Diabetes and the Eyes

According to a report in 2022, there may be up to 37 million americans of all ages with diabetes. However, about 23% of those with diabetes were unaware of having diabetes. There are about 1.5 million new diagnoses of diabetes each year in the United States.

There are two types of diabetes mellitus.

The more severe form of diabetes is type 1 diabetes, or insulin dependent diabetes. Type 1 diabetes is frequently diagnosed in childhood although it can affect anyone regardless of age, race, and weight. Type 1 diabetes prevents the body from producing insulin, which is responsible for regulating blood sugar.

Type 2 diabetes or non-insulin dependent diabetes is also known as adult onset diabetes. This form of diabetes is typically diagnosed in adults. Treatment generally involves lifestyle and nutritional changes, and often treated with oral medications. Insulin drug therapy is also used for type 2 diabetics.

Diabetes is the leading cause for blindness for patients under the age of 65. There are many eye complications due to diabetes, some much more severe than others. Eye complications due to diabetes include:
⦁ Sudden and large shifts in eyesight (I used to wear glasses, but now I don't need them anymore). This is associated with changes in blood sugar levels. High blood sugar affects all cells in the body, which includes the cornea and the retina.
⦁ Cataract development and advancement. Cataracts tend to develop sooner and more rapidly in people with diabetes.
⦁ Diabetic retinopathy presents in many different ways, usually starting with leaky blood vessels that leak fluid into and underneath the retina.
⦁ Diplopia (double vision) generally lasts 1-2 weeks due to temporary nerve weakness by compromised blood flow to the nerves that control the eye muscles.
⦁ Glaucoma and its development is a risk factor for those with diabetes.

Diabetic retinopathy occurs when abnormalities in the blood vessels of the retina exist with diabetes. Some complications of diabetic eye disease cause symptoms, but many do not. There are two types of diabetic retinopathy, non-proliferative and proliferative diabetic retinopathy.

Non-proliferative diabetic retinopathy is more common and involves
⦁ Microaneurysms- tiny bulges in the blood vessels.
⦁ Hemmorrhages- bleeding within the layers of the retina
⦁ Exudates- leaking serum into the retina which turn into deposits of protein
⦁ Edema- leaky vessels cause swelling in the retina.

Proliferative diabetic retinopathy involves
⦁ Macular Edema- swelling close to the macula
⦁ Neovascularization- new blood vessel growth
⦁ Severe hemorrhaging- larger bleeds cause decreased eyesight and blurred vision
⦁ Retinal detachments- due to new blood vessel growth.

The most important aspect of treatment for diabetic eye complications is to regulate and control the blood sugar levels. Some people are able to control their disease by exercise and diet changes. Others need medications to help control their blood sugar

With the proper control of blood sugar levels, complications due to diabetics can improve. However, this is not always the case. Laser retina therapy is used to either seal leaky blood vessels or to prevent blood leaking into certain areas. Laser therapy is effective, not not always the preferred choice since laser is destructive, destroys retinal tissue, and does not improve eyesight. More invasive surgeries like vitrectomy surgery can be performed in eyes with advanced disease with retinal complications.