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You probably know that diabetes can cause eye problems, possibly even blindness. Yet despite that startling truth, it’s important to recognize that with regular checkups and good blood glucose control, you can keep minor vision problems in the “minor” category. Even some of the more severe issues may be treated if caught early enough.
Understanding diabetic retinopathy
Diabetic retinopathy is the most common cause of vision loss among people with diabetes. The condition involves changes to the tiny blood vessels (known as capillaries) found in the retina, which is the light-sensitive tissue that lines the back of the eye. Those changes cause the blood vessels to bleed or leak fluid, distorting vision.
There are two major types of retinopathy you should know about: non-proliferative and the more advanced proliferative kind.
With non-proliferative—the most common type of retinopathy—small areas of balloon-like swelling occur in the retina’s blood vessels. As the condition progresses, blood vessels continue to swell and they may also lose their ability to transport blood.
Although retinopathy doesn’t usually cause vision loss at this stage, the walls of the blood vessels may become damaged. As a result, fluid can leak into the macula, the part of the retina that provides sharp, central vision. When the macula swells with fluid—a condition known as macular edema—vision becomes blurry. In severe cases, vision loss may result.
Non-proliferative retinopathy itself does not typically require treatment. But when macular edema develops, it must be treated. Thankfully, treatment for macular edema can often stop and may even reverse vision loss.
The more advanced stage of retinopathy—called proliferative retinopathy—is far less common. With this form of the disease, the blood vessels are so damaged they close off. In response, new blood vessels start growing in the retina. These new vessels are fragile, however, so they’re more likely to leak and bleed, blocking vision.
The growth of these new blood vessels may also lead to the development of scar tissue, which can in turn lead to retinal detachment. When this condition takes hold, the retina may become distorted or even pulled out of place.
At first, diabetic retinopathy may cause no symptoms or only mild vision problems. If left untreated, however, it can cause permanent vision loss and perhaps blindness.
But there are some steps you can take to help maintain your vision:
Maintain target blood glucose levels
Chronically high blood glucose can lead to blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. The eye tries to grow new blood vessels, but they don’t develop properly, which can cause fluid to leak into the retina.
People with diabetes who keep their blood glucose levels close to normal are less likely to have retinopathy, according to the American Diabetes Association (ADA). And if those folks end up being diagnosed with the condition, they’re more likely to have a milder form.
Keep blood pressure under control
What’s bad for your heart can also be bad for your eyes if you have diabetes. That’s why the ADA says it’s important to keep blood pressure and cholesterol in the healthy range to reduce your risk or to slow the progression of diabetic retinopathy.
If you have diabetes, the ADA recommends keeping your blood pressure below 140/90 mm Hg. The American Heart Association recommends a level below 130/80. If you’re not able to do that through lifestyle changes, your doctor will likely prescribe a blood pressure drug such as an ACE inhibitor (short for angiotensin-converting enzyme inhibitor) or an angiotensin II receptor blocker (ARB), both of which are effective treatments for diabetic retinopathy. Your doctor may also prescribe a statin to control your cholesterol.
Have your eyes checked regularly
In the early stages of diabetic retinopathy, there are often no symptoms. As the disease progresses, however, you may see spots or floaters, your vision may be blurry or you may have trouble seeing at night. In its most severe stage, retinopathy can cause vision loss.
It’s crucial to have your eyes checked regularly if you have diabetes. If you’re an adult with type 1 diabetes, the ADA recommends seeing an eye care specialist such as an ophthalmologist or an optometrist for a dilated retinal examination within five years of being diagnosed and then annually thereafter. If you have type 2, you should have the exam when you’re diagnosed and every year after that. (If you show no signs of the disease at one or more of your annual eye exams and you’re hitting your blood glucose targets, your doctor may recommend less frequent exams.)
When you have a dilated retinal exam, your healthcare provider will put drops in your eyes that temporarily enlarge the pupils (the black centers of your eyes) to allow a thorough look at the inside of your eye.
If you’re a woman with diabetes who’s planning to get pregnant or is already pregnant, take note: Pregnancy is associated with a rapid progression of diabetic retinopathy, so the ADA recommends having your eyes examined before pregnancy or in the first trimester if you’re already pregnant. You should then be monitored every trimester and for a year after you’ve given birth.
With regular checkups, you can help keep minor eye problems from progressing to major ones. And if you do develop sight-threatening issues, there are treatments for diabetic retinopathy that often work well if you begin them right away.
