What are the ways diabetes can impact your eyesight?
What is diabetes and what are the risk factors?
November is Diabetic Eye Disease Month, so when better for us to have a look at the ways in which diabetes can affect your vision and eye health? It’s especially pertinent when we consider that the number of people in the UK with diabetes is growing at a rapid pace. Around 5 million people here are now living with diabetes and, by 2030, this number is expected to rise to 5.5 million people. This is in stark contrast to the 1998 figure of 1.9 million people with diabetes in the UK. It is thought that, as a society, we are generally becoming more sedentary and are eating diets higher in sugar, resulting in a more overweight population. Obesity is a key risk factor for type 2 diabetes, so this could explain our rising rate of people living with diabetes.
Diabetes occurs when your blood sugar is too high. Your blood sugar is your main source of energy and it comes from the food and drink you consume. You need a hormone called insulin to convert the sugars from food into energy to be used by your cells, but sometimes your body doesn’t make enough insulin to do this. The sugars then stay in your blood and don’t reach your cells. People who have type 1 diabetes typically develop it in childhood or adolescence and find that their bodies’ immune systems attack the cells which make the insulin. Type 2 diabetes is more common and this is acquired over the course of your life. It often occurs in people who are overweight, inactive, or who have become resistant to insulin.
One of the main risk factors for developing diabetes, aside from being overweight and inactive, is in your genes. It is thought that diabetes is inherited, running in some families more than others. Diabetic retinopathy – one of the most common health issues stemming from diabetes – is actually the leading cause of blindness in working-age UK adults. We’ll have a look now at exactly how diabetes affects your eyes, and what you can do to prevent this from happening.
What is Diabetic Eye Disease?
Diabetic Eye Disease (DED) is the name for a group of eye conditions which can occur as a result of diabetes. Essentially, they are caused by consistently high blood pressure and blood sugar levels. The conditions that fall under DED are:
One in three adults over the age of 40 with diabetes shows signs of diabetic retinopathy (DR). On top of this, people with diabetes are 1.5 times more likely to develop glaucoma and also have a twice as high risk of developing cataracts. The high blood sugar levels associated with diabetes cause fluid to build up in your eyes leading to glaucoma, as well as causing the characteristic clouding of the lens leading to cataracts. Macular edema occurs as a result of DR, leading to the retina swelling and the loss of sharp vision. Over time, if left untreated, this can cause loss of vision and even total blindness.
One of the main things to note about DED is that the damage it causes usually occurs gradually. People often don’t notice their vision changing at all and complications are usually picked up at a routine eye test. This highlights the importance of attending regular eye tests, especially if you have already been diagnosed with diabetes.
People with type 2 diabetes have more eye issues than people with type 1 diabetes and also often find they have more eye issues upon diagnosis. If you experience any of the following symptoms, you should also visit your optician as it could be a sign of the onset of DED:
- Watery eyes
- Headaches
- Halos around lights
- Blurry vision
- Sudden loss of vision
- Eye pain
- Redness in sclera
- Floaters
- Gradually worsening vision
Your risk of developing DED is higher depending on several biological and lifestyle factors. These include if:
- You are a long-term diabetic
- You are pregnant
- You have high blood sugar and/or blood pressure
- You smoke
- You have high cholesterol
What is diabetic retinopathy?
Diabetic retinopathy is an eye condition which develops as a complication of diabetes. There are tiny blood vessels in your eye which deliver blood to your retina (the part of your eye which passes images to the brain). The retina is at the back of your eye and when it is damaged, or underserved by damaged blood vessels, vision loss and even total blindness can occur. Diabetes affects the blood vessels in your eye by causing them to leak blood, become blocked, or grow in places that they shouldn’t. This prevents blood from reaching your retina, stopping you from seeing as well as you should.
Symptoms of diabetic retinopathy include increasingly blurry vision, floaters or blind spots. These can be caused by leaking blood, so it’s vital that if you experience any of these symptoms, you book an appointment with your optician as soon as possible. Damage caused by diabetic retinopathy usually occurs so gradually that you may not even notice any changes to your vision at first. Diabetic retinopathy is often picked up at a routine eye test, so if you know you have diabetes, you should have your eyes checked annually. The condition is the number one cause of blindness in adults aged between 20-74, so being aware of the symptoms and monitoring changes to your vision is crucial.
What is diabetic macular edema?
Diabetic macular edema (DME) occurs when your macula begins to swell due to damage in your eye caused by diabetic retinopathy. This is because the blood vessels in your eye leak into your macula, which is a part of your retina. In fact, around 50% of people with diabetic retinopathy will go on to develop DME, becoming more likely the more advanced the progress of diabetic retinopathy is. DME affects your central vision as this is the part of your vision which your macula is responsible for. Although any type of vision loss is devastating, loss of your central vision is particularly scary as it means you will struggle to recognise people’s faces, read or drive safely.
Symptoms of DME which you should look out for include:
- Objects appearing wavy
- Fading colour vision
- Objects appearing as different sizes, depending on which eye you look out of
- Blank spots in your central vision
These symptoms will vary in severity depending on how advanced your DME is. Further to this, in some people, DME may only cause mildly blurred vision, while others experience the full range of symptoms we’ve mentioned here.
What treatments are there for Diabetic Eye Disease?
At Optimax, we tend to see in our patients that those with diabetes develop cataracts sooner than non-diabetic patients do. Thankfully, treating cataracts is a very simple surgery and is in fact one of the most commonly-performed treatments in the world. We simply extract your eye’s natural clouded lens and replace it with a clear artificial one. This restores youthful vision again. Discover more about cataract surgery.
Treatment for glaucoma is improving all the time. There are now a range of treatments available to minimise the effects of glaucoma and save thousands of people’s sight. Eye drops are available to reduce the amount of aqueous in your eyes, or to increase the rate at which it flows out. This works to lower your eye pressure which is they key cause of glaucoma. Medication in the form of tablets is another option, again aiming to reduce the amount of fluid produced in your eye. This can also improve the drainage, lowering your overall eye pressure. Learn more about glaucoma on our blog here.
Diabetic macular edema also has various treatment options. Medicines can be injected into the eye to prevent the growth of abnormal blood vessels in the eye. These medications can also prevent fluid leaks, treating DME, preserving the patient’s central vision and even improving some people’s vision. DME can also be treated by a laser, applying a beam to leaking blood vessels and any extra fluid in the eye.
To treat diabetic retinopathy, there is laser treatment. This procedure is different to the refractive laser surgery we offer at Optimax but it can reduce the swelling in your retina caused by diabetic retinopathy. The laser is applied to the blood vessels in your retina to shrink them and prevent them from leaking further. You may even be recommended specific eye injections to slow down the progression of diabetic retinopathy, or your doctor might suggest a vitrectomy. This is a type of surgery during which the doctor removes the vitreous (the gel-like liquid in your eye) and replaces it with a different substance. This helps to remove any blood or scarring in the vitreous which was leaked from blood vessels, hopefully improving your vision in the process.
While type 1 diabetes can’t be prevented, type 2 diabetes can. The best way you can protect your vision from diabetes-related complications is to avoid developing type 2 diabetes in the first place. This can be done by living an active lifestyle and eating a healthy, balanced diet. Often, when your vision has been damaged or lost by DED complications, it can’t be recovered, so it’s best to prevent those changes to your eyes from occurring at all. Speak to your doctor if you are worried you may have diabetes, and visit your optician if you notice any changes to your vision.
