Diabetes In Eye: Who Is At Risk?

5 min read

Diabetic retinopathy is the medical terminology for diabetes eye problems. It is one of the leading causes of irreversible blindness in the world. Diabetic eye disease can happen from Type 1 or Type 2 diabetes, but the risk with Type 1 is much higher.

This is because Type 1 Diabetes tends to happen earlier in life and a person has to live with it for many years. A study was done to evaluate the rates of diabetic retinopathy. This study was The Wisconsin Epidemiologic Study of Diabetic Retinopathy, abbreviated as WESDR. This study showed that after having diabetes for 20 years, 99% of patients with type 1 diabetes will some level of diabetic retinopathy.

Type 2 diabetics are also likely to develop diabetic retinopathy, but are less likely than people who have Type 1 Diabetes. The WESDR study showed that after 20 years, 60% of type 2 diabetics will have some degree of diabetic retinopathy in the eye.

If you developed diabetes during your pregnancy (called Gestational Diabetes Mellitus, or GDM), you have a 70% chance of going on to develop Type 2 diabetes in your life. If you already have diabetes and become pregnant, your diabetes could become much worse during pregnancy so it is important to control your blood sugars so that you do not have pregnancy-related complications or any eye problems from diabetes.

Risk Factors For Diabetic Retinopathy

There are a few risk factors for developing diabetic eye disease. The first major risk factor is how long a patient has had diabetes. Since Diabetes Type 1 develops earlier in life, it is not surprising that nearly all patients with Type 1 Diabetes will have some degree of retinopathy after 20 years. Poor blood sugar control is another major risk factor for developing diabetes eye problems. Blood sugar control is measured in two ways. One is through a daily prick with an at-home glucose monitor. This gives you your blood sugar level at that moment. There is a blood test for Hemoglobin A1C which gives your doctor an average of how your blood sugar has been doing over the last 3 months. This level is important because it is not just about one point in time but rather has 3 months of data. High hemoglobin A1c (HbA1c) levels increase your risk of diabetic eye disease. Also, high blood pressure is associated with an increased risk of diabetic retinopathy.

Types Of Diabetic Eye Diseases

There is more than one way diabetes can affect the eye. In some patients, diabetes can cause swelling in the central part of the retina. This is called macular edema. In other cases, patients may have bleeding in their retina, or can even develop a retinal detachment from their diabetes. Some patients with diabetic eye problems will have new vessels that grow in different parts of their eyes. While new blood vessels do not seem like a bad thing, having new blood vessels grow inside the eye is very dangerous. These vessels can disrupt the way the normal eye works and cause bleeding, increased pressure, and vision loss.

Symptoms Of Diabetic Eye Disease

In most cases, early diabetic eye diseases are not very symptomatic. In fact, most patients have no idea that their eye is being negatively affected by diabetes until they go to see an eye doctor. It is important to see an ophthalmologist at least once a year for a dilated eye exam if you have diabetes. If you have poorly controlled diabetes, then your ophthalmologist may even want to see you every 6 months.

One late symptom of diabetic eye disease is blurry vision, which may be from macular edema but also could be from bleeding in the eye (vitreous hemorrhage). Another symptom can be total vision loss or severe blurry vision. This may be from a retinal detachment. In less common cases, eye pain and eye redness can be a result of diabetes if the diabetes is causing a high eye pressure. This is called neovascular glaucoma and it is a very serious and late-stage complication of diabetes.

Diabetes In Eye: Take Home Points

Good blood sugar control is the number one factor in preventing diabetic eye problems. Once diabetic retinopathy develops it causes many other problems in the eye like retinal detachments, bleeding, and even glaucoma. It is very important to control your blood sugar and to see an ophthalmologist for a dilated eye exam every year if you have diabetes. Once you lose vision from diabetes, it is very hard, even with modern treatment, to recover all of the lost vision.

Sources:

Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT; Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-82. doi: 10.1016/S0161-6420(03)00475-5. PMID: 13129861.

https://pubmed.ncbi.nlm.nih.gov/13129861/

Sabanayagam C, Banu R, Chee ML, Lee R, Wang YX, Tan G, Jonas JB, Lamoureux EL, Cheng CY, Klein BEK, Mitchell P, Klein R, Cheung CMG, Wong TY. Incidence and progression of diabetic retinopathy: a systematic review. Lancet Diabetes Endocrinol. 2019 Feb;7(2):140-149. doi: 10.1016/S2213-8587(18)30128-1. Epub 2018 Jul 11. PMID: 30005958.

https://pubmed.ncbi.nlm.nih.gov/30005958/

Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010 Jul 10;376(9735):124-36. doi: 10.1016/S0140-6736(09)62124-3. Epub 2010 Jun 26. PMID: 20580421.

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