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.
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 (70-130 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.
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1.What is the relationship between diabetes and glaucoma?
The relationship between diabetes and open-angle 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 open-angle 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.
1(a)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.
2.Cataracts and Diabetes
Cataracts are cloudy opacifications of the lens of the eye
Cataracts are one of the sight-related 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.
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 .
3(a)What is diabetic maculopathy?
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).
3(b)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
3(c)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 (anti-vascular 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.
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).
4(a)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.
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 vision-such 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:
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.
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