A common complication of diabetes is diabetic eye disease. Diabetic eye disease refers to a group of sight-threatening eye problems that people with diabetes may develop. If you have diabetes, regular visits to your eye doctor for regular exams are important to avoid eye problems. High blood sugar (glucose) increases the risk of eye problems from diabetes. In fact, diabetes is the leading cause of blindness in adults ages 20 to 74.

1. How Does Diabetes
Affect Your
Eyesight?
Diabetes Support Site Website
http://diabetessupportsite.com/

2. How Does Diabetes Affect Your Eyesight?
A common complication
of diabetes is diabetic eye
disease. Diabetic eye
disease refers to a group
of sight­threatening eye
problems that people with
diabetes may develop.
If you have diabetes,
regular visits to your eye
doctor for regular exams
are important to avoid eye
problems. High blood
sugar (glucose) increases
the risk of eye problems
from diabetes. In fact,
diabetes is the leading
cause of blindness in
adults ages 20 to 74.
High blood sugar in diabetes
causes the lens of the eye to
swell, which changes your
ability to see. To correct this
kind of eye problem, you
need to get your blood sugar
back into the target range
(70­130 milligrams per
deciliter or mg/dL before
meals, and less than 180
mg/dL one to two hours after
a meal). It may take as long
as three months after your
blood sugar is well controlled
for your vision to fully get
back to normal.
Blurred vision can also be a
symptom of more serious eye
problem with diabetes. The
three major eye problems that
people with diabetes may
develop and should be aware
of are cataracts, glaucoma,
and retinopathy.

3. What is the relationship between Diabetes and Glaucoma?
The relationship between
diabetes and open­angle
glaucoma (the most
common type of
glaucoma), has intrigued
researchers for years.
People with diabetes are
twice as likely to develop
glaucoma as are non­
diabetics, although some
current research is
beginning to call this into
question. Similarly, the
likelihood of someone
with open­angle glaucoma
developing diabetes is
higher than that of a
person without the eye
disease.
Neovascular glaucoma,
a rare type of
glaucoma, is always
associated with other
abnormalities, diabetes
being the most
common.
In some cases of
diabetic retinopathy,
blood vessels on the
retina are damaged.
The retina
manufactures new,
abnormal blood
vessels.
Neovascular glaucoma
can occur if these new
blood vessels grow on
the iris (the colored
part of the eye), closing
off the fluid flow in the
eye and raising the eye
pressure.
Neovascular glaucoma
is a difficult disease to
treat. One option is
laser surgery to reduce
abnormal blood
vessels on the iris and
on the retinal surface.
Recent studies have
also shown some
success with the use of
drainage implants.

5. Glaucoma and Diabetes
Glaucoma is caused by excess fluid
pressing on the nerve at the back of
the eye
Glaucoma may occur amongst
people with and without diabetes,
and can be a complication of
diabetes if retinopathy develops.
Glaucoma is caused by an excess
amount of fluid pressing on the
nerve at the back of the eye.
How does glaucoma start?
The eye produces a small amount
of fluid like water in its middle
chamber, which flows around the
lens of the eye into the front
chamber.
The fluid leaves the eye using a
drainage network and then enters
the bloodstream.
Commonly, glaucoma causes the
drainage system to become
blocked, and fluid becomes trapped
in the eye. This causes pressure to
build up in the eye and pass to the
nerve at the rear of the eye.
This nerve may become damaged
by glaucoma.

6. What are the Symptoms of Glaucoma?
Glaucoma has very
few symptoms in its
early stage, so
people may be
unaware that
something is wrong
with them.
As someone with
diabetes, an
optometrist or
another eye
specialist should
test you for
glaucoma at least
once each year.

7. How is glaucoma diagnosed?
Glaucoma may be diagnosed
by an optometrist by
measuring your eye pressure,
checking the eye at the optic
nerve, and testing the field of
your vision.
A common test these days is
a noncontact tonometry test
(NCT test) in which a brief puff
of air will be directed into the
front of your eye. The machine
you sit in front of measures
the resistance of your eye to
the puff of air without needing
to make contact with your eye.
The puff of air is noticeable
but is not painful.
Experts will quickly be able to
determine if you have
glaucoma.
How is glaucoma treated?
Glaucoma will usually be treated with eye drops to relieve pressure in the eye. Treatments include:
Beta blockers (such as betaxolol hydrochloride, levobunolol hydrochloride or timolol)
Prostaglandin analogues (such as latanoprost, bimatoprost , tafluprost or travoprost)
Carbonic anhydrase inhibitors (such as brinzolamide or dorzolamide)
Your healthcare professional will be able to advise you further on the most suitable drops for your condition.
Alternative treatments include laser treatment (laser iridotomy) and trabeculectomy surgery.

8. What is the worst case scenario, will I go blind?
In developed stages of
glaucoma, poor vision
starts to spread, which
can extend to include
the whole of the sight.
If the pressure of
glaucoma can be
successfully eased,
however, the condition
should not deteriorate
further. Should your
vision become
significantly impaired,
there are a number of
aids which can help
people with diabetes
who have visual
impairments.

9. Cataracts and Diabetes
Cataracts are cloudy
opacifications of the
lens of the eye
Cataracts are one of
the sight­related
complications of
diabetes that can
cause misting or
blurring of vision.
Attending regular eye
checks as part of your
annual diabetic review
will help your health
team to identify any
signs of cataracts at an
early stage and advise
on treatment.
What are the symptoms of
cataracts?
The main signs of cataracts are:
Cloudy or misty vision
Blurred vision
Spots in your vision
Being dazzled by bright lights
Seeing a circle of light around lights
A yellowing of your vision
Early stage cataract symptoms may
barely influence the vision, and a
cataract diagnosis may come as a
genuine surprise.
Challenging visual situations such
as driving at night and bright
sunlight may cause your sight to
become hazy. Attending regular
eye checks and screenings will
make it easier for your health team
to diagnose cataracts at an early
stage.
What causes cataracts?
The lens of the eye is
made up of fluids that
contain protein.
Over time this fluid may
begin to cloud over,
causing cataracts. Age is
one of the factors and
other factors include:
Having diabetes
Smoking
A family history of
cataracts
Long periods of taking
corticosteroids

11. Does diabetes increase the risk of cataracts?
Diabetes is one of the key
factors that result in the
development of cataracts.
Although the reasons why
are still not fully
understood, people with
diabetes mellitus
statistically face a 60%
greater risk of developing
cataracts. As with most
complications of diabetes,
maintaining good control
of your blood sugar levels
will help to reduce your
risk.
In addition, research has
shown that people with
type 2 diabetes who lower
their HbA1c level by just
1% can reduce their risk
of cataracts by 19%.

12. How are Cataracts Treated?
Cataracts treatment has advanced
considerably in recent years.
Surgery is often prescribed, with
the lens removed and replaced with
an artificial one. Cataract surgery is
widely recommended and is
commonly performed.
Your ophthalmologist will determine
whether you need cataract surgery.
Cataract surgery is generally safe,
so the point at which an operation
is undertaken depends partly on
the individual.
Cataract operations are typically
day cases, with the local
anaesthetic often sited as the most
uncomfortable part.
For people with diabetes, there is a
slightly greater risk of developing
more serious problems such as
macula oedema, diabetic
retinopathy complications, and
infections as a result of the surgery.

13. Diabetic Maculopathy
Diabetic maculopathy may
result from retinopathy
Diabetic maculopathy is a
condition that can result from
retinopathy. Maculopathy is
damage to the macula, the
part of the eye which provides
us with our central vision.
A common from of damage is
from diabetic macular
oedema (DMO) in which fluid
builds up on the macula.
Diabetic maculopathy is often
treated by laser surgery.
A number of other treatments
are possible but there has
recently been a lot of
discussion about which
treatments are appropriate .
The macula is the part of the
eye that helps to provide us
with our central vision.
Diabetic maculopathy is when
the macula sustains some
form of damage. One such
cause of macular damage is
from diabetic macular
oedema whereby blood
vessels near to the macula
leak fluid or protein onto the
macula.
If the leakages cause the
retina to harden and exudates
(deposits of fat from the
blood) become significantly
large and close to the fovea,
then the condition is termed
as Clinically Significant
Macular Oedema (CSMO).

14. Symptoms of diabetic maculopathy
The symptoms of diabetic maculopathy are a blurring of one’s central vision.
This may be noticed by:
Trouble with reading
Recognising faces in the centre of your vision
How is diabetic maculopathy /
diabetic macular oedema treated?
Mild macular oedema may resolve
itself without treatment but most
people will need the first line of
diabetic maculopathy treatment
which is laser photocoagulation
treatment.
Other treatments include having
injections of what are called anti­
VEGF drugs (anti­vascular
endothelial growth factor), such as
Lucentis or Avastin.
In December 2012, Lucentis was
approved for use in treating
diabetic macular oedema in
Scotland.
Another treatment, which is rare
because of the side effects that can
exist, is to have injections of
intravitreal steroids.

15. Diabetic Retinopathy
Retinopathy is a
disease of the retina .
The retina is the nerve
layer that lines the back
of your eye. It is the
part of your eye that
“takes pictures” and
sends the images to
your brain.
Many people with
diabetes get
retinopathy. This kind of
retinopathy is called
diabetic retinopathy
(retinal disease caused
by diabetes).

16. Diabetic Retinopathy – Cause
Diabetic retinopathy can
lead to poor vision and
even blindness. Most of
the time, it gets worse
over many years. At first,
the blood vessels in the
eye get weak.
This can lead to blood
and other liquid leaking
into the retina from the
blood vessels. This is
called nonproliferative
retinopathy. And this is
the most common
retinopathy. If the fluid
leaks into the center of
your eye, you may have
blurry vision.
Most people with
nonproliferative
retinopathy have no
symptoms.
If blood sugar levels stay high,
diabetic retinopathy will keep getting
worse. New blood vessels grow on
the retina.
This may sound good, but these
new blood vessels are weak. They
can break open very easily, even
while you are sleeping.
If they break open, blood can leak
into the middle part of your eye in
front of the retina and change your
vision.
This bleeding can also cause scar
tissue to form, which can pull on the
retina and cause the retina to move
away from the wall of the eye
(retinal detachment).
This is called proliferative
retinopathy. Sometimes people
don’t have symptoms until it is too
late to treat them. This is why
having eye exams regularly is so
important.(Get your eyes checked at
least once a year for Diabetic
Retinopathy)
Retinopathy can also cause swelling
of the macula of the eye. This is
called macular edema.
The macula is the middle of the
retina, which lets you see details.
When it swells, it can make your
vision much worse. It can even
cause legal blindness.
If you are not able to keep your
blood sugar levels in a target range,
it can cause damage to your blood
vessels.
Diabetic retinopathy happens when
high blood sugar damages the tiny
blood vessels of the retina.
When you have diabetic retinopathy,
high blood pressure can make it
worse
High blood pressure can cause
more damage to the weakened
vessels in your eye, leading to more
leaking of fluid or blood and clouding
more of your vision.

17. Diabetic Retinopathy – Symptoms
Most of the time, there are
no symptoms of diabetic
retinopathy until it starts to
change your vision. When
this happens, diabetic
retinopathy is already
severe. Having your eyes
checked regularly can find
diabetic retinopathy early
enough to treat it and help
prevent vision loss.
If you notice problems
with your vision, call an
eye doctor
(ophthalmologist) right
away. Changes in vision
can be a sign of severe
damage to your eye.
These changes can
include floaters, pain in
the eye, blurry vision, or
new vision loss.
An eye exam by an eye specialist
(ophthalmologist or optometrist) is
the only way to detect diabetic
retinopathy.
Having a dilated eye exam
regularly can help find retinopathy
before it changes your vision. On
your own, you may not notice
symptoms until the disease
becomes severe.
Symptoms of diabetic retinopathy
and its complications may include:
Blurred, double, or distorted vision
or difficulty reading.
Floaters or spots in your vision.
Partial or total loss of vision or a
shadow or veil across your field of
vision.
Pain, pressure, or constant
redness of the eye.

18. Diabetic Retinopathy – What Increases Your Risk
Your risk for diabetic retinopathy
depends largely on two things: how
long you have had diabetes and
whether or not you have kept good
control of your blood sugar.
You can control some risk factors,
which are things that may increase
your risk for diabetic retinopathy
and its complications.
Risk factors that you can control
include:
Pregnancy
Women who have diabetes are at
increased risk of developing
retinopathy during pregnancy.
In women who already have
retinopathy when they become
pregnant, the condition can become
much worse during pregnancy.
If you get pregnant, you will need to
have an eye exam sometime during
the first 3 months. You’ll also need
close follow­up during your
pregnancy and for 1 year after you
have your baby.
Consistently high blood sugar
High blood sugar levels increase
your risk of retinopathy.
(Hyperglycaemia) Keeping your
blood sugar levels in a target range
can reduce your risk for diabetic
retinopathy and can slow the
progression of the disease if it has
already started.
High blood pressure
In general, people with diabetes
who also have high blood pressure
are more likely to develop
complications that affect the blood
vessels in the body, including those
in the eyes.
Delayed diagnosis and treatment
Getting a dilated eye exam will not
prevent retinopathy. But it may
reduce your risk of severe vision
loss from complications of
retinopathy. By detecting it early,
you can get treatment that can
prevent vision loss and delay the
progression of the disease.

19. SmokingAlthough smoking has
not been proved to
increase the risk of
retinopathy, smoking
makes many of the
other health problems
faced by people with
diabetes worse,
including disease of
the small blood
vessels.Stopping
smoking has many
health benefits ,it will
reduce your chances of
getting serious diabetic
complications as well
as the financial gain
you will have more
money in your pocket
at the end of the
month.

20. Diabetic Retinopathy – Exams and Tests
Diabetic retinopathy can
be detected during a
dilated eye exam by an
ophthalmologist or
optometrist.
An exam by your primary
doctor, during which your
eyes are not dilated, is not
an adequate substitute for
a full exam done by an
ophthalmologist. Eye
exams for people with
diabetes can include:
Visual acuity testing
Visual acuity testing
measures the eye’s ability
to focus and to see details
at near and far distances.
It can help detect vision
loss and other problems.
Ophthalmoscopy and slit lamp
exam
These tests allow your doctor
to see the back of the eye and
other structures within the eye.
They may be used to detect
clouding of the lens (cataract),
changes in the retina, and
other problems.
Gonioscopy
Gonioscopy is used to find out
whether the area where fluid
drains out of your eye (called
the drainage angle) is open or
closed.
This test is done if your doctor
thinks you may have
glaucoma, a group of eye
diseases that can cause
blindness by damaging the
optic nerve.
Tonometry
This test measures the
pressure inside the eye, which
is called intraocular pressure
(IOP).
It is used to help detect
glaucoma. Diabetes can
increase your risk of
glaucoma.
Your doctor may also do a test
called an optical coherence
tomography (OCT) to check
for fluid in your retina.
Sometimes a fluorescein
angiogram is done to check
for and locate leaking blood
vessels in the retina,
especially if you have
symptoms, such as blurred or
distorted vision, that suggest
damage to or swelling of the
retina.

21. Fundus Photography
Can track changes in the
eye over time in people
who have diabetic
retinopathy and especially
in those who have been
treated for it.
Fundus photography
produces accurate
pictures of the back of the
eye (the fundus).
An eye doctor can
compare photographs
taken at different times to
watch the progression of
the disease and find out
how well treatment is
working.
But the photos do not
take the place of a full eye
exam.

22. Early DetectionEarly detection and
treatment of diabetic
retinopathy can help
prevent vision loss. For
people in whom diabetic
retinopathy has not been
diagnosed, the Diabetes
Association recommends
that screening be done
based on the following
guidelines:
People with type 1
diabetes who are age 10
and older should have a
dilated eye exam within 5
years after diabetes is
diagnosed and then every
year.
People with type 2
diabetes should have an
exam as soon as diabetes
is diagnosed and then
every year.
If your eye exam
results are normal,
your doctor may
consider follow­up
exams less often.
For example, you
may have an exam
every 2 years. But if
you are diagnosed
with retinopathy,
you may need
frequent eye
exams.
Women who have type
1 or type 2 diabetes
and who are planning
to become pregnant
should have an exam
before becoming
pregnant, if possible,
and then once during
the first 3 months (first
trimester) of
pregnancy.
The eye doctor can
decide whether you
need further screening
for retinopathy during
pregnancy based on
the results of the first­
trimester exam.

23. Diabetic Retinopathy – Treatment
There is no cure for
diabetic retinopathy. But
laser treatment
(photocoagulation) is
usually very effective at
preventing vision loss if it
is done before the retina
has been severely
damaged.
Surgical removal of the
vitreous gel (vitrectomy)
may also help improve
vision if the retina has not
been severely damaged.
Sometimes injections of
an anti­VEGF (vascular
endothelial growth factor)
medicine or an anti­
inflammatory medicine
help to shrink new blood
vessels in proliferative
diabetic retinopathy.
Because symptoms may
not develop until the
disease becomes severe,
early detection through
regular screening is
important. The earlier
retinopathy is detected,
the easier it is to treat and
the more likely vision will
be preserved.
You may not need
treatment for diabetic
retinopathy unless it has
affected the center
(macula) of the retina or,
in rare cases, if your side
(peripheral) vision has
been severely damaged.
But you do need to have
your vision checked
regularly.
If the macula has been
damaged by macular edema,
you may need laser
treatment.
For more severe retinopathy,
you may need either laser
treatment or vitrectomy.
These procedures can help
prevent, stabilize, or slow
vision loss when they are
done before the retina has
been severely damaged.
Newer treatment includes
medicines like anti­VEGF
medicine or steroids that are
injected into the eye.
Surgical removal of the
vitreous gel (vitrectomy) is
done when there is bleeding
(vitreous hemorrhage) or
retinal detachment, which are
rare in people with early­stage
retinopathy. Vitrectomy is also
done when severe scar tissue
has formed.

24. Diabetic Retinopathy – Treatment
Treatment for diabetic
retinopathy is often very
effective in preventing,
delaying, or reducing
vision loss.
But it is not a cure for the
disease. People who have
been treated for diabetic
retinopathy need to be
monitored frequently by an
eye doctor to check for
new changes in their eyes.
Many people with diabetic
retinopathy need to be
treated more than once as
the condition gets worse.
Also, controlling your blood
sugar levels is always
important. This is true even if
you have been treated for
diabetic retinopathy and your
eyes are better. In fact, good
blood sugar control is
especially important in this
case so that you can help
keep your retinopathy from
getting worse.
Ideally, laser treatment should
be done early in the course of
the disease to prevent serious
vision loss rather than to try to
treat serious vision loss after
it has already developed.
People with diabetes who
have any signs of retinopathy
need to be examined as soon
as possible by an
ophthalmologist.

25. Diabetic Retinopathy – Prevention
There are steps you can take to
reduce your chance of vision loss
from diabetic retinopathy and its
complications:
Control your blood sugar levels.
Keep blood sugar levels in a target
range by eating a healthful diet,
frequently monitoring your blood
sugar levels, getting regular
physical exercise, and taking
insulin or medicines for type 2
diabetes if prescribed.
Control your blood pressure.
Retinopathy is more likely to
progress to the severe form and
macular edema is more likely to
occur in people who have high
blood pressure. It is not clear
whether treating high blood
pressure can directly affect long­
term vision.
But in general, keeping blood
pressure levels in a target range
can reduce the risk of many
different complications of diabetes.
Have your eyes examined by an
eye specialist (ophthalmologist or
optometrist) every year
Screening for diabetic retinopathy
and other eye problems will not
prevent diabetic eye disease. But it
can help you avoid vision loss by
allowing for early detection and
treatment.
See an ophthalmologist if you have
changes in your vision. Changes in
vision­such as floaters, pain or
pressure in the eye, blurry or
double vision, or new vision loss­
may be symptoms of serious
damage to your retina. In most
cases, the sooner the problem can
be treated, the more effective the
treatment will be.
The risk for severe retinopathy and
vision loss may be even less if you:
Don’t smoke
Although smoking has not been
proved to increase the risk of
retinopathy, smoking may
aggravate many of the other health
problems faced by people with
diabetes, including disease of the
small blood vessels.
Avoid hazardous activities
Certain physical activities, like
weight lifting or some contact
sports, may trigger bleeding in
the eye through impact or
increased pressure.
Avoiding these activities when
you have diabetic retinopathy
can help reduce the risk of
damage to your vision.
Get adequate exercise
Exercise helps keep blood
sugar levels in a target range,
which can reduce the risk of
vision damage from diabetic
retinopathy.
Talk to your doctor about what
kinds of exercise are safe for
you.

27. Everything You Need To Know About Diabetes
Diabetes Support Site Website
http://diabetessupportsite.com