Diabetes is a leading cause of blindness in American adults.

Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly.  Insulin is the hormone that regulates the level of sugar (glucose) in the blood.  Diabetes can affect children and adults.  

When you have diabetes, your body doesn't use sugar (glucose) properly. If your blood sugar level is too high or too low, your natural lens may swell on and off— which can blur your vision intermittently.  Also, too much sugar in your blood damages the tiny blood vessels in your body (capillaries) and in the retina over time.  This leads to diabetic retinopathy or damage to the retina. This makes the blood vessels leaky and causes retinal bleeding and swelling leading to decreased vision.  In advanced stages,  poor blood flow and lack of oxygen signal the growth of abnormal new blood vessels in the retina.  The body is trying desperately to get oxygen to the retina, but these vessels are weak.   This progresses to scarring and retinal detachment.   Finally, this can result in blindness.  A healthy retina is essential to good vision,

Some of the common signs and symptoms of diabetic retinopathy include blurred vision (due to swelling), floaters (due to bleeding and hemorrhages inside the eye), a gradual or sudden loss of vision.  Diabetics, in general, also develop cataracts earlier.  Cataracts can further lead to a decrease in vision by creating cloudiness within the natural lens of the eye.  There may also be a greater risk of glaucoma (increased eye pressure and damage to the optic nerve within the eye) in patients with diabetes.

Who’s at risk?  All people with diabetes--both type 1 and type 2.  It’s essential that every diabetic patient get a thorough, comprehensive, dilated eye exam annually.  A person can have significant retinopathy, requiring treatment, with no symptoms at all.  Approximately half of all diabetics have some form of retinopathy. The risks greatly increases the longer you have the disease with almost 90% of patients having signs of eye disease after 10 years of having diabetes.

Treatment for diabetic retinopathy will depend on its severity.  Typically, laser treatment of the retina has shown good success in treating the abnormal growth and leakage of blood vessels.  Surgery to remove blood and scar tissue from bleeding vessels can also help in severe diseases.  Newer medications, which are injected directly into the eye can help control bleeding vessels.   An ophthalmologist or a retinal specialist, who specializes in retinal laser treatment and surgery for diabetics, can guide you through the best and most effective treatment for your eyes after a careful examination.

The best treatment, of course, is prevention. Controlling the blood sugar well and having your eyes checked for any early signs for the disease routinely.  Also control of blood pressure is important.  The combination of poor blood sugar and blood pressure control can be devastating to the eye.  Most diabetic patients are frequently examined by an internist or endocrinologist who in turn should work closely with an ophthalmologist to manage the eye disease.

About the author:  Dr. Angana Shah is a board certified eye physician and fellowship trained retinal surgeon.   She specializes in retinal laser treatment and complex surgeries of the retina.  Her areas of expertise include diabetic eye disease, macular degeneration, and retinal detachment repair.  She practices at Princeton Eye & Ear center in Lawrenceville, NJ.  She can be reached at 609.895.9797

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