People with diabetes are at an increased risk of vision and eye problems. Keeping your diabetes under control can lower this risk, but if you’re experiencing vision-related diabetes complications, Dr. Jason Crosson, a retina specialist with Retina Consultants of Alabama, shares what you should know. 1. Q: How does diabetes affect the eyes? A: Over time, diabetes causes your blood sugar to be high, which damages blood vessels. These damaged blood vessels are located throughout the body, inside areas like the heart, kidneys, and your retina, the area in the back of your eye that senses light and allows you to see. Many years of progressive damage to these vessels can lead to a condition called diabetic retinopathy, which, if allowed to progress, can cause vision loss in two main ways. First, the blood vessels become leaky, causing fluid to seep out into your retina. This is called diabetic macular edema (DME). “Macula” refers to the center of the retina and “edema” means swelling. The second way diabetes can lead to vision loss is called proliferative diabetic retinopathy (PDR). It’s called “proliferative” because your eye is actually “proliferating,” or growing, new blood vessels. This occurs when your retina is not getting enough blood flow and oxygen because the normal vessels are damaged. The new proliferative vessels produced are weak and tend to bleed into the eye. DME leads to blurry vision, difficulty reading and driving, and if untreated, it can lead to serious vision loss. This occurs because the macula, which is responsible for helping you to see details like faces and words on a page, becomes swollen. When the abnormal new vessels from PDR bleed, you will often experience severe floaters (black or red spots) in your vision, sometimes leading to complete loss of vision. Without treatment, these harmful vessels can continue to bleed and then contract, leading to retinal detachment, in which the retina pulls away from the back of the eye; in some cases, this results in irreversible vision loss. Another eye condition that tends to occur in diabetic patients is cataracts; while cataracts can affect people without diabetes, those with diabetes are more likely to develop it at a younger age. With cataracts, the lens of the eye becomes cloudy, significantly disrupting vision. Cataracts have the potential to cause severe vision loss, so it’s important for people with diabetes to see an ophthalmologist at least once a year for a dilated eye exam. When caught early, there’s a lot we can do to restore vision and prevent further loss of sight. 2. Q: How are diabetic eye diseases treated? A: Cataracts are typically treated with surgery. When treating early stages of diabetic retinopathy, when it’s not yet proliferative, our first step is to encourage patients to do what they can to get blood sugar levels balanced. Once diabetic retinopathy has progressed into DME or PDR, we have treatments available. The main therapies used for DME and PDR are eye injections and laser treatments. The eye injections, known as anti-VEGF therapy, work to block a protein called vascular endothelial growth factor (VEGF); blocking VEGF prevents the eye from forming new abnormal blood vessels, helps get rid of the existing abnormal blood vessels, and also stops the vessels from leaking. These injections, then, help improve the swelling of DME and help the bad blood vessels of PDR reduce in size. This can restore vision and keep the eyes healthy. These injections need to be performed repeatedly, every month or so, depending on the patient. Laser treatments are also helpful for DME and PDR. Focal laser directed to the leaky areas can improve DME and limit the number of injections required. Laser therapy for the periphery of the retina (called panretinal photocoagulation or PRP) can help the proliferating vessels in PDR go away as well. Both these laser treatments make the injections more effective and help prevent future complications from diabetic retinopathy. We can also turn to steroid injections for DME if other therapies aren’t sufficient, and many patients respond very well to them. Finally, in severe cases that have gone untreated, surgery is necessary to repair the retina. Although we can often repair a retina surgically in these cases, it’s best to not let it progress to such a severe stage, as sometimes the damage is irreparable. 3. Q: What are the risk factors for diabetic eye disease? A: The longer you’ve had diabetes, the higher your risk for developing diabetic eye disease. If you’ve had diabetes for 20 years, you’re much more likely to develop eye-related complications, even if your sugars are under control. If your blood sugar levels have been out of whack for a long time, that also raises your risk. And high blood pressure can increase your chances, too. The most important things you can do to lower your risk of diabetic eye disease is take your diabetes and blood pressure medications as prescribed, eat a healthy diet, get plenty of exercise, lower stress levels, and get an annual dilated eye exam. This exam helps your ophthalmologist see what’s going on behind the scenes before you start to experience symptoms. When these conditions are caught early, it’s much more likely that we’ll be able to prevent vision loss and keep your eyes healthy.