Diabetes increases the risk for multiple health problems, from cardiovascular disease to kidney damage to skin conditions. Another common – and often preventable – problem linked to diabetes is vision loss. November is Diabetes Eye Disease Month, a time to spotlight the most common eye disorders associated with diabetes and focus on ways to decrease your risk.

According to the Centers for Disease Control and Prevention’s “National Diabetes Statistics Report 2020,” which analyzed health data through 2018, 34.2 million Americans – just over 1 in 10 – have diabetes. In addition, 88 million American adults – approximately 1 in 3 – have prediabetes. Further, 7.3 million adults over 18 were unaware or did not report having diabetes.

Over time, diabetes can damage your eyes and cause poor vision, even blindness. It can lead to
diabetic eye disease, a group of eye problems that includes diabetic retinopathy, diabetic macular edema, cataracts and glaucoma.

The retina is the inner lining of the back of the eye. It senses light entering the eye and turns it into signals that your brain translates into images. Consistently high blood glucose levels associated with diabetes damages the small blood vessels in the eye, which can harm the retina and cause a disease called diabetic retinopathy.

In the early stage of diabetic retinopathy, called nonproliferative diabetic retinopathy, damaged blood vessels can weaken, swell, or leak into the retina. In the more serious stage, called proliferative diabetic retinopathy, some blood vessels close off and new blood vessels grow on the surface of the retina. These blood vessels are abnormal and can cause serious vision problems.

Diabetic macular edema involves fluid build-up on the center part of the retina, called the macula, which is responsible for the detailed, straight-ahead vision necessary for reading, driving and seeing faces. The built-up fluid makes the macula swell, blurring vision and destroying this sharp vision. Diabetic macular edema, which can cause permanent vision loss, typically develops in people who already have other signs of diabetic retinopathy.

The eye’s lens is a clear structure that sits behind the iris (the colored part of the eye) and helps focus light onto the retina. Natural lenses tend to become cloudy from protein deposits as people age. Cloudy lenses are called cataracts. People with diabetes are twice as likely to develop cataracts at a younger age than people without diabetes. That’s because, it is believed, high glucose levels cause protein deposits to build up on the lens.

Glaucoma is a group of diseases that cause damage to your eye’s optic nerve, which can lead to permanent vision loss. Glaucoma occurs when pressure builds up in your eyes. This pressure pinches the blood vessels that carry blood to the retina and optic nerve, causing gradual vision loss. Having diabetes doubles your chances of getting glaucoma.

With open-angle glaucoma, the most common type, pressure builds up inside your eye when fluid can’t drain effectively through the normal drainage channel, called the trabecular meshwork. This type of glaucoma can be treated with medication and eye drops that lower eye pressure, speed up drainage, and reduce the amount of fluid your eyes make

People with diabetes are at risk for a condition called neovascular glaucoma, in which new blood vessels form on the eye’s iris. These blood vessels block the normal flow of fluid and raise eye pressure. Treatment for neovascular glaucoma may include use of a laser to reduce the number of blood vessels or anti-neovascular endothelial growth factor (anti-VEGF) injections to halt the growth of new blood vessels.

There are other eye conditions associated with diabetes including branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Arteries and veins are blood vessels that carry blood throughout the body. There is one main artery and one main vein supplying the retina.

When this vein becomes blocked, blood and fluid spills out into the retina and the macula can swell, which affects your sharp central vision. Over time, if blood circulation remains cut off, nerve cells in your eye can die and more vision can be lost.

When branches of the retinal vein become blocked, the resulting condition is called branch retinal vein occlusion (BRVO). When the main retinal vein becomes blocked, it is called a central retinal vein occlusion (CRVO).

Here’s the good news: You can help prevent all of these diabetes-related eye disorders by taking steps to manage your diabetes. To do that, you must control your blood glucose, blood pressure and cholesterol levels. Take good care of yourself through healthy eating, exercising regularly and taking medications as prescribed.

In addition, if you smoke, quit. There are many resources online and in the community to help you quit smoking. And don’t forget to get a complete, dilated eye exam once a year, so your eye care professional can detect early signs of diabetic eye disease. Be eye smart: Take steps to protect your vision.

The US Centers for Disease Control and Prevention (CDC) reports that more than 100 million adults in this country are living with diabetes or prediabetes. Of those, 30.3 million – that’s 9.4 percent of the US population – have full-blown diabetes.

Another 84.1 million US adults have prediabetes. That’s a condition that, if left untreated, can lead to type 2 diabetes within five years. More than a third of adult Americans has prediabetes, and most of them don’t know they have it.

Why should we take note of these figures? Because consistently high blood glucose (sugar) levels, the hallmark of uncontrolled diabetes, can cause serious injury to your body’s nerves and blood vessels, impairing circulation and damaging your heart, liver, brain cells and eyes.

Most serious eye diseases related to diabetes begin when high blood glucose damages the eye’s tiny blood vessels. The four main eye diseases that can threaten the vision of a person with diabetes are diabetic retinopathy, diabetic macular edema, glaucoma and cataracts.

Diabetic retinopathy is the most common cause of vision loss for people with diabetes and the leading cause of blindness for all adults in the US. It occurs when high glucose blocks the tiny blood vessels that nourish the retina, the part of your eye that detects light and sends signals to your brain. These damaged blood vessels can begin to swell and leak fluid. This stage is called non-proliferative diabetic retinopathy.

In some cases, non-proliferative diabetic retinopathy progresses into the proliferative stage. That’s when the eye grows new blood vessels to make up for the blocked vessels in a process called neovascularization. But the newly formed blood vessels are highly unstable and leak and bleed easily.

These leaking blood vessels may even hemorrhage into the jelly-like material that fills the center of your eyes, called the vitreous. Blood in the vitreous results in dark spots that can block vision.

Diabetic retinopathy can also cause scar tissue to form in the back of your eye, which may pull the retina away from the back of the eye. This is called a retinal detachment, and it’s a serious complication that can cause loss of vision if not repaired quickly.

As the unstable blood vessels in your retina continue to bleed, they eventually cause the macula, the area of the retina that enables you to read, drive and see faces, to swell. This condition is called diabetic macular edema. Over time, this condition can destroy your sharp vision and lead to partial vision loss and eventually blindness.

The natural lenses of your eyes are clear structures that provide sharp vision. But over time, they can become cloudy, a condition called cataracts. People who have diabetes can develop cataracts at an earlier age than people without the disease, and people with diabetes are two to five times more likely to develop cataracts. It’s believed that high glucose levels cause protein deposits to build up on the lenses, leading to the cataracts.

Sometimes, blood from the leaking vessels blocks the normal drainage channels for fluid in the eyes. As a result, fluid builds up and pressure in the eye increases, which can damage the optic nerve and affect vision. Glaucoma is a group of eye diseases related to increased eye pressure. Having diabetes nearly doubles your risk of developing a type of glaucoma called open-angle glaucoma.

The best way to prevent vision loss from these eye diseases is to control your blood glucose levels and get regular exams by your eye doctor to look for swelling and changes in the blood vessels in your eyes.

To help control your diabetes, eat a healthy and balanced diet, exercise regularly and maintain a healthy body weight. High blood pressure and high cholesterol can affect your blood glucose level, so take all medications your doctor prescribes for these conditions and get them checked regularly. Don’t smoke and drink alcohol in moderation.

Regular eye exams can help find problems early, when they’re easier to treat. Early detection can save your vision. See you eye doctor yearly or as often as your doctor recommends. Call your eye doctor right away if you experience any of the following symptoms:

• Black spots in your vision
• Flashes of light
• “Holes” in your vision
• Blurred vision

 

Do you worry about your vision? Many of us do. Vision loss is a common condition in the United States. It’s estimated that 25 million Americans are blind or visually impaired. One in 28 Americans ages 40 and older have low vision. Since low vision is so prevalent, I thought we ought to learn more about it.

First of all, let’s define low vision. It’s a significant visual impairment that can’t be corrected by any type of prescription lenses, or by medication or surgery. Low vision can make it difficult to perform your daily activities, as well as to read, use a computer, drive and watch TV. This can make you feel cut off from the world around you.

Low vision can also affect your mobility. It can interfere with your ability to get around independently. When mobility and communication are hampered, it can lead to feelings of anxiety and depression, and quality of life can be negatively affected in some people.

Eye disorders and injuries to the eye are the primary causes of low vision. These include diseases like macular degeneration, glaucoma and diabetic retinopathy, and genetic conditions like retinitis pigmentosa, as well as conditions like cataracts and traumatic brain injury, including head injuries, brain tumors and stroke.

There are a few common types of low vision. The first is the loss of central vision in which there’s a blur or blind spot in the middle of your vision, but your peripheral, or side, vision remains intact. This can occur with macular degeneration because the macula is responsible for central vision.

Low Vision Chart

• 20/30 to 20/60, this is considered mild vision loss, or near-normal vision.

• 20/70 to 20/160, this is considered moderate visual impairment, or moderate low vision.

• 20/200 to 20/400, this is considered severe visual impairment, or severe low vision.

• 20/500 to 20/1,000, this is considered profound visual impairment, or profound low vision.

• less than 20/1,000, this is considered near-total visual impairment, or near-total blindness.

• no light perception, this is considered total visual impairment, or total blindness.

 

Other types of low vision include loss of peripheral vision. With this, you won’t be able to distinguish anything at one or both sides, or anything directly above and/or below eye level. Loss of peripheral vision can happen with glaucoma and stroke. With blurred vision, both your near and far vision is out of focus. Cataracts can cause this.

There’s also a condition called generalized haze, when it seems like there’s a film covering everything you look at. Extreme light sensitivity is another common type of low vision. This is when regular amounts of light feel overwhelming. With night blindness, another type, you cannot see outside at night or in dimly-lit places indoors. Various eye disorders can cause these conditions.

Anyone can be affected by low vision, but it’s more common as we get older. That’s true, in part, because conditions that often cause low vision, such as macular degeneration and glaucoma, most commonly develop as people age.

Low vision is more frequently seen in people over age 45 and even more frequently seen in people over age 75. In fact, one in six adults over age 45 has low vision, and one in four adults over 75 has it.

The best way to catch and control the diseases and conditions that lead to low vision is by having regular eye exams by an eye care specialist. But if you notice any changes in your vision, contact your eye doctor right away.

Your eye doctor will perform a complete eye exam to diagnose low vision, including tests designed to check your vision and look for eye diseases. Your doctor will test your eyes for visual acuity or how well you see. He or she may use different instruments and lights when testing your vision.

If your eye doctor diagnoses low vision, he or she may refer you to a low vision specialist. A low vision specialist will help you learn new ways to use your remaining vision, modify your home and teach you how to use devices to aid your vision. Visual rehabilitation is part of this process.

Visual rehabilitation begins by recognizing the challenges of vision loss and making adjustments to maximize what vision you have left. It’s a process of learning how to do tasks, such as reading and writing, in news ways.

For example, if you have a blind spot, you may be asked to imagine the object you want to see is in the center of a large clock. You’ll be told to move your eyes along the clock numbers and note when you see the object most clearly. The doctor will tell you to use the same viewing direction when you look at other objects to see them as clearly as possible.

There are also many low vision aids that can help you see when doing your everyday activities. These includes a variety of optical magnifiers, including those that attach to your glasses, those that are handheld and those that stand on their own hands-free.

Telescopes can help you see things that are far away. They can be handheld or attached to your glasses. Non-optical aids that are available include everyday devices that talk. Some examples are watches, timers and blood sugar monitors that have an audio component.

There are also electronic devices such as video magnifies in portable and desktop formats. These devices combine a camera and a screen to make objects, like printed pages, forms and pictures, look larger.

Also helpful to those with low vision are audio books and electronic books that allow you to increase word size and contrast. The latest technology in smartphones, tablets and computers can read aloud or magnify what’s on the screen.

Low vision may be preventable in people with diabetes if they maintain healthy blood glucose levels. The best way to prevent the progression of low vision is by getting your eyes examined regularly so your doctor can catch and manage the eye disorders that can contribute to low vision. Do your eyes a favor, keep an eye on them!

Do you have diabetes? If so, you’re certainly not alone. The American Diabetes Association estimates that 30.3 million Americans have diabetes and another 8.1 million have it but haven’t been diagnosed. Another 84.1 million people in the US have prediabetes, and nine out of ten aren’t aware of it. Still, 1.2 million new cases of diabetes are diagnosed in this country every year.

Maintaining healthy glucose (sugar) levels in your blood is a constant concern if you’ve got diabetes. Consistently high blood glucose can damage many parts of the body, such as the heart, kidneys and blood vessels. That includes the tiny blood vessels in the eyes, which can affect the retina, macula, lens and optic nerve.

When high glucose levels negatively affect the blood vessels in the retina, which is an area of light-sensitive tissue located in the back if the eye, it leads to a condition called diabetic retinopathy. There are two main types of retinopathy, nonproliferative and proliferative.

Nonproliferative retinopathy has several stages. It progresses from mild to moderate to severe. It starts as small areas of balloon-like swelling in the tiny blood vessels. These areas may start leaking fluid into the retina. In the moderate stage, the blood vessels that feed the retina may start swelling and distorting, losing their ability to transport blood.

In severe nonproliferative retinopathy, many blood vessels become blocked, which deprives the retina of its nourishing blood supply. Growth factors are also released during this stage. These factors initiate the development of new blood vessels.

In some people, the severe stage progresses into proliferative retinopathy. With that, new blood vessels start growing, but these vessels are very fragile and weak. They can leak blood, which can block vision. Scar tissue can also be created, which can cause the retina to pull away from the back of the eye, a condition called retinal detachment.

Another consequence of retinopathy is macular edema, which is swelling, or the build-up of fluid, in the macula. The macula is the area of the retina responsible for central vision. It’s the macula the enables you to recognize faces, read and drive. Macular edema is the most common cause of vision loss in people who have diabetic retinopathy.

If you maintain good control of your blood glucose levels and your blood pressure, you’ll be less likely to develop diabetic retinopathy or, if you do, you’ll get a milder form of it. Those are risk factors you can control. Risk factors you can’t control are your genes and how long you’ve had diabetes.

Having diabetes puts you at higher risk for other eye conditions as well, including cataracts and glaucoma. Rapidly changing blood glucose levels can affect the eye’s lens and cause it to become cloudy. This can lead to a cataract. Anyone can get cataracts, but people with diabetes tend to get them earlier, and they progress faster.

With glaucoma, pressure builds up inside the eye when fluid can’t be removed through the eye’s drainage system that includes the trabecular meshwork. High blood glucose levels damage the cells of this meshwork, so it can’t function properly. Fluid doesn’t drain and pressure builds up in the eye. If not treated, the pressure can damage the optic nerve, leading to permanent vision loss.

Diabetic retinopathy, macular edema and glaucoma usually have no early symptoms. You may not know you have these diseases until they’ve already done damage to your eyes and affected your vision. That’s why an annual examination by an eye specialist is so important. The specialist can check your eyes for signs of these disorders, so early treatment can be started.

According to the US Centers for Disease Control and Prevention, about 90 percent of diabetes-related vision loss can be prevented. Early detection is one of the ways to reach that goal, and it’s another reason for an annual eye exam. Another way to help prevent vision-stealing eye diseases is by maintaining good blood glucose and blood pressure control.

Following these simple tips can help save your vision. So can knowing these symptoms  that signal an emergency. If you notice any of these symptoms, call your doctor right away:

• Black spots in your vision
• Flashes of light
• “Holes” in your vision
• Blurred vision