Diabetes is becoming much more prevalent around the globe. According to the International Diabetes Federation, approximately 425 million adults were living with diabetes in the year 2017 and 352 million more people were at risk of developing type 2 diabetes. By 2045 the number of people diagnosed is expected to rise to 629 million.

Diabetes is a leading cause of blindness as well as heart attacks, stroke, kidney failure, neuropathy (nerve damage) and lower limb amputation. In fact, in 2017, diabetes was implicated in 4 million deaths worldwide. Nevertheless preventing these complications from diabetes is possible with proper treatment, medication and regular medical screenings as well as improving your diet, physical activity and adopting a healthy lifestyle.

What is Diabetes?

Diabetes is a chronic disease in which the hormone insulin is either underproduced or ineffective in its ability to regulate blood sugar. Uncontrolled diabetes leads to hyperglycemia, or high blood sugar, which damages many systems in the body such as the blood vessels and the nervous system.

How Does Diabetes Affect The Eyes?

Diabetic eye disease is a group of conditions which are caused, or worsened, by diabetes; including: diabetic retinopathy, diabetic macular edema, glaucoma and cataracts. Diabetes increases the risk of cataracts by four times, and can increase dryness and reduce cornea sensation.

In diabetic retinopathy, over time, the tiny blood vessels within the eyes become damaged, causing leakage, poor oxygen circulation, then scarring of the sensitive tissue within the retina, which can result in further cell damage and scarring.

The longer you have diabetes, and the longer your blood sugar levels remain uncontrolled, the higher the chances of developing diabetic eye disease. Unlike many other vision-threatening conditions which are more prevalent in older individuals, diabetic eye disease is one of the main causes of vision loss in the younger, working-age population. Unfortunately, these eye conditions can lead to blindness if not caught early and treated. In fact, 2.6% of blindness worldwide is due to diabetes.

Diabetic Retinopathy

As mentioned above, diabetes can result in cumulative damage to the blood vessels in the retina, the light-sensitive tissue located at the back of the eye. This is called diabetic retinopathy.

The retina is responsible for converting the light it receives into visual signals to the optic nerve in the brain. High blood sugar levels can cause the blood vessels in the retina to leak or hemorrhage, causing bleeding and distorting vision. In advanced stages, new blood vessels may begin to grow on the retinal surface causing scarring and further damaging cells in the retina. Diabetic retinopathy can eventually lead to blindness.

Signs and Symptoms of Diabetic Retinopathy

The early stages of diabetic retinopathy often have no symptoms, which is why it’s vitally important to have frequent diabetic eye exams. As it progresses you may start to notice the following symptoms:

• Blurred or fluctuating vision or vision loss
• Floaters (dark spots or strings that appear to float in your visual field)
• Blind spots
• Color vision loss

There is no pain associated with diabetic retinopathy to signal any issues. If not controlled, as retinopathy continues it can cause retinal detachment and macular edema, two other serious conditions that threaten vision. Again, there are often NO signs or symptoms until more advanced stages.

A person with diabetes can do their part to control their blood sugar level. Following the physician’s medication plan, as well as diet and exercise recommendations can help slow the progression of diabetic retinopathy.

Retinal Detachment

Scar tissues caused by the breaking and forming of blood vessels in advanced retinopathy can lead to a retinal detachment in which the retina pulls away from the underlying tissue. This condition is a medical emergency and must be treated immediately as it can lead to permanent vision loss. Signs of a retinal detachment include a sudden onset of floaters or flashes in the vision.

Diabetic Macular Edema (DME)

Diabetic macular edema occurs when the macula, a part of the retina responsible for clear central vision, becomes full of fluid (edema). It is a complication of diabetic retinopathy that occurs in about half of patients, and causes vision loss.

Treatment for Diabetic Retinopathy and Diabetic Macular Edema

While vision loss from diabetic retinopathy and DME often can’t be restored, with early detection there are some preventative treatments available. Proliferative diabetic retinopathy (when the blood vessels begin to grow abnormally) can be treated by laser surgery, injections or a procedure called vitrectomy in which the vitreous gel in the center of the eye is removed and replaced. This will treat bleeding caused by ruptured blood vessels. DME can be treated with injection therapy, laser surgery or corticosteroids.

Prevent Vision Loss from Diabetes

The best way to prevent vision loss from diabetic eye disease is early detection and treatment. Since there may be no symptoms in the early stages, regular diabetic eye exams are critical for early diagnosis. In fact diabetics are now sometimes monitored by their health insurance to see if they are getting regular eye exams and premium rates can be affected by how regularly the patients get their eyes checked. Keeping diabetes under control through exercise, diet, medication and regular screenings will help to reduce the chances of vision loss and blindness from diabetes.

November 14th is World Diabetes Day. This year, the theme of World Diabetes Day is women and diabetes – our right to a healthy future. The goal of this campaign is to promote awareness of the importance of equal and affordable access for all women, whether they are at risk or already living with diabetes, to the treatments, medications, technology, education and information they need to prevent diabetes and to obtain the best possible outcome of the disease.

Here are some facts about women and diabetes around the World:

• 199 million – the number of women living with diabetes to date.
• 313 million – the projected statistic for the year 2040.
• 2.1 million – the number of female deaths due to diabetes per year.
• 9 – diabetes is the ninth leading cause of death in women on a global scale.
• 60 million – which is 2 out of 5 diabetic women, are of reproductive age, which increases the risk of early miscarriage, vision loss and having malformed babies.
• 10 – women with type 2 diabetes are ten times more likely to develop coronary heart disease.

Much of these incidences of diabetes occur in women lacking access to proper medical care, education, physical activity and information they need to prevent and manage the disease. If more efforts and monies were put toward improving this situation, these numbers could drop significantly.

Pregnant women with hyperglycemia and gestational diabetes are also a major cause of concern. Limited access to screening tests, pre-pregnancy planning services, education and medical care could also improve the outcome of both the mother and the baby in these cases. The majority of instances of gestational diabetes occur in women from low and middle-income countries or households with limited access to maternal care.

Here are some additional facts about diabetes and pregnancy:

• 1 out of 7 – the number of births worldwide affected by gestational diabetes.
• 1 out of 2 – the number of women with gestational diabetes that develop type 2 diabetes within 5-10 years after giving birth.
• 1 out of 2 – the number of cases of gestational diabetes that are found in women under 30 years of age.

Diabetes and Your Eyes

Diabetes damages many systems in your body including your eyes and vision. Most individuals with diabetes will eventually develop some extent of retinopathy or eye disease due to the consistently high levels of glucose in the blood which damage the blood vessels in the eye. Diabetic retinopathy can be a devastating disease that can leave you with permanent vision loss or blindness. It is a leading cause of blindness worldwide. Diabetes also speeds up the formation of cataracts and other ocular diseases which can lead to further vision loss and complications.

Women who have been diagnosed with diabetes prior to becoming pregnant have to be especially careful during pregnancy. It is much more difficult to regulate blood sugars during pregnancy, and more rapid progression of diabetic retinopathy can occur if one is not careful. Keeping track of diet and exercise, and taking medications as directed, can prevent or delay the impact of diabetes on the eyes.

In addition to poorly managed blood sugar levels, additional factors that contribute to developing diabetic retinopathy are high blood pressure, high cholesterol, Hispanic or Native American descent, smoking, pregnancy, and the length of time you have the disease. The condition can be managed with regular eye exams in combination with steps to control blood sugar levels.

It’s important to note that diabetes sometimes causes symptoms of vision fluctuation (good days and bad days with vision or focusing) but many times the damage is asymptomatic in its early stages. This is why it is essential to have regular checkups even when you have no pain or vision symptoms.

If you or someone you know has diabetes, regular eye exams are essential to monitor and prevent vision loss. Stay informed and spread awareness about this challenging condition. You can help be part of the change to improve the lives of women and people all over the world that suffer from diabetes and the serious complications that come with it.

Diabetes is a growing health crisis in North America as an estimated 29 million Americans and 3.4 million Canadians are currently living with the disease. Chances are it affects you or someone you know. November has been dedicated as a time to spread awareness about the disease, its risk factors and the effects it has on your body, your daily life and the lives of your loved ones.

Diabetes and Your Eyes

Diabetes is a systemic disease that causes fluctuations in glucose (blood sugar) levels which can affect blood vessels throughout the body including those in your eyes and visual system. People with diabetes are at higher risk for blindness than the general population, however with regular eye exams and proper care, most of the complications are minor and treatable.

Minor changes in glucose levels could result in complications such as blurred or double vision, floaters or even visual field loss. These conditions are usually quite treatable. Diabetics are also at greater risk for developing eye diseases such as glaucoma (40% increase risk) and cataracts (60% increased risk). With early detection, both of these conditions can be treated and the majority of vision restored.

Diabetic eye disease often has NO noticeable symptoms or pain, so comprehensive eye exams that include dilating the pupils are essential to detect signs of diabetes. Online vision assessments will not detect diabetic eye disease.

The condition that is the most concerning risk of diabetes is called diabetic retinopathy which can lead to blindness if not diagnosed and treated.

What You Need to Know About Diabetic Retinopathy

Diabetic retinopathy occurs when the tiny blood vessels or capillaries in the back of the eye develop weakened vessel walls. If not treated, the vessels leak fluid and become blocked. This can progress to hemorrhages in the retina, and over time the eye does not receive enough oxygen and nutrients. As a result, new fine blood vessels start to grow. These proliferating vessels leak and can cause further bleeding, scarring and potentially lead to blindness. A special zone in the central retina called the macula is especially susceptible to diabetes. Diabetic macular edema (when fluid seeps into the macula) can cause permanent vision loss if not promptly detected.

There are treatments for stopping the progression of the disease such as laser therapy or intraocular injections, although once damage to vision has occurred, it is often permanent. This is why the condition must be diagnosed and treated early on.

All diabetics should have a regular comprehensive eye exam to catch any early signs of diabetic retinopathy or other vision threatening conditions. Because risk factors vary, speak to your eye doctor about how often you should have an exam. Risk factors for diabetic retinopathy include:

• Length of time living with diabetes
• Uncontrolled blood sugar levels
• High blood pressure
• Smoking
• Alcohol consumption
• Pregnancy
• Genetics

Although blindness from diabetes is preventable it is still a leading cause of blindness among working-age adults. If you or someone you know has the disease, make sure that proper eye care is a priority.