“Focusing” on your Diabetes: What is diabetic eye disease and how do you prevent it?

By Bobbi Livengood, MD

Diabetes mellitus is a health condition that affects the blood sugar levels in your body. Type 1 diabetes mellitus is often diagnosed when people are younger (childhood to adolescents) and occurs when the body is unable to make a normal amount of insulin to control blood sugar. Type 2 diabetes mellitus is often diagnosed in adulthood and is caused by the body resisting the effects of insulin. In this situation, the body is unable to make enough insulin to keep blood sugars in the normal range. High blood sugar caused by poorly controlled diabetes can have negative consequences on multiple organs, including the eyes. 

Diabetic eye disease is one of the leading causes of vision loss in older adults and oftentimes is diagnosed one to two decades after being diagnosed with diabetes. Elevated blood sugars result in injury to the retina which is the innermost layer of the back of the eye responsible for processing vision. Similar to other organs, diabetes can cause inflammation and injury to the blood vessels and nerves within the retina. When this damage occurs in either type 1 or type 2 diabetes, it is called diabetic retinopathy.

In the early stages of diabetic retinopathy, people often do not have any symptoms. As the damage to the blood vessels and nerves of the retina progresses, some people have trouble focusing on objects, some develop dark spots in their vision, and some develop floaters. Sometimes these symptoms come and go and are not permanently present. In its advanced stages, diabetic retinopathy can lead to severe vision loss and blindness. 

To prevent this from happening, an annual screening for diabetic eye disease, including a dilated eye exam, is recommended for all people with diabetes. During this exam, your eye doctor will administer drops in your eyes that dilate your pupils. This allows the eye doctor to see your retina and optic nerve easier. Once your pupils are dilated, your eye doctor will use an ophthalmoscope to assess the back of your eye. The exam is not painful and only takes a few minutes.

There are treatments to help prevent vision loss if you are diagnosed with diabetic retinopathy, but there is no cure for the condition. Sometimes in its very early stages, your doctor will monitor your retina with a dilated eye exam every few months to watch how fast the disease is progressing. Sometimes ophthalmologists use laser treatments to help slow the spread of damage to the retina. In some cases, they use medications that are injected into your eye to help prevent progression of diabetic retinopathy. In severe cases, they may need to perform surgery on your eye if you develop complications of diabetic retinopathy. 

If you have been diagnosed with diabetes mellitus, I encourage you to complete an annual dilated exam with an eye doctor. Annual eye exams allow your doctors to catch diabetic retinopathy in its early stages and help prevent irreversible vision loss by intervening early. Lifestyle changes (increasing physical activity, eating a healthier diet) and medications prescribed by your doctor can help improve your blood sugar and blood pressure and prevent diabetic eye disease. If you have diabetes, see your primary doctor to discuss how you can best control your blood sugars and prevent diabetic eye disease. If you do not currently have an eye doctor, let your primary doctor know and they can refer you to an eye doctor that performs diabetic eye exams.

Dr. Livengood is a family physician at Allina Health United Family Physicians, 233 Grand Ave, Saint Paul, MN 55102, phone – 651-241-5200.