Did you ever think that diabetes can be a cause of vision problems too? People with blurry vision or eyesight-related problems often ignore them as temporary symptoms or aging signs. While it is known that uncontrolled diabetes affects the heart and kidneys, it does not show any mercy on the eyes either.
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Diabetes can cause varying extents of vision impairment. About 45% of diabetics visiting eye clinics in India had already lost their vision before the condition was even diagnosed[1]. The two most common types of vision loss related to diabetes are macular edema and retinopathy. Diabetes also increases the risk of other eye conditions, including cataracts and glaucoma.
When we think of eye problems, our mind never even considers diabetes as a cause. Diabetes affects the small blood vessels throughout the body, including the eyes, causing a lack of blood supply. The retina (back part of the eye) is affected due to this lack of blood supply, and this condition is known as diabetic retinopathy (DR). It primarily manifests as swelling in the central part of the retina (macula) which is called diabetic macular edema (DME). As bleeding and swelling intensify, individuals may notice the presence of floating objects in their vision or experience a dim and impaired sight. In severe cases, it may lead to complete vision loss.
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Diabetic eye disease is a term for several eye problems caused by uncontrolled diabetes. These eye problems include diabetic retinopathy, glaucoma, diabetic macular edema, and cataract [2], with the prevalence of diabetic retinopathy up to as high as 16.9%[1] in India.
Could you be at risk of getting diabetes-related eye disease?
Anyone with type 1 or type 2 diabetes can get diabetic retinopathy. The longer you have had diabetes, the higher you are at risk for this disease. Therefore, the day you are diagnosed with diabetes, you need to get your eyes checked, especially the retina, for any effects of diabetes. Over time, more than half of diabetic people will develop diabetic retinopathy. However, it is crucial to know that the onset of DR depends on the duration of diabetes and the progression depends on metabolic control along with other factors such as control of blood pressure and cholesterol levels.
How to spot the warning signs?
There may be no warning signs in the initial stages of diabetic retinopathy. Therefore, it is extremely important to get regular eye checkups done, even without any problems with your vision. The onset of diabetic eye disease may be recognized by the following symptoms:
-Frequent change of glasses
-Difficulty in reading newspapers or any small font
-Hazy vision
-Sighting black or red color floaters
-Seeing a dark curtain
Important facts to pay heed to
-You may still have the onset and progression of diabetic retinopathy even after your diabetes is under good control.
-The major risk factor for the onset of diabetic retinopathy is the duration of diabetes.
-Checkups at an optical shop may not detect the presence or absence of diabetic retinopathy.
-Diabetic retinopathy can only be diagnosed by the examination of the retina.
Prevent diabetic retinopathy: Take charge of the ABC
Any diabetic patient is bound to have diabetic retinopathy depending on the duration of diabetes. Hence, managing your diabetes ABCs, which include your A1c (<7.0%),blood pressure (<130/80 mmHg, and cholesterol (LDL-C <100 mg per dL)[3], is the best way to lower the risk of diabetic retinopathy.
The glycosylated hemoglobin (A1c or HbA1c) is the average blood sugar for the past 2-3 months, which helps track how well you are managing your diabetes. Perform regular physical activity, eat healthily, and carefully follow your doctor’s instructions for insulin or other diabetes medicines.
High blood pressure or high cholesterol, along with diabetes, increases your risk for diabetic retinopathy. Therefore, it is best to keep your blood pressure and cholesterol in check to lower your risk of vision loss.
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Screening for diabetic retinopathy may vary depending on the type of diabetes
Type 1 diabetes: It is advisable to get a dilated fundus examination (it consists of dilating your pupils to have a better look) along with a comprehensive eye examination within 5 years of the onset of diabetes.
Type 2 diabetes: Get a dilated fundus examination along with a comprehensive eye examination at the time of diagnosis of diabetes, and follow up the screenings based on the stage of diabetic retinopathy.
Treating diabetic retinopathy: Know your options
The treatment of diabetic retinopathy is possible, and the options depend on the stage and progression of the disease. Following are the treatment options[4]:
1. Laser treatment: This is done to treat the growth of new blood vessels in the retina.
2. Eye injections: These injections are given inside the eye to treat severe degeneration of the macula that threatens your sight.
3. Vitreoretinal eye surgery: This procedure is done to remove blood or scar tissue from the eye when laser treatment is not possible because of the advancement of retinopathy to later stages.
Tata 1mg has joined hands with the Vitreo-Retinal Society India (VRSI), an esteemed, exclusive group of over 90% of India’s actively practicing Vitreo-Retina specialists across the country who are dedicated to providing highly specialized retinal care to patients suffering from diabetes.
If you are looking to explore your treatment options, seek advice from world-class retinologists (retina specialists) at VRSI. Find a retina specialist in your city.
Remember!
Diabetes is a silent killer and by the time you realize it may be too late. Prioritize your well-being by staying vigilant and scheduling regular screenings for diabetic eye disease. Extend extra care to your eyes if you have diabetes, ensuring that your sugar levels are well-controlled for the sake of maintaining a healthy vision.
(The article is reviewed by Dr. Swati Mishra, Medical Editor and Vitreo Retina Society of India -VRSI)
References:
1. Kumar S, Kumar G, Velu S, Pardhan S, Sivaprasad S, Ruamviboonsuk P, Raman R. Patient and provider perspectives on barriers to screening for diabetic retinopathy: an exploratory study from southern India. BMJ Open. 2020 Dec 10;10(12):e037277. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733174/
2. What is Diabetic Eye Disease? Diabetic Eye Disease. National Institute Of Diabetic And Digestive And Kidney Diseases. May 2017.
https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-eye-disease
3. Vouri SM, Shaw RF, Waterbury NV, Egge JA, Alexander B. Prevalence of achievement of A1c, blood pressure, and cholesterol (ABC) goal in veterans with diabetes. J Manag Care Pharm. 2011;17(4):304-312.
https://pubmed.ncbi.nlm.nih.gov/21534641/
4. Diabetic Retinopathy. Treatment. National Health Services UK. Dec 2021.
https://www.nhs.uk/conditions/diabetic-retinopathy/treatment/