What Is Diabetic Eye Disease?

​Diabetic eye disease is not one disease, but actually a group of eye conditions that affect people with diabetes. Each has the potential to not only affect vision permanently, but also lead to severe vision loss and even blindness. The good news is that about 90 percent of diabetes-related vision loss can be prevented with early detection, according to the Centers for Disease Control and Prevention (CDC). The bad news is that studies show that sixty percent of diabetics are not getting the exams their doctors recommend, according to the American Academy of Ophthalmology. 
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So what are these diabetic eye conditions that can cause vision loss and have the potential to be prevented with proper detection? They include diabetic retinopathy and associated macular edema, glaucoma, and cataracts. We’ll take a look at each in more detail, with a special focus on diabetic retinopathy, which is most common cause of vision loss among people with diabetes, and according to the National Eye Institute, the leading cause of blindness among working-age adults. 

Diabetic Retinopathy and Macular Edema

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​Diabetic retinopathy occurs when people with diabetes suffer from changes to the retina, the light sensitive area in the back of our eyes. It affects people with diabetes differently. Some will have blood vessels in the retina that swell and leak. Others will have new, abnormal blood vessels that grow on the retina in a process called neovascularization.
 
Diabetic retinopathy occurs in four stages:

1. Mild Nonproliferative Retinopathy, which is characterized by swelling like a small balloon (microaneurysm) in the blood vessels in the retina.
2. Moderate Nonproliferative Retinopathy, which is characterized by blockage of some of the blood vessels that nourish the retina.
3. Severe Nonproliferative Retinopathy, which is characterized by blockage of many more blood vessels in the retina, depriving it of nourishment. These blockages signal the retina to create new blood vessels (neovascularization). As these new vessels are weak and tend to leak, edema or swelling caused by microaneurysms in the macula, the part of the retina that converts light into electrical images, may also become more pronounced.
4. Proliferative Retinopathy, which is characterized by blockage of even more blood vessels in the retina. As neovascularization increases, weak, fragile, and leaky blood vessels grow along the retina and the vitreous gel inside the eye causing bleeding in the center of the eye.

 
Vision may be unaffected in the first two stages of diabetic retinopathy. This makes regular exams for anyone with diabetes critical, even if no symptoms are evident. Vision changes such as blurring of vision may become noticeable and progressively worse in stages three and stage four. (In our next post, we’ll look at signs of diabetic retinopathy and when to see an ophthalmologist.)
 
Diabetic retinopathy typically affects both eyes and can progress to other vision-threatening conditions including macular edema, detached retina, vitreous hemorrhage, and neovascular glaucoma. Macular edema can occur at any stage of diabetic retinopathy, but is most likely to occur in stage four. In fact, it affects about half of the people with proliferative retinopathy. The swelling in the macula can cause fluid to leak into the center of the macula, the part of the eye responsible for fine, detailed vision. This contributes to worsening vision as diabetic retinopathy progresses.
 
Detached retina and vitreous hemorrhage are serious conditions that can cause rapid vision loss and that constitute an eye emergency. Symptoms include black spots and flashes of light in central vision.
 
Everyone with diabetes is at risk of developing diabetic eye disease and subsequent vision loss. Further, as diabetic retinopathy progresses, vision loss cannot be reversed in many cases. For those reasons, early detection and treatment by an ophthalmologist who specializes in diabetic eye disease are necessary to preserve vision.
 
On our Diabetic Eye Disease page, we discuss diabetic retinopathy risk factors and diabetic retinopathy and macular edema detection. We also provide detailed information on diabetic eye disease treatments, including medical, laser, therapeutic, and surgical options. You can also learn more about diabetic retinopathy by visiting the American Academy of Ophthalmology’s website.
 
If you have diabetes and have not had a complete eye exam in the last year, please call our office at 508-746-8600 today to schedule an appointment. If you have diabetes and have been diagnosed with diabetic eye disease, diabetic retinopathy, or diabetic macular edema and have questions or would like a second opinion, please call our office at 508-746-8600 to schedule and appointment with one of our diabetic eye disease specialists:

• Eddie F. Kadrmas, MD, PhD
• Lawrence I. Rand, MD

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Glaucoma

According to the American Diabetes Association, “People with diabetes are 40% more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is. Risk also increases with age.”
 
People with diabetes will typically develop a type of glaucoma called neovascular glaucoma, which is a secondary glaucoma caused by diabetic retinopathy. It is commonly linked to proliferative diabetic retinopathy (stage 4 diabetic retinopathy). This condition is characterized by growth of new blood vessels (neovascularization) in the angle of the eye, which blocks drainage of eye fluid. This blocked fluid increases eye pressure and causes damage to the optic nerve, which affects vision. Eye pressure can also increase when weak, fragile neovascular vessels leak and bleed into the eye, causing edema in the anterior chamber of the eye, the area between the cornea and iris.
 
To learn more about glaucoma and specifically neovascular glaucoma, including detection and treatment, click the links to visit our webpages dedicated to these subjects.
 
It bears repeating, if you have diabetes and have not had a complete eye exam in the last year, please call our office at 508-746-8600 today to schedule an appointment. If you have diabetes and have been diagnosed with glaucoma, secondary glaucoma, or neovascular glaucoma and have questions or would like a second opinion, please call our office at 508-746-8600 to schedule and appointment with our ophthalmologist who specializes in glaucoma diagnosis and treatment:
 

• Richard W. Strecker, MD

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Cataracts

“People with diabetes are 60% more likely to develop [cataracts]. People with diabetes also tend to get cataracts at a younger age and have them progress faster,” according to the American Diabetes Association.
 
Cataracts are a clouding of the lens of the eye that can cause symptoms such as blurred and yellowed vision, diminished ability to see colors, and difficulty seeing at night. Excess blood sugar caused by diabetes can lead to changes in the lens and consequently cataracts, which may need to be removed surgically.
 
To learn more about cataracts, including detection and treatment, visit our cataracts webpage and review our cataracts blog posts.
 
If you have symptoms consistent with those of cataracts and are due for an eye exam or if you have been diagnosed with cataracts and want a second opinion, please call our office at 508-746-8600 to schedule and appointment with our ophthalmologist who specializes in cataract diagnosis and treatment:
 

• Richard W. Strecker, MD

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Is There More to Know about Diabetic Eye Disease?

Yes, most definitely. Please stay tuned for our upcoming blog posts on diabetic eye disease, including:  
 

• 8 Diabetic Retinopathy Symptoms and When to See an Ophthalmologist
• Who Is at Risk of Diabetic Eye Disease and Diabetic Retinopathy?
• How Can Diabetic Eye Disease Be Prevented or Controlled?

 
And if you haven’t already done so, please visit our first post in the series, Diabetes, Pre-Diabetes, Eyes & Vision: What You Need to Know Now.
 
As always, if you have any questions or concerns about your eye health or feel that you need to see an ophthalmologist, please contact our office at 508-746-8600 so that we may assist you. 
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