Blood sugar control is key to preserving your invaluable eyesight.
Eyesight is something it’s easy to take for granted: It’s not until your vision is threatened that you start to realize just how important it is to you, or how scary the possibility of permanent damage is. For people diagnosed with diabetes, monitoring and preserving their eye health is another critical part of managing the condition.
“Since we know that eye disease is a big consequence of diabetes, and uncontrolled diabetes, patients need what’s called a dilated eye exam,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at The Mount Sinai Hospital.
These exams, which you should get at least once a year, can detect a variety of eye problems associated with diabetes. Here are some of the health problems that may impact vision, according to Minisha Sood, MD, an endocrinologist in New York City:
Retinopathy: damage to the blood vessels of the retina
Macular edema: swelling in the macula part of the retina
Glaucoma: damage to the optic nerve, which connects the eye to the brain
Cataracts: clouding of the eye’s lens
Each of these issues can cause severe vision loss and possibly blindness, according to the National Eye Institute (NEI).
Among people with diabetes, retinopathy is the most common cause of vision loss. The back of the eye—the retina—takes in light from the cornea and pupil and converts it into images for the brain to decode, according to the American Diabetes Association (ADA). The retina contains small blood vessels; damage to the blood vessels from sustained high blood sugar levels can make them become blocked or closed off.
If you are experiencing retinopathy, you may notice these symptoms, according to Dr. Sood.
Temporary vision loss
Loss of color vision
Seeing your eye doctor regularly is crucial, however; not all cases of diabetic retinopathy have obvious symptoms. “You may have significant diabetic retinopathy, yet you may have no symptoms whatsoever,” according to Marc Werner, MD, ophthalmologist in Manhattan and Long Island. “[If] you’ve had diabetes for 10 years [and] you think your vision is fine, that’s not a reason not to see the eye doctor.”
A formal and thorough dilated eye exam is the only way to be diagnosed with diabetic retinopathy, says Dr. Werner.
The macula is a part of the retina that specializes in fine, extra-sharp details, according to the ADA. “Diabetic macular edema is a situation that occurs once someone has diabetic retinopathy,” says Dr. Sood. “If the macula has bleeding within it from an abnormal blood vessel that was there because of retinopathy, that can impair vision.”
Blocked blood vessels in and near the eye put a lot of pressure on the eyeball. Over time, this can damage the optic nerve, which connects and transmits signals between the eye and the brain. With glaucoma, peripheral vision becomes blurry or lost first; all vision may be lost eventually. People with diabetes have twice the risk of developing glaucoma as those without diabetes, according to NEI.
Taking Care of Your Vision
To prevent vision loss from diabetes, regular checkups are crucial. “Whether it’s type 1 or type 2 [diabetes], you at least need an annual eye exam to make sure nothing bad is going on in the back of the eye,” says Dr. Werner. (Learn more about the recommended medical care routine for type 2 diabetes here.)
That said, don’t wait for your next appointment if you notice any new or troubling symptoms: “Should you notice any change in your vision at any time, don’t wait for that annual eye exam,” says Dr. Werner. “Get right into the office.”
The severe complications from diabetes—blindness, kidney failure, amputations, to name a few—can be scary. However, strong diabetes management and good glycemic control can prevent most of them. In fact, 90 percent of vision loss from diabetes is preventable, according to the Centers for Disease Control and Prevention, and early treatment plays a big role.
“Every percentage that you can reduce your A1C level confers a significantly reduced risk of developing eye disease,” says Dr. Sood. Managing blood pressure can also reduce the risk of retinopathy and other eye conditions, according to ADA. (Learn the link between diabetes and heart disease here.)
The health of your eyes can also be a good gauge of your overall diabetes control. When examining the eyes, your eye doctor can get a good look at the blood vessels in the back of the eye. “If the blood vessels are looking good in the back of your eye,” says Dr. Werner, “you have an excellent chance that they’re working everywhere in your body and that you’re managing your diabetes very well.”
Dr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.Minisha Sood
Dr. Sood is a board-certified endocrinologist in private practice in New York City and an assistant professor at Hofstra School of Medicine.Marc Werner
Dr. Werner is an ophthalmologist and partner with Stahl Eyecare Experts in New York City and Long Island.
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Since we know that eye disease is a big
consequence of diabetes and uncontrolled
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diabetes, patients need at least once
a year what's called a dilated eye exam.
00:00:12,751 --> 00:00:18,144
00:00:18,144 --> 00:00:22,724
A few of the eye problems that we see in
people with diabetes are retinopathy,
00:00:22,724 --> 00:00:25,430
macular edema, glaucoma, cataracts.
00:00:25,430 --> 00:00:29,330
Diabetic retinopathy at the most basic
level is damage to the retina, or
00:00:29,330 --> 00:00:31,000
the back part of the eye.
00:00:31,000 --> 00:00:33,400
And without the retina, you can't see.
00:00:33,400 --> 00:00:37,510
So symptoms of diabetic
retinopathy can include floaters.
00:00:37,510 --> 00:00:44,230
Fluctuating vision, temporary vision loss,
they could have loss of color vision.
00:00:44,230 --> 00:00:46,817
You may have significant
diabetic retinopathy, yet
00:00:46,817 --> 00:00:50,058
you may have no symptoms what so
ever, that's really important.
00:00:50,058 --> 00:00:51,750
So you've had diabetes for ten years,
00:00:51,750 --> 00:00:56,500
you think your vision is fine, that's
not a reason not to see the eye doctor.
00:00:56,500 --> 00:01:00,290
The only way to diagnose diabetic
retinopathy is through a thorough
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dilated eye examination.
00:01:01,730 --> 00:01:04,480
So that's the part of the exam
where you go to the eye doctor and
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we put drops in your eyes.
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The drops that you don't
like that blur your vision.
00:01:08,480 --> 00:01:11,160
Diabetic macular edema
is a situation that occurs
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once someone has diabetic retinopathy.
00:01:13,500 --> 00:01:16,630
The macula is a part of the retina
which is at the back of the eye, and
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it's critical for sight.
00:01:18,380 --> 00:01:23,550
If the macula has bleeding within it from
an abnormal blood vessel, that was there
00:01:23,550 --> 00:01:28,310
because of retinopathy, that can impair
vision and that is what macular edema is.
00:01:28,310 --> 00:01:32,205
Glaucoma is an eye condition that develops
in people with diabetes, especially
00:01:32,205 --> 00:01:36,265
because pressure can build up in
the eyes when blood vessels are damaged.
00:01:36,265 --> 00:01:40,325
Whether it's type 1 or type 2,
you at least need an annual eye
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exam to make sure nothing bad is
going on in the back of the eye.
00:01:43,705 --> 00:01:47,605
But the other caveat that we tell
all of our patients with diabetes is
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should you notice any change in your
vision at any time, don't wait for
00:01:51,525 --> 00:01:53,970
that annual eye exam,
get right into the office.
00:01:53,970 --> 00:01:58,360
You know what scares people
about diabetes, it's blindness,
00:01:58,360 --> 00:02:01,520
it's kidney failure, it's toe amputation.
00:02:01,520 --> 00:02:06,100
So when I talk about the eyes I talk about
the fact that there are changes that
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you can make early on in treatment
to avoid having eye have problems.
00:02:10,030 --> 00:02:15,600
I talk about every percentage that
you can reduce your A1C level
00:02:15,600 --> 00:02:19,690
confers a significantly reduced
risk of developing eye disease.
00:02:19,690 --> 00:02:23,730
When we examine the back of your eye
we can actually see the blood vessels.
00:02:23,730 --> 00:02:26,703
And if the blood vessels are looking
good in the back of your eye,
00:02:26,703 --> 00:02:30,669
you have an excellent chance that they're
working well everywhere in your body, and
00:02:30,669 --> 00:02:32,950
that you're managing
your diabetes very well.
Blindness and vision impairment. Atlanta, GA: Centers for Disease Control and Prevention, 2017. (Accessed on March 27, 2018 at https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/Blindness.html.)Diabetes and eye health. San Francisco, CA: American Academy of Ophthalmology. (Accessed on May 5, 2021 at http://www.diabetes.org/living-with-diabetes/complications/eye-complications/.) Diabetic eye problems. Washington, DC: U.S. National Library of Medicine. (Accessed on May 5, 2021 at https://medlineplus.gov/diabeticeyeproblems.html.) Eye complications. Arlington, VA: American Diabetes Association. (Accessed on May 5, 2021 at http://www.diabetes.org/living-with-diabetes/complications/eye-complications/.) Facts about diabetic eye disease. Bethesda, MD: National Eye Institute. (Accessed on May 5, 2021 at https://nei.nih.gov/health/diabetic/retinopathy.) Glaucoma. Washington, DC: U.S. National Library of Medicine. (Accessed on May 5, 2021 at https://medlineplus.gov/glaucoma.html.)