Diabetic Eye Diseases: Overview and More

Diabetic eye diseases are eye problems that can affect you if you have diabetes. Some of these diseases, like diabetic retinopathy and diabetic macular edema, occur exclusively in those who have diabetes. Other eye problems like glaucoma and cataracts can occur in anyone, but your chances of developing them are higher when you have diabetes.

Diabetic eye diseases are increasing due to the growing number of people with diabetes. There are 34.2 million people with diabetes in the United States, or 10.5% of the total population. About 40% of those with diabetes develop diabetic retinopathy.

Here is more information about eye diseases associated with having diabetes.

Diabetic Retinopathy

Diabetic retinopathy is an eye disease that affects the light-sensitive part of the back of your eye, called the retina. When you have diabetic retinopathy, the retina’s blood vessels can leak, swell, and close off. The disease also can cause new blood vessels to grow on the retina’s surface.

Poorly controlled diabetes puts you at a higher risk for developing diabetic retinopathy. However, you’re also at higher risk the longer amount of time that you have had diabetes.

There are two types of diabetic retinopathy—nonproliferative and proliferative. Nonproliferative diabetic retinopathy is the early stage. Most people with type 1 or type 2 diabetes will eventually develop nonproliferative diabetic retinopathy. Proliferative retinopathy is the more advanced stage. It is less common, but it can threaten your vision.

Diabetic retinopathy is the most common eye disease associated with having diabetes. It also is the number-one cause of irreversible blindness in working-age Americans.

Diabetic retinopathy typically affects both eyes, but it does not always have symptoms. That’s why regular, comprehensive eye exams are crucial when you have diabetes.

When diabetic retinopathy does have symptoms, they include:

• Vision changes: For instance, you may have difficulty reading something or find it hard to see objects at a distance. These vision changes may happen inconsistently.
• Seeing dark spots or streaks: These can occur in the later stages of diabetic retinopathy and are caused by blood vessels in the retina that have started to bleed into the gel-like fluid in the center of the eye called the vitreous.

At the early stages of diabetic retinopathy, an eye doctor may monitor your eyes regularly but not use any treatment. As the disease develops, treatments used include:

• Injections in the eye of a type of medicine called anti-vascular endothelial growth factor (VEGF) can slow down the disease.
• Laser treatments can lower swelling and help blood vessels to become smaller and stop leaking.
• A vitrectomy is a type of surgery used if your eyes are bleeding a lot or there is scarring from the leaky blood vessels.

It is always helpful to control your blood sugar to avoid further effects from diabetic retinopathy and diabetes.

The treatments for diabetic retinopathy can help prevent further eye damage, but they typically do not restore vision loss. That’s another reason why prevention of the disease with regular eye exams is important. Your eye doctor can let you know how often you should have your eyes examined when you have diabetes. Many will recommend it once a year.

Diabetic Macular Edema

Diabetic macular edema refers to fluid that has built up in the center of the retina, in the area called the macula. The fluid makes the macula swell, affecting your vision.

Diabetic retinopathy is a common cause of diabetic macular edema. Macular edema also can occur after eye surgery for age-related macular degeneration. There are other causes of macular edema, but diabetic macular edema is specifically associated with having diabetes and diabetic retinopathy.

An estimated 750,000 people with diabetic retinopathy also have diabetic macular edema. Non-Hispanic Blacks are three times more likely to develop edema than non-Hispanic Whites, although this may be due to the higher prevalence of diabetes among Blacks.

Symptoms of diabetic macular edema include:

• You have blurry or wavy vision in the center of your eye. However, if you have diabetic macular edema in only one eye, you may not notice your blurry vision in that eye until it gets bad.
• Colors appear washed out or faded.
• You have problems reading.

Similar to diabetic retinopathy, treatments for diabetic macular edema include anti-VEGF injections and laser treatment. These can help block the blood vessels that may form and prevent leaky blood vessels in the retina. The treatments can help stop or delay further vision loss from diabetic macular edema.

Glaucoma

Your optic nerve connects your eyes to your brain. When you have glaucoma, you have additional pressure in the eye that affects the blood vessels that bring blood to the optic nerve and retina. This can cause vision damage and blindness if not treated.

Almost 3 million people in the United States have glaucoma. If you have diabetes, you are twice as likely to develop glaucoma as someone who does not have diabetes. The risk for glaucoma also increases with age and the longer you have had diabetes.

There are several different types of glaucoma. Open-angle glaucoma is most common among those with diabetes as well as among the general U.S. population. A less common type of glaucoma called neovascular glaucoma also has some association with diabetes due to the potential for abnormal blood vessel growth from diabetic retinopathy.

Glaucoma does not always have symptoms. This is yet another reason why you should see your eye doctor regularly for eye exams to help detect glaucoma or other diabetic eye diseases early on. If vision loss occurs, it will be your peripheral or side vision.

Treatment for glaucoma does not restore lost vision. However, the available treatments have expanded in recent years to offer more ways to preserve vision and reduce eye pressure. Those treatments include:

• Various types of eye drops, including prostaglandin analogs, beta blockers, and carbonic anhydrase inhibitors
• Various surgeries, including minimally invasive glaucoma surgery and a trabeculectomy
• Glaucoma drainage devices that help to release fluid from the eye

Cataracts

A cataract is a clouding of the lens in the eye. Cataracts are very common, especially as you get older. About 24.5 million Americans have a cataract, and there are two million cataract surgeries performed each year. When you have diabetes, you are more likely to develop a cataract and to do so at a younger age.

Initially, you may not notice any symptoms from a cataract. Over time, you may:

• Have cloudy vision
• Notice colors that appear faded
• Have to change your eyeglass prescription more often
• Notice lights that seem to be too bright
• Have problems seeing at night

Early on, an eye doctor may not recommend surgery for a cataract. You can make changes such as getting new glasses, using a magnifying lens, and wearing anti-glare sunglasses.

Eventually, you will likely need cataract surgery, which removes the cloudy lens and replaces it with an artificial lens. This artificial lens is called an intraocular lens. Ninety percent of those who have cataract surgery report seeing better after surgery.

A Word From Verywell

Diabetes does not just affect your blood sugar. It affects your whole body, including your eyes. Make sure to see an eye doctor regularly for eye exams to detect early signs of any eye diseases. Do your best to control your blood sugar for better overall health, including eye health.

Let your eye doctor know if you have eye symptoms such as changing vision. Doing so can help preserve your vision when you have diabetes and lessen your chances of developing diabetic eye diseases.