There can be many things to prevent, reduce and manage the signs of diabetes-related complications.
This article explains how to prevent eye complications, what happens during annual examinations, the most common diabetes-related eye complications, and treatment options available today.
Preventing eye complications of diabetes
What anyone with diabetic can do to prevent diabetic eye complications is to manage their blood sugar levels as effectively as possible.
This is easier said than done, but damage that occurs in small but critical blood vessels in the eyes when blood glucose levels are high can lead to a considerable number of conditions, including severe vision loss or blindness.
The American Diabetes Association (ADA) HBA1C guidelines recommend maintaining A1C below 7.0% (a measure of glucose control over the past 2-3 months) for the best possible prevention of diabetes-related ocular complications.
A 2021 research study showed that lower A1C levels were also associated with a lower risk of developing retinopathy.
You can also talk to your healthcare team about taking vitamin supplements that include lutein, vitamins A, E, C, and other things, and other people who support healthy eye functioning. However, it should be noted that vitamin supplements cannot protect your eyes from nerve damage caused by persistent hyperglycemia levels.
Annual Diabetic Eye Test
Here is your eyes. It is easy for these common diabetic eye complications to develop and worsen without being evident in daily life until it is too late.
However, there are some important indications that the American Optometry Association (AOA) says that anyone with diabetes should quickly schedule an appointment with an optometrist or ophthalmologist.
- Sudden blur or double vision
- It’s difficult to read and concentrate on nearby jobs
- Eye pain and pressure
- A prominent aura or dark ring around lights or illuminated objects
- Visually visible dark spots or flashing light images
Expert examinations by an optometrist yearly can diagnose and treat diabetes-related eye conditions, protecting and protecting them at the earliest stage, and keep Your vision.
Let’s take a closer look at four tests conducted during our annual ophthalmology examination.
Eye test
This eye chart test measures the ability of a person to see clearly at various distances. There’s probably nothing you haven’t done every year for your pediatrician when you were a child!
This test involves reading letters from charts that are usually located 20 feet away. This test evaluates how well you can see the details of the text. This helps you determine the clarity of your vision.
This is especially important for people who manage diabetes, as it helps detect visual changes that may indicate early signs of diabetes-related eye conditions.
Tonomatories
This test measures the internal pressure of the eye, known as intraocular pressure (IOP). In diabetic patients, it is important to monitor IOP as high intraocular pressure can exacerbate pre-existing retinal damage caused by diabetic retinopathy.
External strains that increase IOP, such as weightlifting and childbirth, can pose additional risks to blood vessels that have already been compromised in the eyes of diabetics.
However, if the eyes are generally healthy and there are no retinal diseases, normal activities that temporarily increase in intraocular pressure are usually not a concern.
Optical Coherence Tomography (OCT)
This technique is similar to ultrasound, but uses light waves instead of sound waves to capture images of tissues in the body. OCT provides detailed images of tissues that can be penetrated by light such as the eyes.
OCT is particularly valuable in eye care as it allows for high-resolution imaging of the retina and provides information about the structure and health of the retina.
This is important for the diagnosis and monitoring of conditions such as diabetic retinopathy, where early detection of retinal changes can have a significant impact on treatment outcomes.
Expansion can be scary, but it is actually painless and definitely essential for a thorough investigation of the most important areas of the eye.
At some point during the appointment, after testing your vision, your doctor will administer a few drops of tropicamide in the eyes.
This allows students to see more detail the structure inside the eye, as they only expand or expand. In particular, you can see more in detail the retina, including the optic nerve and macula (the central part of the retina that causes sharp, straight vision).
You will then be asked to wait approximately 15 minutes while the eyes are fully expanded before the next part of the exam.
Once the dilation occurs, the optometrist will look at the next eye.
- The blood vessels change
- Signs of blood vessel leakage
- Swelling of the macular (diabetic macular edema)
- Changes in the lens
- Damage to the optic nerve
By the way, don’t forget to bring your sunglasses to your appointment! It can take several hours for the dilator to wear out, so you should wear it when you leave. With an enlarged student, you feel like you are standing seven feet in front of the sun! It’s too bright!
For pregnant or currently pregnant women
For women with diabetes who are considering pregnancy, an expanded eye examination should be performed to identify existing signs of retinopathy. This is important. This is important as hormonal changes and increased blood volume during pregnancy can worsen existing retinopathy.
This does not mean that women with retinopathy should not pursue pregnancy, but careful management and regular monitoring are essential. Regular visits to your pregnant ophthalmologist are recommended to manage changes in your condition.
Although concerns about vaginal birth due to pressures that may have on the blood vessels of the eye are understandable, decisions regarding the mode of delivery should be made by both an obstetrician and an ocular specialist based on the severity of the retinopathy and overall health.
Even if your pregnancy is a surprise, it is still important to schedule an appointment with your ophthalmologist as soon as you know you are pregnant.
Common diabetic ocular complications
Among all these diabetes-related eye conditions is a common theme within all of blood glucose control.
Not all conditions are necessarily the result of persistent hyperglycemia (hyperglycemia), but people with very healthy blood glucose levels can develop diabetic retinopathy. Your glucose control will play a leading role in the development and progression of diabetic ocular complications.
This is the most common diabetes-related ocular complication.
- Diabetic retinopathy
- Diabetic macular edema
- Glaucoma
- Cataract
- Dry eye syndrome
Let’s take a closer look at each of these conditions and how we can handle them.
What is diabetic retinopathy?
The most common cause of vision loss in diabetics is retinopathy. And that’s probably what you’ve heard the most.
In fact, there are four stages of diabetic retinopathy, and of course, the earlier it is detected, the more likely it is to stop its progression and prevent further damage to eye health and function.
The four stages of diabetic retinopathy defined by the National Eye Institute (NEI) are as follows:
Stage 1 – Mild Nonnutrient Retinopathy (NPDR)
This early form of dr is identified by “a small area of balloon-like swelling in small blood vessels in the retina called microuria.” The fluid from these microbial uria can leak into the retina of the eye.
This early stage of DR is detectable during each year’s visit to an optometrist, and is a very good reason to expand your eyes and thoroughly examine each year!
Stage 2 – Moderate Non-trophic Retinopathy (NPDR)
The second stage of DR is when the blood vessels, which are the key to “nourishing” the retina, begin to swell and distort, Nay explains.
“They may also lose their ability to transport blood. Both conditions can cause characteristic changes in the appearance of the retina, which can contribute to diabetic macular edema.”
Stage 3 – Severe Nonnutrient Retinopathy (NPDR)
This next step in DR is when a considerable number of blood vessels in the retina are “blocked.” In other words, the retina is being severely deprived of an appropriate blood supply.
This ischemia (lack of blood supply) encourages the retina to release growth factors that stimulate the formation of new blood vessels.
Additionally, fluid leaking from microbial uria continues to accumulate, worsening the condition and increasing the risk of further complications such as diabetic macular edema.
Stage 4 – Proliferative Diabetic Retinopathy (PDR)
“In this advanced stage, growth factors secreted by the retina cause the growth of new blood vessels that grow along the inner surface of the retina and grow into vitreous gel, a liquid that fills the eye,” explains Nay.
However, these new blood vessels are very compromised and vulnerable. This means that even though they are new, they are extremely vulnerable to leaks and bleeding.
Furthermore, evolving scar tissue from numerous microuria can cause the retina to be densely separated, known as the “detached retina.” Detached retina usually requires immediate care of surgery and can lead to permanent vision loss if it cannot be repaired.
Vision loss associated with diabetic retinopathy
For many people, vision loss in diabetic retinopathy is irreversible, but NEI says early detection and appropriate treatment can reduce the risk of vision loss by 95%.
Additionally, anyone with existing retinopathy may need to see an optometrist or ophthalmologist at least once a year.
Signs and symptoms of diabetic retinopathy
only The way to catch retinopathy in the early stages is to visit an ophthalmologist for your annual examination.
Otherwise, like most diabetic eye complications, there are no obvious signs or symptoms that will inform you that retinopathy is developing and progressing in your daily life.
At some point in its progression, long after detecting it during an eye examination, bleeding from the retinal vessels can cause floating spots or “floaters” that move across your field of vision.
These floaters are caused by bleeding from abnormal blood vessels in the retina. They may seem sunny at times, but their presence indicates the ongoing damage that needs to be addressed.
The more these symptoms are ignored and left untreated, the more likely they will experience worsening vision and permanent vision loss. The progressive state of diabetic retinopathy can also lead to complications such as DME.
Treatment Options
“Retinopathy treatment options today continue to improve and are constantly evolving,” explains Angela Bevels, OD.
“Retinopathy should be treated by a retinal expert,” says Dr. Bevel. This is because the overall problem with retinopathy can lead to irreversible vision loss, and each stage of retinopathy needs to be treated with great care.
Most importantly, new treatment options for retinopathy can often stop the progression of the disease – it can save your vision, so it is very important to catch it early during your annual examination.
Based on your eye progression and condition, there are several treatment options available today for retinopathy.
Anti-VEGF injection
Additionally, anti-VEGF injections work to treat DME by blocking a specific protein called “vascular endothelial growth factor” (VEGF). This protein stimulates abnormal blood vessels to grow, leaks fluid, and plays an important role in contributing to DME and retinopathy.
These injections reverse abnormal vascular growth and reduce retinal fluid. They may sound intimidating and uncomfortable, but anti-VEGF injections are highly effective and are considered first-line treatment for people diagnosed with retinopathy.
FDA approved brands of anti-VEGF injections include Lucentis (Ranibizumab), Avastin (Bevacizumab), and Eylea (Aflibercept).
Scattered laser surgery
“For decades, PDR has been treated with panretinal laser surgery or spray laser surgery called panretinal photocoagulation,” explains Nei.
“Treatment involves performing 1,000 to 2,000 small laser burns in areas of the retina away from the macula. These laser burns are intended to reduce abnormal blood vessels.”
Surprisingly, although this laser treatment can only be completed in one session, some patients may require more than two sessions depending on the severity of their retinopathy.
Nei also explains that this treatment can maintain central vision, but can actually result in loss of the degree of peripheral vision, chromoscopic vision, and night vision.
Vitrectomy surgery
“Vitrectomy is the surgical removal of the vitreous gel in the center of the eye,” explains Nei. “This procedure is used to treat severe bleeding to the vitreous and is performed locally or under general anesthesia.”
During the surgery, Nay says, “A port (a temporary watertight opening) is placed in the eyes, allowing the surgeon to insert and remove equipment such as small light or small vacuums called vitr agents.
A clear salt solution is gently pumped into the eye through one of the ports to maintain intraocular pressure during surgery and replace the removed vitreous body. The same equipment used during vitrectomy can be used to remove scar tissue or repair detached retina. ”
For some people, this is an outpatient procedure, but for others who need more postoperative observation and support, nightly stays in the hospital may be required.
“After treatment, your eyes may be covered in patches for days to weeks and may be red and painful,” explains Nei. “Drops may be applied to the eyes to reduce the risk of inflammation and infection. If both eyes require vitrectomy, the second eye is usually treated after the second eye has recovered.”
Corticosteroid injection
Corticosteroid injections are another therapeutic option for DR, particularly when anti-VEGF therapy is not effective or appropriate. These injections help reduce retinal inflammation and reduce retinal leakage by stabilizing the blood retinal barrier.
However, using corticosteroids in the eyes can lead to potential side effects, such as increased intraocular pressure and cataract formation.
Due to these risks, corticosteroid treatments are generally considered when other treatment options have not achieved the desired outcome or are contraindicated (use is not recommended).
Commonly used corticosteroids include triamcinolone, dexamethasone (often delivered via slow release implants), and fluocinolone. The choice of steroids and delivery methods are based on the person’s specific needs and the severity of their condition.
What is diabetic macular edema?
DME is a serious complication of diabetic retinopathy. It occurs when fluid accumulates in the macula.
This fluid accumulation causes swelling and thickening of the macula, which adversely affects its function. The macula is essential for tasks that require detailed vision, such as reading, driving, and facial recognition.
DME can lead to major vision loss and is the main cause of blindness among people with diabetic retinopathy, but is not exclusive to the late stages of retinopathy.
DMEs can develop at any stage of diabetic retinopathy, highlighting the need for early and continuous surveillance of eye health in diabetic patients.
Signs and symptoms of diabetic macular edema
Similar to retinopathy, diabetic macular edema is most easily detected during annual vision tests.
Some common signs and symptoms of this condition include:
- Blurred or distorted vision
- It’s difficult to read or see the details
- Decreased central vision
- View spots and floaters
- Changes in color perception
Your vision problem can be a sign of DME, but waiting until obvious symptoms develop will only help you treat it well and reduce the chances of preventing it from progressing. Regular eye exams are mandatory when it comes to stopping DME on that track.
Diabetic macular edema treatment options
Anti-VEGF injection
As mentioned earlier in the discussion on the treatment of retinopathy, anti-VEGF injections are also considered to be the main treatment for DME.
They work by blocking certain proteins called “vascular endothelial growth factor” (VEGF). This protein stimulates abnormal blood vessels to grow, leaks fluid, and plays an important role in contributing to DME and retinopathy.
FDA approved brands of anti-VEGF injections include Lucentis (Ranibizumab), Avastin (Bevacizumab), and Eylea (Aflibercept).
Focus/Grid Macular Laser Surgery
This procedure involves several or hundreds of small laser burns into blood vessels that are leaking fluid near edema. Through these laser burns, fluid leakage is quickly slowed down and retina swelling is reduced.
“The procedure usually takes just one session,” explains Nei. “However, some people may need multiple treatments. Local/grid lasers may sometimes be applied on days of anti-VEGF injections only if DME cannot be properly improved before, sometimes after anti-VEGF injections, sometimes after anti-VEGF injections, and sometimes after 6 months of anti-IVEGF therapy.”
Corticosteroids
These steroids can be injected or actually implanted in the eye and can be used alone or in combination with other treatment options.
“Ozuldex (dexamethasone) implants are for short-term use, while irubian (fluosinolone acetonide) implants last longer,” explains NEI. “Both are biodegradable and release sustained doses of corticosteroids to suppress DME.”
However, using this type of steroid in the eye increases the risk of developing cataracts and glaucoma. This means that anyone using DME using corticosteroids should also closely monitor signs of increased eye pressure and glaucoma.
What is glaucoma?
“Glaucoma is a group of diseases that can damage the optic nerves of the eye, leading to loss of vision and blindness,” explains Nei. “This is one of the main causes of blindness in the US. However, early treatment can protect your eyes from severe vision loss.”
In other words, if it means detecting and treating glaucoma before it progresses too much, then examining the eyes properly by an optometrist or ophthalmologist every year can save your vision.
The US Centers for Disease Control and Prevention (CDC) says people with diabetes are twice as likely to develop glaucoma as people without diabetes.
The most common types of glaucoma are “acute angle glaucoma” and “acute angle glaucoma.”
“If your parents or siblings have a disease, are African American or Latino, or have diabetes or cardiovascular disease, you have a higher risk of glaucoma.” “The risk of glaucoma also increases with age.”
Signs and symptoms of glaucoma
Glaucoma cannot have obvious symptoms to many people until it is too late. For others, later stages of the disease can cause blurred vision, distorted vision, and alter the degree of vision loss.
“There are usually no early warning signs or symptoms of open glaucoma,” explains GRF. “It develops slowly over the years without noticeable vision loss.”
“Most people with green glaucoma don’t notice changes in their vision initially, as the initial loss of vision is lateral or peripheral vision.
In the case of less common acute angular glaucoma, the symptoms according to GRF are:
- Fluffy or blurry vision
- Rainbow circles appearance around bright light
- Severe eye and head pain
- Nausea and vomiting (associated with severe eye pain)
- Sudden loss of vision
Glaucoma treatment options
“Now in the US, eye drops are often the first option to treat patients,” explains GRF. “For many people, the combination of medication and laser treatments can safely control intraocular pressure for years.”
Eye drops used to treat glaucoma reduce eye pressure by draining excess fluid from the eye and reducing the amount of fluid produced by the eye.
The types of eye drops to treat glaucoma include:
- Prostaglandin analog
- Beta Blocker
- Alpha agonists
- Carbonate Anhydrase Inhibitor (CAIS)
- Rho Kinase Inhibitors
Many people need a combination of medications to manage glaucoma.
“Glaucoma is an eye disease that can be treated until it is not,” explains Bevel. “The best advice is to use prescription drops to control intraocular pressure, as dictates by eye care providers. There’s nothing scary about eye drops, but it’s a problem for older patients with dexterity issues, and surgery is the best option.”
What is a cataract?
Cataracts are the result of clouding in your eye lenses. They are small and only slightly interfere with your vision, but they can be large enough that interference with your vision becomes important and impossible.
People with diabetes, especially those who smoke, are at a higher risk of developing cataracts, but they may develop in healthy people if they do not.
“Cataracts are most developed in people over the age of 55,” explains AOA.
Signs and symptoms of cataracts
Unlike many other diabetic ocular complications, cataracts have the following prominent symptoms:
- When you look at your eyes in the mirror, you can see “cloudy” or opaque areas
- Visual or cloudy spots affecting some parts of your vision
- Looking at double (diplopia) perceives two images instead of a single object
- Improved sensitivity to light and glare
- It’s difficult to see at night or need more light to read and perform other activities
- Usually, bright colors are perceived as faded or less vibrant
Cataract Treatment Options
Some cataracts may not be so bad that they require treatment. However, for many people, surgery is essential to improve and restore vision.
“If a cataract develops to the point where your daily activities are affected, you will be referred to an ophthalmologist who may recommend surgical removal of the cataract,” says AOA.
Surgery may sound intimidating, but cataract surgery is relatively simple and can often be performed in a short outpatient procedure in the surgeon’s office rather than in the operating room of a hospital.
“Using a small incision, the surgeon removes the fogged lens and in most cases replace it with an intraocular lens implant,” explains AOA. “In general, medications can be placed in the eye after surgery and patches on the eyes.”
What is Dry Eye Syndrome?
Dry Eye Syndrome (DES), Dry Eye Disease (DED) or “Keratococonsectititis SICCA” is a condition seen in over 50% of all people with diabetes, and is a common eye complication of diabetes.
“Many patients are asymptomatic, but there are still early disease and developmental processes,” says Bevel.
“Chronic use of any topical medication can lead to a diagnosis of dry eye,” she adds.
This means that those who need long-term medication in the eyes should keep an eye on signs of dry eye syndrome, seek an appropriate diagnosis, and quickly follow treatment to prevent complications.
Signs and symptoms of dry eye syndrome
The most common are:
- A stab, burning, itching, or wounded sensation in and around your eyes
- Thin mucus is present around your eyes
- Frequent redness in white of your eyes
- Increased sensitivity to light (photophobia)
- Feeling of having something (a foreign object)
- In particular, my eyesight has become blurred over the long term, focusing on tasks such as reading and using a computer.
Dry Eye Syndrome Treatment Options
For some people, daily application of artificial tears is sufficient to manage dry eye syndrome, along with improving blood sugar levels.
However, those with a more advanced stage of retinopathy or DME may need Maybomb gland analysis (examination of the eyelid glands that produce the oily layer of tears) and consistent treatment.
One effective approach to dealing with mybomian gland dysfunction is intense pulsed light (IPL) therapy. This technology uses broad-spectrum light to target and treat affected areas, stimulate glands and enhance the production of oily layers of the tear film.
“Some patients may also suffer from evaporative dry eye disease,” adds Bevel.
Take care of your eyes – you need them!
Care for diabetes is essential as our eyes are essential to our everyday experience of being alive.
“Other simple things you can do to protect your eyes,” adds Bevel. “It’s about wearing UV protection sunglasses outdoors and considering eye supplements with high levels of zinc, lutein and carotene.”
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