A general question by the patients, can diabetes affect the eyes? The answer is “YES”.
Many people know that diabetes can affect the eyes, but they do not understand how it can affect them and how to prevent it.
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Diabetes
Diabetes is a condition in which the human body’s ability to produce or respond to insulin is affected, resulting in abnormal carbohydrates and elevated glucose levels in the blood.
Diabetic Eye Diseases
This is a term used for eye problems in people who have diabetes. Often, there are no warning signs of diabetic eye disease or vision loss in the initial stage. Hence, a dilated eye exam helps your doctor find and treat eye problems early—often before much vision loss can occur.
What are the effects of Diabetes on Ocular Health?
Diabetes can affect nearly all parts of the eye. As a result, it can cause several eye conditions that can harm your eyes and lead to blindness.
- Refractive errors:
People sometimes have blurry vision for a few days or weeks when their blood sugars are not under control and when they are changing their diabetes care plan or medicines.
High glucose can change fluid levels and cause swelling in the lens of your eyes, that help you to focus, causing blurred vision. This type of blurry vision is temporary and goes away when your glucose level gets closer to normal.
- Diabetic Retinopathy:
This condition affects the retina, a tissue layer situated on the backside of the eye. Here the blood vessels inside the retina get damaged and cause a disease called Diabetic Retinopathy. It contributes a lot to the loss of vision and optic nerve-related issues.
- Cataracts
Cataract is the opacification of the clear, crystalline natural lens. It is an age-related condition that starts when the proteins present in the lens start degenerating. It prevents the light from entering the eye’s retina, and diabetic patients are more likely to have early cataract formation.
- Glaucoma :
Accumulation of fluid in the retina and abnormal growth of blood vessels in the eye can increase the intraocular pressure and cause stress to the optic nerve. This condition is called glaucoma.
Also, diabetes damages the blood vessels supplying the optic nerve which may further worsen the glaucoma . Not all diabetics develop glaucoma, but diabetics are twice as likely to develop glaucoma.
- Eyelid Infections
Diabetics are generally prone for infections when blood sugars are not under control. Infection of the eyelid glands and margins are, where patients develop recurrent, small, painful boils on the lids. Poor lid hygiene may also cause poor tear film quality and dryness in the eye.
- Optic nerve
Diabetes hinders the blood supply to the optic nerve. Often diabetics have concomitant risk factors like hypertension and heart blocks that also contribute in decreasing the blood perfusion in the nerve. This condition is called optic neuropathy. Patients present with vision loss and painful eye movements.
Many cases where patients develop a squint or double-vision arising from mononeuropathy are associated with diabetes. The onset may be sudden and recovery may take a few months after the control of diabetes.
- Diabetic Blindness:
One must remember, “Diabetes can cause blindness, and it is preventable“. About one in three people with diabetes who are older than age 40 already have some signs of diabetic retinopathy. Diabetic retinopathy is the most common cause of vision loss in people with diabetes .
Mechanism of retinopathy:
Retina has a delicate vasculature. In diabetes, high blood glucose levels thicken the blood vessel walls and can cause vascular damage. When retinal blood vessels weaken, it can cause a condition called diabetic retinopathy. Non proliferative diabetic retinopathy is when the weakened retinal blood vessels leak and fluid accumulates in the retina, resulting in blurred vision.
As the disease progresses, blood vessels in the retina close and new, abnormal blood vessels grow in their place. This is called proliferative diabetic retinopathy and can lead to vision loss and detachment of retina.
How can diabetic blindness be prevented?
Everybody diagnosed with diabetes should have their first eye checkup at the time of diagnosis. All diabetic patients need to have reasonable control of blood sugars, blood pressure, and cholesterol.
Eye Screening for Diabetes:
When a person comes for eye screening, it is important to provide all the details regarding their systemic health conditions. The recent report of blood parameters pertaining to diabetes should be informed to the doctor.
During the examination, the doctor, apart from vision and eye pressure, will also do a slit lamp examination to see your eye under high magnification and see the retina in detail by doing Indirect Ophthalmoscopy. When diagnosed with diabetic retinopathy, the ophthalmologist conducts an additional test called Optical Coherence Tomography (OCT). Here your inner retinal layer can be analyzed in micron resolution.
Furthermore, at times, a Fluorescein angiography procedure, done by injecting a fluorescein dye into the bloodstream and taking serial photographs of the eye to analyze the type and extent of damage may be done.
Based on the reports, the retina surgeon decides on the mode of treatment.
Laser for Diabetic Blindness:
Lasers create tiny burns inside the eye with a beam of light. This method treats leaky blood vessels and extra fluid, called edema.
It is less likely to bring back the vision already lost in diabetes when compared to anti VEGFs. They only try to maintain the existing vision.
Diabetic retinopathy may not have any symptoms at early stages. Detecting it at the earliest can help you in protecting your vision. The risk of diabetic retinopathy increases the longer you have diabetes.
Conclusion:
If you have diabetes, you are at risk of developing a myriad of eye problems. Therefore, it is important to keep a tab on your diabetic status ,along with blood pressure and cholesterols. And a periodic eye examination is a must to prevent or delay irreversible loss of vision due to diabetic
