Many people think failing eyesight is a natural part of aging. But one of the leading causes of vision loss is actually due to diabetes.
It’s called diabetic retinopathy, and it affects more than 285 million people globally and 7.7 million in the U.S., according to the Centers for Disease Control and Prevention. That number is expected to nearly double by 2050.
Here’s what you need to know about the warning signs and how to treat this condition.
Diabetic retinopathy is caused by diabetes
In the simplest terms, diabetic retinopathy is a diabetes-related complication that affects the eyes and can cause severe vision problems.
There are two types of diabetes: Type 1 diabetes typically emerges during childhood (although it can occur at any age) when the body attacks cells inside the pancreas that produce insulin. Type 2 diabetes occurs more often in adulthood, and it’s caused by the body’s resistance to insulin. Both kinds of diabetes put you at risk for damage to other tissues, like the kidneys, feet and eyes.
When you have diabetic retinopathy, the blood vessels in your eyes, specifically in your retinas, start leaking abnormally.
“The eye is a pretty special organ and it has a very intricate blood supply,” says Dr. Russell Van Gelder, chair of the Department of Ophthalmology at the University of Washington School of Medicine and director of the UW Medicine Eye Institute. “It really needs its blood flow to remain intact and function well.”
Symptoms are usually obvious
For most patients with diabetic retinopathy, the blood vessels in the retina will begin to leak fluid, which causes the retina to swell. That, in turn, leads to vision problems. Your vision becomes less sharp, and you may feel like the world around you is blurred.
“The retina is very thin, the width of a Kleenex, and we can think of it as the film of a camera,” Van Gelder says. “It should usually be kept dry. But when the blood vessels become leaky, it’s like looking through water.”
Another symptom that sounds like it’s straight out of a horror movie? You might also develop tiny blood splotches on the retina, as well as specks or dots that are actually yellow bits of fat that are being released from the leaky blood vessels.
“These hemorrhages are so characteristic of this disease that if you look into someone’s eyes and you see this, you can tell them that they probably have diabetes,” Van Gelder says.
If you have too much bleeding in the retina, your retina will become starved for oxygen and create new blood vessels, which often work poorly. They can bleed easily, filling the eye with blood, sometimes leading to blindness.
Screening is key for prevention
To avoid those worst-case scenarios, if you have diabetes, it’s important to make sure you follow standard recommendations for keeping the disease under control, like doing a good job managing your blood sugars and blood pressure, exercising regularly and not smoking.
It's also critical to get your eyes checked regularly.
Current recommendations encourage children with type 1 diabetes to sit for a dilated eye exam within a year of being diagnosed. Adults with type 2 diabetes should get screened at the time of diabetes diagnosis.
“In both groups, you’ll then want to get a dilated eye exam at least every year, for the rest of your life,” Van Gelder says.
Though eye exams are pretty straightforward, many people who could benefit from them don't get them. The American Academy of Ophthalmology found that, in 2016, more than half of people with diabetes didn't get an annual eye exam.
Getting every diabetic to screen for diabetic retinopathy every year can be a tough sell, both for care providers (who may not have enough capacity for all of these patients at their clinics) and for patients (who may not have time or the financial means to do so).
To combat this, Van Gelder says UW Medicine clinics have implemented a telemedicine initiative, where people with diabetes can get screened for diabetic retinopathy via a picture of their retina rather than an in-person visit.
“If there’s disease, then they go in,” he says of the results. “And if the picture isn’t clean, they go in. But otherwise, you can just do the picture method for two out of every three years. They should still have a full, in-person eye exam on the third year.”
Treatment typically involves lasers or injections
If you do have diabetic retinopathy, don’t worry — you have a few options for treatment.
First, Van Gelder says, it’s important to note that there are a few “flavors” of retinopathy: There are people who don’t have any visible new blood vessels but may have the dots of blot hemorrhages. For them, the best treatment is often just to get screened every three months.
For people who have proliferative diabetic retinopathy — which means there are new blood vessels developing in the retina — the best treatment options usually involve laser therapies, which destroy areas that are problematic.
Laser therapy can be uncomfortable, and it can also limit people’s peripheral vision, but it is very effective for stopping the development of diabetic retinopathy.
Another treatment option, particularly for patients with fluid on the retina, involves medications for macular degeneration, which can be injected into the retina. The only downside to these injections is that you often need to get them as often as once each month, versus a one-and-done procedure like laser therapy — but Van Gelder says the injections are the treatment of choice for patients who have edema.