the day, so try to check it at different times.
2. Monitoring blood pressure and cholesterol: It is important to monitor blood pressure and cholesterol levels, as hypertension and high cholesterol can worsen retinal damage. If you have diabetes, you'll normally be advised to aim for a blood pressure reading of no more than 140/80mmHg, or less than 130/80mmHg if you complications such as eye damage. A healthy total cholesterol level is below 4mmol/l.
3. Regular check-ups: Early detection through regular eye exams is crucial, since damage can occur without noticeable symptoms. Even if you think your diabetes is well controlled, it's still important to attend your diabetic eye screening appointments when invited, as this can detect signs of a problem before you notice anything is wrong.
4. Lifestyle changes: Emphasising a healthy lifestyle, including diet, exercise, and abstinence from smoking, reduces the risk of complications from diabetic eye disease. Aim for a diet that is low on salt, fat and sugar. It is also advisable not to drink more than 14 units of alcohol per week.

If you have any questions regarding eye care at Optimax, please don’t hesitate to get in touch with us. We are more than happy to discuss queries with you over the phone (0800 093 1110) or email (enquiry@optimax.co.uk).