Diabetes Can Destroy Your Eyesight

By J. Coney, MD
Diabetes is an Epidemic Crisis Worldwide

As the number of individuals with diabetes increases , so do the complications related to the disease such as eye disease which leads to vision loss as well as nerve and blood vessel disease that can cause amputation,  kidney disease that can require dialysis, heart disease, and strokes.

Diabetic retinopathy (DR) is the most common cause of blindness in the working population. Diabetic macular edema (DME), which is swelling in the retina, is the most common complication of DR that leads to potential visual impairment if not treated. 

When DME affects the center of vision, the individual can lose 50 percent of vision by 3 years without treatment.  As the disease progresses, reduced blood flow and poor oxygenation lead to a debilitating loss of vision from bleeding and scar tissue in the back of the eye that often requires surgery. 

Unfortunately, delayed treatments and diagnosis can result in irreversible damage to the retina and poor visual prognosis, affecting quality of life.

Diabetes and diabetes-related complications are seen at higher rates in certain ethnic groups, affecting Blacks and Hispanics disproportionally when compared with Caucasians. Blacks are almost 3 more times likely than whites to develop DR and to have vision-threatening DR. Mexican Hispanics are more than twice as likely as whites to develop DR and almost twice as likely to have vision-threatening DR . 

Male sex, as well as higher A1c levels, which indicate blood sugar levels over time, longer duration of diabetes, insulin use, and higher blood pressure are independently associated with the presence of DR. Although the reasons may be multifactorial, the fact that diabetes and its complications disproportionately affect people of color is related to poor access to healthcare, under-insured or lack of insurance, poor knowledge of disease and its complications, and poor compliance in these communities.

In order to prevent the long-term complications of DR, early detection and treatment are important in preserving vision. A study at the Joslin Clinic (an affiliate of the Harvard Medical School) has shown that 50 percent of diabetics have sight- threatening vision loss and are not even aware. With early detection and proper management, diabetes-related eye disease no longer means blindness.

Over the past decade, newer treatment has changed the landscape on how retina specialists can halt the progression of DR and visual loss and possibly restore vision in some patients. 

Research has shown that intravitreal anti-VEGF injections dosed at frequent intervals for the first year can improve vision, with treatment rarely required after 3 years with long-term follow-up. There is no reason why anyone needs to go blind from diabetes 
if they are diagnosed and treated early.