I Decide to Take Care of My Eyes

Keep watch on your vision. Regular exams are the best way to prevent diabetes-related eye problems

People who have diabetes are at higher risk of vision problems and blindness than people without the disease. Many eye diseases have no symptoms until it's too late. But with regular eye exams, you can catch problems in their early stages, when they're much more treatable.

Diabetes-related eye conditions

Glaucoma: People with diabetes are 40 percent more likely to suffer from glaucoma — a leading cause of blindness — than people who don't have diabetes. Glaucoma starts when pressure builds inside the eye. The pressure pinches the blood vessels that carry blood to the retina (the lining of the back of the eye) and the optic nerve (the nerve connecting the eye and the brain), leading to permanent vision loss. Treatments include medicated eyedrops and laser surgery. Glaucoma typically has no symptoms until the eye has been damaged. That's why regular eye exams with dilation (drops to enlarge your pupils) are so important. Computerized retinal scans may also be an option.

Cataracts: People with diabetes are 60 percent more likely to develop cataracts than the rest of the population. They also tend to get cataracts at a younger age. A cataract is a clouding of the eye's clear internal lens. It can blur vision, distort colors and cause glare or halos around lights. If you have a mild cataract, you may need to wear sunglasses regularly and change your glasses or contact lens prescription. An advanced cataract is usually removed during surgery and replaced with a clear lens. The surgery is usually very safe, but in people with diabetes, removing the cloudy lens can trigger glaucoma and worsen retinopathy.

Retinopathy: Retinopathy is a general term for all disorders of the retina caused by diabetes. The longer you have diabetes, the more likely you are to have retinopathy. Other risk factors include poor blood glucose control, high blood pressure and family history.

There are two major types of retinopathy. Nonproliferative retinopathy is the more common type. Almost everyone with type 1 diabetes, and most people with type 2, will eventually develop nonproliferative retinopathy. In this early stage, the tiny blood vessels in the retina swell and weaken. There are often no symptoms. But sometimes the weakened blood vessels leak blood and other fluids into the macula (the center of the retina). This can lead to macular edema (swelling), which blurs vision and can cause vision loss. Laser treatment for macular edema can help prevent vision from deteriorating further.

Proliferative retinopathy is less common but more serious. In this case, the blood vessels in the retina become so damaged that they close. To compensate, new — but very weak — blood vessels start growing in the retina. They break and bleed profusely, blocking vision. They can also scar and detach the retina (pull the retina out of place), causing blindness.

Surprisingly, some people with proliferative retinopathy have no symptoms until it's too late to treat the problem. That's why you should have regular eye exams with dilation. The earlier the problem is diagnosed, the more likely laser surgery can help prevent vision loss. The best results occur when sight is still normal.

Dry eye: People with diabetes are more likely to have dry eyes. Symptoms can include irritation, a gritty feeling, redness, watery eyes and pain. If you have diabetic neuropathy, your corneas (the surface of the front of your eyes) may have reduced sensation and you may not feel these symptoms, raising your risk of eye infection and other problems. Dry-eye treatments include lubricant eyedrops and medicated eyedrops.

Preventive eye care

• Don't wait until you have symptoms to see your eye doctor. Have a dilated eye exam and/or computerized retinal scan every year.
• Control your blood glucose, blood pressure, cholesterol and triglyceride levels.
• Don't smoke.
• Wear sunglasses with UV protection.
• Avoid vigorously rubbing your eyes, and consider glasses instead of contact lenses.

Copyright American Diabetes Association, 2009.