Symptoms Of Diabetic Eye Disease

In the early stages, diabetic retinopathy often has no symptoms. Changes in the vision can appear as the condition progresses. Possible symptoms may include:

• Blurry vision
• Trouble reading or seeing faraway objects
• Vision that changes from clear to blurry
• Dark, floating spots or cobweb-like streaks
• Sudden vision loss (in advanced cases)

Diabetic retinopathy is a major complication of diabetes, but keeping blood sugar in check can help prevent it. Get tested regularly—early detection of diabetes can protect your vision and overall health.
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Causes Of Diabetic Eye Disease

High blood sugar from diabetes is the main cause of diabetic retinopathy. Diabetes can damage your eyes' small blood vessels, leading to vision problems.

Some of the extra sugar turns into sorbitol, which builds up in eye cells and causes swelling and damage. Other harmful effects, like stress, can also weaken the blood vessels, making them leak more and grow in abnormal ways.

Special support cells called Müller cells in the eye also stop working properly. They swell and cause fluid buildup, which can lead to blurry vision. Several factors can contribute to these changes, which we’ll explore further in the next section.

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Risk Factors For Diabetic Eye Disease

Anyone with diabetes is at risk of developing diabetic retinopathy. Other factors can include:

Non-modifiable risk factors

• Age of diabetes onset (People diagnosed with diabetes under the age of 50 have a higher risk)
• Longer duration of diabetes
• Family history of diabetic retinopathy
• Puberty
• Pregnancy

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Modifiable risk factors

• Poor glycemic control (high HBA1C levels)
• Hypertension
• High cholesterol levels
• Nephropathy (kidney disease)
• Obesity (high BMI)
• Smoking

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Other risk factors

• Chronic inflammation
• Apolipoproteins (these help carry fats in the blood, and changes in their levels can affect the blood vessels of the eyes)
• Hormonal influences
• Oxidative stress (happens when harmful molecules called free radicals build up and start damaging the tiny blood vessels and cells in the eye)
• Sunlight exposure ( especially over 5 hours a day may raise the risk of diabetic retinopathy by damaging the retina through harmful UV rays) 
• Vitamin D deficiency 

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Diagnosis Of Diabetic Eye Disease

Getting the right diagnosis for diabetic retinopathy (DR) is key to protecting your vision. Understanding the severity helps doctors decide the right treatment. Classification of diabetic retinopathy based on severity:

• No DR: Eyes look healthy, no damage seen

• Mild DR: Microaneurysms (small bulges in blood vessels) start to appear

• Moderate DR: More damage to blood vessels, but not very severe

• Severe DR: Significant vessel damage, which includes bleeding, blocked veins, or abnormal vessel growth.

• Proliferative DR: New, fragile blood vessels grow and may bleed into the eye, risking loss of vision.

To confirm the diagnosis, the following tests may be used:

Eye tests

• Basic eye exam: It checks vision, eye pressure, and any diabetes-related changes in the eyes.

• Dilated eye exam: This helps doctors see the retina and grade the severity of diabetic retinopathy.

• Fundus photography: In this test, pictures of the retina are taken to track changes and help with diagnosis.

• Fluorescein angiography (FFA): A dye is used to highlight damaged blood vessels and areas lacking oxygen.

• Ultrawide Field Fundus Imaging (UWFI) and Fundus Fluorescein Angiogram (UWFA): This test captures a wide view of the retina to spot early or hidden issues.

• Optical Coherence Tomography (OCT) scan: It is a detailed scan to check for swelling, bleeding, or membrane issues in the retina.

• Ultrasonography (B Scan): This test is useful when the view is unclear due to bleeding or cataract.

• Optical Coherence Tomography Angiography (OCTA): It is a non-invasive scan to see blood flow in the retina without using dye.

Lab tests

• Fasting blood sugar (FBS): Shows if your blood sugar is in the normal, prediabetic, or diabetic range.

• HbA1c (glycosylated hemoglobin) test: Reflects average blood sugar over 2–3 months; should stay below 7%.

Note: Tests for kidney, heart, liver, thyroid, blood pressure, and nerves are also required since diabetes affects many organs.

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Specialist To Visit

Diabetic retinopathy requires timely care from specialists who can help manage the condition and prevent further vision damage. These include:

• General physician
• Diabetologist
• Ophthalmologist
• Retina specialist
• Optometrist

A general physician monitors overall health, manages diabetes, and refers you to specialists for diabetic retinopathy when necessary.

A diabetologist focuses on managing diabetes effectively, helping prevent or control complications like diabetic retinopathy.

An ophthalmologist is a doctor specializing in eye health and vision problems.

A retina specialist is an ophthalmologist with advanced training in retinal diseases.

An optometrist is required for routine eye exams and monitoring vision changes.

When To See A Doctor?

See a doctor immediately if you notice the following:

• Blurred or fluctuating vision
• Dark spots or floaters in your vision
• Difficulty seeing at night
• Sudden loss of vision
• Pain or pressure in the eye
• If you have diabetes and notice any vision changes.

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Prevention Of Diabetic Eye Disease

Preventing diabetic retinopathy is essential to protect your vision and avoid irreversible eye damage from diabetes. Things to keep in mind include:

1. Start screening early

Diabetic retinopathy often has no early symptoms, making screening very essential.

When to start eye exams? 

• Type 1 diabetes: Begin 5 years after diagnosis, if older than 15.

• Type 2 diabetes: Get checked right after diagnosis.

• Pregnant with diabetes: Get your eyes checked in the first trimester.

How often should you get screened?

• No DR + good control: Every 2 years.

• Mild DR or poor control: Once a year.

• Pregnancy, or eye symptoms: As recommended by your eye doctor.

2. Make steady lifestyle changes

• Eat smart: Cut down on salt, sugar, and unhealthy fats.

• Move more: Aim for at least 150 minutes of activity weekly. Walking, cycling, or even dancing counts.

• Maintain a healthy weight: Try to stay within a BMI of 18.5–24.9

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• Quit smoking & drink less: Avoid tobacco of any form and alcohol consumption

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• Take your meds as prescribed: This includes insulin, blood pressure pills, or statins if needed.

3. Know your health stats

• Try to keep your HBA1c under control (around6.5%)

• Keep your blood pressure below 140/80 mmHg or below 130/80 mmHg if you already have eye complications.

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• Maintain total cholesterol under 4 mmol/L for best protection

Regular blood sugar and cholesterol checks are key to preventing diabetic retinopathy and protecting your vision.
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Treatment Of Diabetic Eye Disease

Diabetic retinopathy treatment research focuses on preventing vision loss by managing blood sugar, blood pressure, and cholesterol, along with specific treatments for the eye. These include:

1. General measures

• Maintain HbA1c below 7%
• Follow a healthy lifestyle with regular exercise and a balanced diabetes-friendly diet
• Take your diabetes medicines on time
• Manage other health issues like high BP, cholesterol, kidney problems, or heart disease with proper treatment and doctor coordination.

2. Laser photocoagulation

• This procedure uses laser beams to seal leaking blood vessels and slow the growth of new, abnormal vessels in the retina
  

• Newer laser methods (like Pattern Scan Laser and Targeted Retinal Photocoagulation) aim to reduce side effects and improve accuracy, but more research is needed to confirm their long-term benefits.

3. Anti-VEGF treatment

Medicine is injected directly into the eye to block VEGF, a substance that causes abnormal blood vessel growth. This helps reduce swelling, prevent bleeding, and preserve vision. Common anti-VEGF drugs include:

• Ranibizumab 
• Aflibercept

4. Corticosteroid treatment 

These are anti-inflammatory medicines that help reduce swelling and fluid buildup in the retina. They are often used when anti-VEGF treatments are not effective or suitable. Common corticosteroids used are:

• Dexamethasone 
• Fluocinolone acetonide 
• Triamcinolone acetonide

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5. Surgery

• Vitrectomy is a surgery used in advanced diabetic eye disease to remove blood from recurrent bleeding or scar tissue pulling on the retina

• The jelly-like vitreous is removed and replaced with a clear fluid

• It's especially needed when there's retinal detachment or vision-threatening bleeding.

6. Novel therapies

• Gene therapy: It works by introducing or modifying genes to reduce disease progression with minimal side effects. 

• Mesenchymal stem cell therapy: These stem cells, especially from bone marrow, may help repair damaged eyes by stopping abnormal blood vessel growth and encouraging healthy tissue to grow back

• SGLT2 inhibitors: Drugs like dapagliflozin may help prevent DR by protecting retinal blood vessels and reducing glucose-related vascular damage. But they are still under research.

• Islet cell transplantation: Transplanting insulin-producing cells helps control blood sugar may slow or prevent DR progression. Though more robust trials are needed for this therapy.

Future direction

• New therapies, including VEGF inhibitors and antioxidants, have shown promising results, but they are still under research.

Home-care For Diabetic Eye Disease

Home care for diabetes has already been discussed under prevention and management. Now, let’s explore additional approaches. Please note that these are not substitutes for medical treatment, and more research is needed to understand their effectiveness fully. These include:

.

1. Herbal remedies

• Turmeric (Haldi): Curcumin in turmeric has anti-inflammatory and antioxidant properties that may protect retinal cells.

How to use it?

Turmeric can be consumed daily by adding 1/2 to 1 teaspoon to warm milk, food. You can also consider a curcumin supplement after consulting with your doctor.

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• Ginkgo biloba: It is a herbal supplement that may help improve retinal blood flow and reduce oxidative stress.

How to use it?

It is usually taken as a standardized extract in capsule or tablet form, as recommended by your doctor.

2. Dietary supplements

• Lutein and zeaxanthin: These are antioxidants that can help protect the eyes by filtering harmful light and supporting retinal health.

• Omega-3 fatty acids: They may help reduce inflammation and retinal damage.

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Complications Of Diabetic Eye Disease

Uncontrolled diabetes can lead to diabetic retinopathy, which can further lead to the following complications:

• Vitreous hemorrhage: Bleeding into the gel-like substance inside the eye can cause sudden vision loss and floaters. In severe cases, the hemorrhage can completely block vision. 

• Retinal detachment: Scar tissue from diabetic retinopathy can pull the retina away from the back of the eye, threatening vision.

• Macular edema: It is the buildup of fluid in the central part of the retina (macula), leading to blurred or distorted vision.

• Neovascular glaucoma: New abnormal blood vessels block fluid drainage, raising eye pressure

• Severe vision loss or blindness: Advanced stages can lead to permanent loss of eyesight.

The best way to avoid these complications is through effective diabetes management. Hear from our experts on how to take control of your health.
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Alternative Therapies For Diabetic Eye Disease

Alternative therapies for diabetic retinopathy are mainly used for symptomatic relief and overall well-being. They should not replace conventional medical treatments. Always consult your doctor before starting any new therapy. These include:

Yoga 

These mind-body practices can help by lowering stress, improving blood sugar control, and enhancing overall circulation. They support better metabolic balance, which can slow the progression of diabetic eye damage.

Acupuncture

It involves inserting thin needles into specific points on the body to restore energy balance. It may help with diabetic retinopathy by improving blood circulation to the eyes and reducing inflammation and oxidative stress, though evidence is limited.

Traditional Chinese Medicine (TCM)

These therapies use herbal remedies, dietary adjustments, and detox practices to support eye and overall health in diabetes. However, their effectiveness for diabetic retinopathy is still under research.

Living With Diabetic Eye Disease

Living with diabetic retinopathy can be challenging. It demands constant attention and can take a toll both physically and emotionally. Here are some things that may help:

Be proactive

• Control blood sugar, blood pressure, and cholesterol
• Watch for vision changes and report them to your doctor
• Adhere to treatment plans for better outcomes
• Get routine eye exams and retinal scans
• Catch issues early with regular checkups.

.

Focus on healthy living

• A healthy diet plays a crucial role in managing diabetes

• Focus on consuming whole grains, lean proteins, healthy fats, and plenty of vegetables

• Limit sugary foods and processed snacks to keep blood sugar levels stable

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In addition to a balanced diet:

• Exercise regularly to improve insulin sensitivity and maintain a healthy weight
• Manage stress through relaxation techniques to prevent blood sugar spikes
• Avoid smoking as it can worsen circulation and damage blood vessels
• Limit alcohol intake to avoid blood sugar fluctuations and liver strain
  

Get all the emotional support

• Stay connected with friends and family 
• Join support groups for shared experiences
• Communicate openly with your doctor about your concerns
• Practice mindfulness to reduce stress
• Seek professional counseling if you are struggling emotionally
• Set small goals and celebrate your progress.

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