More than 1 million Australians have diabetes, a condition which carries an increased risk of developing eye complications. Diabetic eye disease includes complications such as diabetic retinopathy, diabetic macular oedema, cataracts and glaucoma.
Diabetes is the leading cause of blindness in working-age adults. People with type 1 and type 2 diabetes are at risk. It’s possible to be unaware that you have severe diabetic eye disease and suddenly go blind. Fortunately most cases of blindness can be prevented with regular eye examinations and proper care.
The persistently high blood sugar levels that occur with diabetes can damage the retina’s small blood vessels (capillaries), which deliver oxygen and nutrients. Diabetic retinopathy affects around 15% of people with diabetes and there are three main types:
Non-proliferative diabetic retinopathy is the early stage in which capillary damage results in blood and fluid leaking into the retina, causing it to swell. Depending on the number of vessels affected, there is usually minimal or no effect on vision.
Diabetic macular oedema occurs if swelling extends to the macula, which is the part of the retina responsible for central vision. Diabetic macular oedema (swelling) is the usual cause of vision loss related to diabetes and the level of impairment can be significant.
Proliferative diabetic retinopathy is the advanced stage of the disease. In an attempt to supply the retina with more oxygenated blood, abnormal blood vessels start to grow but these are fragile and bleed easily. This can lead to the formation of scar tissue. If these new vessels bleed, the person may see ‘floaters’ or even lose all vision. This requires emergency treatment.
A cataract is a clouding of the lens in the eye. Left untreated, cataracts can eventually lead to blindness. People with diabetes are more likely to develop cataracts at an earlier age, and suffer visual impairment faster than those without the condition. Learn more
This is a group of conditions that can damage the optic nerve. The optic nerve transmits signals from the retina to the brain for processing. Glaucoma is often (but not always) a result of increased pressure inside the eye. The risk of glaucoma in people with diabetes is significantly higher than that of the general population. The two main types are open-angle glaucoma (also called ‘the sneak thief of sight’) and angle-closure glaucoma (this comes on suddenly and is a medical emergency).
Diabetic eye conditions often have no signs or symptoms, particularly in the early stages. By the time someone with diabetes notices changes in their vision, the condition is quite advanced.
Signs and symptoms may include:
Blurry, cloudy or dim vision
Floaters and flashes
Poor night vision
Sensitivity to light and glare
Double vision, seeing halos around lights
Frequent changes in spectacle and contact lens prescriptions
Headaches, nausea, vomiting
The Fred Hollows Foundation, which some of our doctors have worked with, has developed a sight simulator to demonstrate the visual impairment a person with diabetic retinopathy may experience.
What is diabetic eye disease?
This is a term used to describe the common eye complications seen in people with diabetes. It includes diabetic retinopathy, diabetic macular oedema, cataracts and glaucoma. Cataract FAQs
Can I prevent diabetic retinopathy?
You can reduce your risk by having your eyes checked as soon as possible after being diagnosed with diabetes (this is called a screening test) and then at regular intervals thereafter.
Keeping the diabetes under control is the most important thing you can do – this means eating a balanced diet, getting exercise, not smoking and monitoring your blood sugar levels. You should also see your doctor regularly to have your blood pressure and cholesterol levels checked. If you experience any changes in your vision, have your eyes checked immediately.
What's the difference between diabetic retinopathy and diabetic macular oedema?
Diabetic macular oedema is a form of diabetic retinopathy.
It occurs when the swelling involves the macula, which is the part of the retina responsible for central vision. Vision can become blurred and distorted, resulting in trouble reading, recognising faces and driving. Macular oedema (swelling) is the usual cause of vision loss related to diabetes and the level of impairment can be significant.
Can diabetic retinopathy be cured?
Vision can often be improved by treatment, but the main goal is to stabilise your condition and prevent it from getting worse. The three main treatments of diabetic retinopathy are injections into the eye, laser treatment or vitrectomy surgery. Your doctor will recommend the most appropriate course of treatment.
How does smoking contribute to loss of vision?
Smoking is not a risk factor for diabetic eye damage, but it can damage the eye in other ways. It increases the risk of developing cataracts, blockages of retinal arteries and the wet form of age-related macular degeneration. Diabetics who smoke also increase their risk of heart attack, stroke and kidney failure.
Is the treatment painful?
No, modern anaesthetics are very effective. Special anaesthetic eye drops are usually used to prevent pain and, for patients undergoing vitrectomy surgery, a sedative given to relieve anxiety. Following laser treatment or surgery, you may feel some mild discomfort the next day.
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