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Diabetes and the Eyes

Diabetes is a disorder of carbohydrate (sugar) metabolism. The swings in blood sugar experienced by diabetics are linked to the reduced ability of cells to absorb the sugar they need for energy. This ultimately results in damage to the small vessels throughout the body. The eye is the only place in the human body that provides a “window” to see this damage before it is too late to treat.

Both Type 1 and 2 diabetics are at risk of developing diabetic retinopathy (damage to the retina). It is one of the leading causes of preventable blindness in adults. Retinopathy is directly correlated with nephropathy (kidney damage) in diabetics, so regular monitoring is of paramount importance

  • What causes diabetic eye disease?

    As noted above, damage to small vessels (capillaries) causes leakage of fluid and/or blood into the surrounding tissue space leading to an insufficient supply of oxygen (hypoxia). The body will try to grow new vessels to supply the tissue, but these are also weak and leaky, leading to further oxygen deprivation and an ensuing cycle of bleeding and scarring. This retinal scarring causes the damage known as diabetic retinopathy and ultimately leads to vision loss.

  • What is the treatment for diabetic eye disease?

    The best defense is prevention. Tightly regulate your blood sugar and ensure A1c levels stay below 7. Good cardiovascular health and blood pressure control will also help reduce the severity of retinopathy. Regardless of control, statistically 60% of diabetics will have some degree of retinopathy 10 years after initial diagnosis.

    Mild retinopathy simply requires monitoring and retinal imaging. If there is leakage close to the macula (central retina), then referral is made to a retinal specialist who will likely inject a drug to control and limit the leakage. If retinopathy is severe (proliferative) then the specialist will likely use a laser to selectively kill the peripheral retina in order to reduce oxygen demand and thus save the central vision. In all cases of retinopathy, care is coordinated with your family physician and internist to ensure your diabetes is well managed systemically in order to prevent further retinal or kidney damage.

  • How often do I need a diabetic eye exam?

    Diabetic eye disease can lead to permanent vision loss if not monitored regularly. Regular exams are important in order to catch early signs of retinal damage before it leads to permanent damage. Guidelines state that:

    Type 1 patients should be seen within 5 years of diagnosis, and annually thereafter.

    Type 2 diabetics should be seen at the time of diagnosis and annually thereafter.

    If signs of damage are noted, the frequency of examination will increase accordingly. Examinations and retinal imaging required explicitly for the management of diabetic eye disease are covered by Alberta Health. However routine comprehensive examinations that include prescriptions for eyewear are NOT funded by the government, regardless of diabetic status. Please call us if you have questions about insurance or Alberta Health coverage.