How To Keep Your Eyes Healthy With Diabetes
By Hope Warshaw
Diabetes can put you at risk for eye issues like retinopathy and glaucoma. The 2023 ADA Standards of Care recommend these steps to maintain your eye health and prevent future damage.
People with diabetes, especially those whose glucose levels are not well managed, are at increased risk of developing eye complications. Such complications include retinopathy, macular edema, cataracts, and glaucoma; in fact, diabetes that has not been closely managed continues to be the leading cause of new-onset blindness in people aged 18 to 64 years of age.
Lower your risk for these conditions by understanding how to maintain the health of your eyes and vision based on guidance from the American Diabetes Association’s 2023 Standards of Care.
Diabetes and eye problems
Four of the most common diabetes-related eye problems are retinopathy, macular edema, cataracts, and glaucoma.
What is diabetic retinopathy?
Retinopathy can occur when high glucose levels over years damage the small blood vessels of the retina (the inner lining of the eye located at the back). Over time these injured blood vessels can weaken, bulge, or leak fluid into the gel-like middle of the eye (called the vitreous). There are different types of retinopathy. Nonproliferative retinopathy occurs when the blood vessels of the retina have been damaged. Fluids, fats and proteins can leak out of the abnormal blood vessels. In proliferative retinopathy, new unstable blood vessels begin to grow on the surface of the retina. These unstable blood vessels cause frequent minor bleeding which causes local irritation and scarring.
How is diabetic retinopathy treated?
There are several types of treatment for diabetic retinopathy. They include:
- Laser treatments make tiny burns inside the eye cavity with a beam of light (laser). Panretinal laser photocoagulation therapy, as it’s also known, is used to prevent further growth of unstable blood vessels.
- Anti-VEGF (Vascular Endothelial Growth Factor) medication: Anti-VEGF medications such as aflibercept (Eylea), bevacizumab (Avastin), or ranibizumab (Lucentis) are newer therapies that are delivered through an injection to the eye. They can be an alternative to laser treatment.
- ACE inhibitors and/or ARBs: Common categories of medications to manage high blood pressure such as ACE inhibitors and ARBs can also help prevent or slow development of retinopathy as well as diabetes-related kidney disease.
Diabetic macular edema (DME)
What is diabetic macular edema?
Years of high glucose levels from diabetes can damage the macula – the part of the retina that is responsible for our central vision, most of our color vision, and the fine detail of what we see – and cause swelling (edema). Diabetic macular edema typically develops when people with diabetes also have signs of retinopathy. Aging can also cause edema of the macula.
How is diabetic macular edema treated?
Treatment options for DME include:
Anti-VEGF medications such as aflibercept (Eylea), bevacizumab (Avastin), or ranibizumab (Lucentis) block the growth of abnormal blood vessels in the eye and can stop fluid leaks. They can stop further vision loss and may even improve vision. The medicine is injected into the eye during an office visit. Treatment requires several injections into the eye.
Laser treatment may be used instead of anti-VEGF injections.
What are cataracts, and how do they relate to diabetes?
A cataract is a cloudy area in the lens of the eye. The development of cataracts is very common as people age, but people who have high glucose levels from diabetes can develop cataracts at an earlier age.
How are cataracts treated in people with diabetes?
Typically, treatment of cataracts requires outpatient surgery to remove the cloudy lens covered by the cataract and to put in an artificial replacement lens. Treatment after surgery requires days of putting drops into the eye, but recovery of vision is rapid.
What is glaucoma, and how does it relate to diabetes?
Glaucoma refers to a group of eye diseases that affect the main bundle of nerves in the eye called the optic nerve. If not treated, glaucoma can lead to loss of vision and eventually blindness. People with diabetes have a greater risk of developing glaucoma. Usually, early-stage glaucoma causes few or no symptoms, however, it can be detected through a dilated eye exam.
How is glaucoma treated in people with diabetes?
There is no cure for glaucoma, but early treatment can often stop or slow the damage. Daily prescription eye drops can help to lower eye pressure and prevent damage to the optic nerve. Laser treatment or surgery may be necessary if eye drops don’t stop the progression.
The connection between blurry vision and diabetes
If your glucose levels have been high for a while, they can cause blurry vision. Blurry vision is a common symptom when diabetes is diagnosed or if a person stops taking their diabetes medications for a longer period of time. The blurry vision usually goes away when glucose levels return to a desirable range. If you wear glasses, experts recommend that you do not get a new prescription for glasses at this time, as your vision will likely slowly return to your prior status as your glucose levels improve.
How to prevent, reverse, and/or delay diabetes-related eye problems
1. Keep your glucose levels, blood pressure and blood lipids in the recommended target range as much as possible.
Read more about the ADA’s current targets for glucose levels, blood pressure, and lipids.
2. Prevent, reverse, and/or delay diabetes-related eye conditions by having regular eye exams.
If you believe you have an eye problem or have sudden changes in your vision, see an optometrist or ophthalmologist as soon as possible (see details below). The eye specialist should check your vision and conduct a complete eye exam that includes dilating your retinas, and measuring the pressure in your eyes (glaucoma). When they conclude the exam, they will let you know if your eyes are healthy and/or provide you with treatment options. Eye problems can progress or worsen without timely treatment, so be sure to heed any next steps.
Below are general suggestions for eye exam frequency, but you should always follow the advice of your doctor. If your eye doctor recommends having an eye exam more often than noted above, get it done. If there’s no evidence of retinopathy or other problems after one or more exams, then screening should be done every year by an ophthalmologist or optometrist. If you are told you have evidence of retinopathy or other eye problems, you should see a specialist for that problem as often as recommended by the specialist.
Eye exams for people with type 1 diabetes
Have an initial comprehensive eye exam by an ophthalmologist or optometrist within five years of diagnosis.
Eye exams for people with type 2 diabetes
Have the same comprehensive eye exam just after being diagnosed. because you may have had undiagnosed prediabetes or type 2 diabetes for several years.
Eye exams for people with diabetes who are pregnant or trying to conceive
Because pregnancy is a risk factor for retinopathy in people with diabetes, pregnant women with diabetes should get an eye exam in their first trimester. In addition, these individuals should have knowledge of and be counseled about the risk of development or progression of diabetic retinopathy during pregnancy or after. They should be monitored every trimester and one year after pregnancy as indicated by their degree of retinopathy.
Eye exams for people beginning glucose-lowering medication
Rapidly lowering glucose levels that have been high for a long period of time have been associated with the onset or worsening of retinopathy, so retinopathy status should be assessed prior to starting to lower glucose levels or with the addition of another glucose-lowering therapy.
How one diabetes expert maintains eye health while living with diabetes
To gain insights into the practical and emotional aspects of preventing or managing diabetes-related eye disease, we spoke with Sarah Mart, who is director of operations for DiabetesSisters and has lived with type 1 diabetes for 41 years.
One way Mart keeps her eyes healthy is by staying organized when it comes to annual eye exams. “I make my appointment for next year’s exam at the end of the prior year’s exam. I put all of my medical appointments in my phone and online calendar right away. Otherwise, it doesn't happen.”
Mart also recognizes that there is a mental health aspect to maintaining good health with diabetes.
“I've been stressed about eye appointments for 41 years, and the anxiety can increase from year to year. I try to remember to breathe mindfully on my way to the exam and during the appointment.
“I use my wide network of ‘diabetes-besties’ and text with them before my eyes get too dilated,” Mart said, adding: “People in this network are my safe space, because when you know, you know.”
About this series
Each year the American Diabetes Association updates its Standards of Medical Care in Diabetes based on current science. We’ve translated key points of the up-to-date Standards into plain English so you know how to stay healthy and minimize diabetes complications.
Other articles in this series: