Seeking Healthy Vision: Eight Strategies For Caring for Eyes
By Kira Wang
We outline diabetes-related eye complications and suggest a few tips to keep your eyes as healthy as possible
Sight is undoubtedly one of our most valuable senses, yet diabetes can threaten vision in a variety of ways. High blood sugar can damage blood vessels all over the body, including in the eyes. As a result, people with diabetes are especially at risk for four types of eye disease: diabetes-related retinopathy, diabetes-related macular edema, cataracts, and glaucoma. In this article, we’ll explain these conditions and what you can do to keep your eyes as healthy as possible.
The retina is a part of the eye that enables us to see. Like film in a camera, the retina is a layer of light-sensitive cells in the back of your eye on which images are imprinted. Blood vessels in the retina provide nourishment to these cells so that you can see clearly. Over time, diabetes can cause these blood vessels to weaken and leak, resulting in diabetes-related retinopathy.
One in three people with diabetes have diabetes-related retinopathy, making this the most common eye disease people with diabetes. Check out diaTribe's infographic on retinopathy. In the early stages of diabetes-related retinopathy (called non-proliferative diabetes-related retinopathy), there are often no symptoms. The best way to care for these early stages is to manage your diabetes through lifestyle changes and therapies to lower blood glucose. As the disease progresses to the more advanced proliferative stage, new and unusual blood vessels will begin to grow, causing blurry vision, floaters (floating shapes in your vision), and possibly blindness. There are treatments available for advanced diabetes-related retinopathy, but some are quite invasive and require multiple visits with your eye care specialist. These include injections into the eye to slow the growth of new and unusual blood vessels, or laser therapy to stop the bleeding of vessels.
The macula is an oval-shaped part of the retina that provides your clearest, most detailed vision. Blood vessels in the retina typically supply nutrients to the macula, but diabetes-related retinopathy can cause these blood vessels to leak into the macula. This creates swelling known as macular edema. Like diabetes-related retinopathy, diabetes-related macular edema can be treated through injections and laser treatments.
For most young people, the lens in our eye is clear and focuses light on the retina. If the lens becomes cloudy as we age, cataracts develop, causing blurry vision, light sensitivity, poor night vision, or yellowish and brown tints to certain colors. Cataracts are quite common in many people as they grow older, but according to the National Eye Institute, people with diabetes are two to five times more likely to develop cataracts. Diabetes can also cause earlier onset of cataracts. Cataracts can be treated by a minimally invasive eye surgery that takes about fifteen minutes – the procedure replaces your cloudy eye lens with an artificial lens that can restore your vision.
Like cataracts, glaucoma is an eye disease that affects people with and without diabetes. In healthy eyes, a drainage system allows fluid to leave the eye to maintain normal pressure in the eye. With glaucoma, an imbalance in the pressure can damage the optic nerve. People with diabetes have almost double the chance of developing glaucoma. Over time, glaucoma may cause vision loss and blindness; while there are treatments to slow the progression of glaucoma, like diabetes-related retinopathy and macular edema, unfortunately no cure exists.
Despite these forms of diabetes-related eye disease, the CDC estimates that 90% of vision loss from diabetes is preventable! Here are eight tips for protecting your eyesight:
Tip #1: Set up annual appointments for a dilated eye exam
When was your last dilated eye exam? How about your next eye appointment? According to the American Diabetes Association, every person with diabetes should have at least one dilated eye exam each year with an ophthalmologist or optometrist. If no retinopathy is found in an exam, you may be able to return in two years for your next visit. In a dilated exam, your healthcare professional will first give you eye drops to enlarge your pupils, then they will look at your retina – the process is pain-free but there are some very mild, temporary side effects (light sensitivity and blurry vision).
These appointments are very important – serious eye disease, like diabetes-related retinopathy, can develop over time without you even noticing. A dilated eye exam can catch a diagnosis early and help you get the necessary treatment to prevent disease progression. During your appointment, tell your eye care professional about any changes in your vision and ask that the results of your visit are shared with your primary care physician. At your next appointment with your primary care physician, update them on how your eye exam went.
Tip #2: Manage your blood glucose levels
To the best of your ability, keep your blood glucose levels within a target range, usually 70-180 mg/dL. Maintaining stable blood glucose levels can not only prevent eye disease from progressing but in some cases, can also reverse the damage to your eyes.
Tip #3: Manage your blood pressure and cholesterol levels
Blood pressure and cholesterol levels should also be managed to promote eye health. High blood pressure and cholesterol levels can cause the blood vessels in your eyes to become blocked, making them leaky, which will hurt your vision. Guidelines suggest target blood pressure under 130/80 mmHg and LDL cholesterol under 100 mg/dL, but these values may not work for everyone. Ask your healthcare professional what blood pressure and cholesterol goals make sense for you.
Tip #4: Pay attention to changes in your vision
Are you noticing spots in your vision? Flashing lights? In the time between annual visits with your eye care professional, you can track changes in your vision. One way is to give yourself an at-home eye test. If you notice symptoms, but your annual visit is still months away, schedule an appointment sooner.
Tip #5: Don’t smoke
Smoking hurts your health in a variety of ways, including damaging your eyes. In general, smoking increases the risk of dry eyes, cataracts, and optic nerve problems. For people with diabetes, smoking increases the odds of developing diabetes-related retinopathy and can worsen your eye disease.
Tip #6: Get exercise
Exercising can help you manage your diabetes, which will have positive effects on your eyes. For example, if you already have diabetes but have not developed diabetes-related retinopathy, exercise can help you maintain healthy blood sugar levels to reduce your risk of future complications.
Tip #7: Wear sunglasses
Our eyes can be easily protected from the sun by wearing sunglasses and protective eyewear. Sunglasses shield your eyes from the sun’s ultraviolet rays and should be worn year-round, even on cloudy days. When shopping for your next pair, look for one that blocks 99% to 100% of UVA and UVB radiation.
Tip #8: Rest your eyes using the 20-20-20 Rule
Many of us spend hours each day looking at computers or phones, making our eyes feel tired and strained. Next time your eyes start to ache, consider using the 20-20-20 rule. After 20 minutes of screen time, look away from your screen and focus on a spot 20 feet away from you for 20 seconds. This will help your eyes feel less strained, making your long days before the computer more manageable.
Now that we’ve shared these eight tips, what can you do next? Make an appointment for a dilated eye exam as soon as you are able and ask your eye care professional what other steps you can take to protect your vision from the onset or progression of diabetes-related eye disease. In 2020, the Year of the Eye, we hope that you can start using these tips to keep your eyes as healthy as possible!
To learn more about the importance of eye screening, read our article by Renza Scibilia and Chris Aldred.
Kira Wang graduated summa cum laude and Phi Beta Kappa from Duke University with a degree in psychology and minors in biology and chemistry. At Duke, she wrote a senior thesis on the coping strategies of parents and youths with chronic illness and spent over two and a half years researching retinal imaging techniques in the Duke Eye Center. She’s currently taking a gap year and plans to go to medical school.