Diabetes and Vision Loss by Stephen John, O.D.

April 28, 2020

Dr. John is a primary care optometrist who specializes in ocular disease and provides ocular surgery co-management.

The Centers for Disease Control and Prevention (CDC) reports that 30.3 million Americans — nearly 10% of the country’s population — live with diabetes. Another 84.1 million Americans have prediabetes, and many of these cases will turn into type 2 diabetes. In addition to affecting blood sugar levels, diabetes can also have devastating effects on your ocular health.

What is Diabetes?

Diabetes is a disease that interrupts the body’s ability to produce or use insulin to control blood sugar (glucose) levels. High blood sugar can cause damage in many parts of the body. Diabetes can damage the heart, kidneys, and blood vessels – including blood vessels in the eyes.

Eye Diseases Linked to Diabetes

Diabetic eye disease is a blanket term for specific diabetes-related eye diseases. Both type 1 and type 2 diabetes increase the risk of many conditions.

The eye diseases most commonly associated with diabetes are:

  • Diabetic retinopathy — Diabetic retinopathy occurs when blood vessels in the retina swell, leak, or completely close. Additionally, new blood vessels might grow on the surface of the retina. Risk of diabetic retinopathy increases the longer a person lives with diabetes.
  • Diabetic macular edema — Diabetic macular edema occurs when fluid builds up on the retina, which causes swelling and blurry vision.
  • Cataracts — Cataract is a clouding of the natural lens in your eye that causes many types of vision disturbance including double vision and poor night vision. The excess blood sugar from diabetes can cause cataracts to form early or exacerbate the progression of cataracts that have already begun to form.
  • Glaucoma — Glaucoma is a group of diseases that cause damage to the optic nerve, which carries signals from the eye to the brain. The risk of developing glaucoma doubles with diabetes.

General Guidelines for Living with Diabetes

Those with diabetes should strictly follow the instructions of their eye care provider to effectively combat permanent vision loss.

Here are some key guidelines to follow:

  • If you have type 1 diabetes, you should have annual screenings for diabetic retinopathy beginning immediately upon diagnosis.
  • If you have type 2 diabetes, you should have a prompt examination at the time of diagnosis and at least yearly examinations after the first examination.
  • Women who develop gestational diabetes do not require an eye examination during pregnancy and do not appear to be at increased risk of developing diabetic retinopathy during pregnancy. However, patients with diabetes who become pregnant should be examined early in the course of the pregnancy.

Maintaining near-normal glucose levels and near-normal blood pressure lowers the risk of retinopathy developing and progressing. As a result, you should keep at the top of your mind the importance of maintaining good glycosylated hemoglobin levels, serum lipids, and blood pressure.

How Can You Prevent Vision Loss?

The key to preventing permanent vision loss is early detection. The CDC states that about 90% of vision loss from diabetes can be prevented. Regular comprehensive eye exams are key to catching eye disease related to diabetes. Studies have shown that up to 60% of diabetes patients do not get eye exams as often as is recommended, placing them at a much higher risk of permanent partial or full vision loss. Comprehensive eye exams need to occur prior to the onset of vision loss and should be performed once a year.

More About Primary Care Optometrist Stephen John, O.D.

Dr. John is a primary care optometrist with the Marietta Eye Clinic who specializes in ocular disease and provides ocular surgery co-management. He earned his doctor of optometry from the University of Alabama at Birmingham School of Optometry before completing residencies at the Ohio State University College of Optometry, the Chalmer P. Wylie VA Ambulatory Care Center, and the Chillicothe VA Medical Center. He is a member of the American Optometric Association, the Georgia Optometric Association, and the Greater Atlanta Optometric Association. He is certified by the American Board of Optometry, the Georgia Board of Optometry, and the National Board of Examiners. Read more about Dr. John here.

References and Additional Resources

The American Academy of Ophthalmology (AAO) is the world’s largest association of eye physicians and surgeons. It describes itself as a “global community of 32,000 medical doctors who protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public.” Its website is a great resource to learn more about how to care for your eyes.

The American Optometric Association (AOA) describes itself as the leading authority on quality care and an advocate for our nation’s health, representing more than 44,000 doctors of optometry, optometric professionals, and optometry students.

Diabetic Eye Disease

https://www.aao.org/eye-health/diseases/diabetic-eye-disease

New CDC report: More than 100 million Americans have diabetes or prediabetes

https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

Screening for Diabetic Retinopathy

https://www.aao.org/clinical-statement/screening-diabetic-retinopathy

Diabetic Retinopathy PPP – Updated 2017

https://www.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp-updated-2017

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