There is often a connection between diabetes and eye diseases.
According to the American College of Family Physicians, almost all people who have had diabetes for 15 years or more, they estimate 98 percent, have some sort of eye disease that is connected with their diabetes.
Some studies also suggest that male and female hormonal changes during puberty, along with diabetes, can increase a child’s odds of developing eye problems.
One study notes that children who develop type 1 diabetes before age ten have a higher risk of developing diabetic retinopathy as they get older (for more about diabetic retinopathy, see below).
What are cataracts?
According to the American Academy of Ophthalmology, a cataract is a cloudy or opaque lens in a person’s eye. Because the incoming light is not properly reflected onto the light-sensitive tissue lining the back of the eye (the retina), the person’s vision becomes blurred, distorted, or cloudy.
Why do people develop cataracts?
Although cataracts are often associated with people who have diabetes (see below), there are other reasons for them.
Cataracts mainly occur in older people and are more common in smokers.
Development of cataracts also runs in families.
They can also occur in people who take high doses of steroids and/or steroids for a long time; if they take certain other medications; if they have had certain surgeries that contribute to cataract development; or if they have other types of eye diseases and/or eye injuries that lead to the clouding of the lens.
In addition, it is thought that eye exposure to the sun also can contribute to cataract development, which is why so many health care professionals recommend wearing sunglasses outside in the sunshine (or on snow or water) and/or having special ultraviolet coating added to eyeglasses.
When the lens of an eye becomes cloudy or opaque, a cataract has formed, compromising one’s vision. Diabetes increases the chance for cataracts to develop.
Do people with diabetes develop more cataracts than those without diabetes?
Yes, according to the American Diabetes Association. In fact, it is estimated that people with diabetes are 60 percent more likely to develop cataracts. It is also estimated that around 20 percent of people who have cataract operations have diabetes. People with diabetes also seem to develop cataracts earlier in life and more quickly than people who do not have the disease.
Why does diabetes often lead to the development of cataracts?
The main reason for the development of cataracts in people with diabetes has to do with blood glucose levels.
The eye’s lens, the object that becomes cloudy when a person has cataracts, gets its nutrients from the aqueous humor (the fluid in the front of the eye).
When a person’s blood glucose levels are not in control, the sugar levels rise in the aqueous humor and lens.
When this occurs, the lens swells, causing the person’s vision to blur.
This is why many people with diabetes often mention blurred vision, an increased problem with glare (especially during nighttime driving), and yellowish or faded views around them.
As with most problems encountered by people with diabetes, one of the best ways to keep cataracts at bay is to maintain healthy blood glucose levels.
What is diabetic retinopathy?
Diabetic retinopathy is a phrase commonly used to describe many different eye disorders caused mainly by diabetes.
It is also the major cause of blindness in the United States among adults ages 20 to 65, and is most associated with people who have diabetes, both types 1 and 2.
According to Harvard Medical School, diabetic retinopathy is considered a degenerative eye disorder; it occurs when chronic high blood sugar causes the tiny blood vessels in the retina (capillaries) to break down and leak fluid into the surrounding tissue.
Not only can the leakage leave what are called hard exudates, or deposits of fat and protein, but if it is near the macula, it will impair the person’s sight, a condition called macular edema.
Why does diabetes often cause blindness?
A ccording to Harvard Medical School, diabetes is the leading cause of new cases of blindness in people ages 20 to 74. The high blood-sugar level in diabetes weakens blood vessel walls in the retina and choroids of the eye. This weakening, in turn, increases the eye’s susceptibility to hemorrhaging, scarring, and retinal detachment, all of which can contribute to blindness.
These vessels also nourish the eyes, and if the capillaries are damaged, it is more difficult for them to supply nutrients and eliminate wastes from the surrounding tissues.
The vessels can also eventually become blocked, and although new vessels form to compensate in the later stages of retinopathy, the newer vessels are more fragile.
This fragility can often lead to bleeding into the vitreous humor (the gel-like substance in the inner eye); the bleeding, in turn, temporarily blocks light and causes a sudden change in vision.
Although the blood is often reabsorbed, scar tissue forms.
This tissue can pull at the retina, often causing retinal detachment.
If this condition is not caught in time, it can lead to permanent vision loss or blindness.
What are the major types of diabetic retinopathy?
According to the American Diabetes Association, there are commonly two major types of diabetic retinopathy, proliferative and nonproliferative.
In proliferative retinopathy, new blood vessels form as others become blocked.
The growth of these new vessels often leads to scar tissue, severe bleeding, and even retinal detachment.
The more common type, nonproliferative retinopathy, forms as capillaries in the back of the eye form pockets.
This type of retinopathy is also caused when blood vessels become blocked but usually does not require treatment.
How do eye specialists detect diabetic retinopathy?
According to the National Eye Institute, there are certain ways in which an ophthalmologist (eye specialist) can detect diabetic retinopathy in a person with diabetes. During a dilated-eye exam, in which the doctor dilates, or widens, a person’s pupil to better see the retina and optic nerve, the tests include a visual acuity test (using an eye chart to measure a person’s ability to see at various distances), a tonometry test (to measure the pressure inside the eye), and an optical coherence tomography or OCT (similar to an ultrasound but using light waves, not sound waves, to produce an image of the tissues inside the eye).
Normal vision compared to pre-proliferative retinopathy, non-proliferative retinopathy, and proliferative retinopathy.
How does an ophthalmologist treat diabetic retinopathy?
In reality, it is the person with diabetes who can “treat” diabetic retinopathy by keeping his or her blood glucose levels under control.
If an ophthalmologist suspects that the patient has diabetic retinopathy, then the doctor may suggest a test called a fluorescein angiogram, in which a fluorescent dye is injected (most often into an arm vein).
As the dye reaches the eyes, images of the retinal blood vessels are taken and examined for possible retinopathy.
If diabetic retinopathy is confirmed, there are usually two major ways of helping the person’s eyesight.
According to the American Academy of Ophthalmology, one procedure uses lasers and is usually performed in a doctor’s office.
The laser treatment causes abnormal new vessels to shrink and often prevents them from growing.
Another procedure is vitrectomy, which is usually performed in a hospital or surgery center operating room (usually on an outpatient basis).
The procedure removes blood and scar tissue that often accompany abnormal blood vessels (that cause the bleeding) in the eye.
When such hemorrhaging is eliminated, light rays are able to focus on the retina again.
What is diabetic macular edema?
Diabetic macular edema (DME) is most often associated with diabetic retinopathy.
With retinopathy, chronic high blood sugar can cause the blood vessels in the retina to break down and leak fluid.
If the leakage is near the center of the macula, it can cause the macula to swell.
This condition is called diabetic macular edema.
Because the macula is the part of the eye responsible for sharp, straight-ahead vision, the person’s vision will blur.
DME is the most common cause of diminished vision in people with diabetes.
Are there ways to prevent macular degeneration?
According to Harvard Medical School, there are several ways to prevent macular degeneration in many people. These include the following: don’t smoke; wear sunglasses (especially in reflective places, such as around the ocean or snow); eat dark, leafy greens (kale and spinach are two of the best sources); exercise (choose a type that fits your lifestyle); if not allergic, eat nuts and oily fish (they both have omega-3, which some research indicates helps prevent macular degeneration); and especially avoid developing diabetes, mainly by eating healthfully and keeping weight in a normal range for your age and height.
Macular degeneration occurs when the center of the retina deteriorates. It affects about 10 million Americans.
What is macular degeneration?
M acular degeneration occurs when a small central portion of the retina called the macula deteriorates. The most common symptoms are slightly blurred vision, difficulty recognizing faces, and the need for brighter light with which to see. According to the American Diabetes Association, age-related macular degeneration is the most common cause of vision loss in people over age 55 (in the United States). Macular degeneration cases are expected to grow as the population ages.
Can a person with diabetes develop eye aneurysms?
Yes, if people with diabetes have damaged blood vessels in the retina from chronic high blood sugar, they can eventually develop what are called microaneurysms, or small sac-like pouches that affect the smaller blood vessels, or capillaries. (The pouches have been associated with diabetic retinopathy since 1879; the microaneurysms of the eye from diabetes were first described in 1943.) The recognition of eye microaneurysms is often used to predict the development of diabetic retinopathy.
In some studies, the microaneurysms have been found to be directly correlated with HbA1c values.
For example, in one study, the researchers found that every 10 percent increase in HbA1c value (for instance, from 8.1 percent to 9.0 percent) was associated with an increase of 0.7 microaneurysms.
This is not a huge amount, but it does indicate that a person’s overall blood glucose level can have an effect on the formation of eye microaneurysms.
The Handy Diabetes Answer Book
HOW DIABETES AFFECTS BONES, JOINTS, MUSCLES, TEETH, AND SKIN
DIABETES, BONES, AND JOINTS
What is arthritis?
The word arthritis is derived from the Latin via Greek word arthron (“joint”) and itis (“inflammation”).
Arthritis is a disease in which a person’s joints become inflamed, most often resulting in joint pain and stiffness.
There are more than 100 types of arthritis, some affecting the skin, muscles, bones, and internal organs, as well as the joints.
For example, one type of arthritis is rheumatoid arthritis, in which the joint pain is caused by the immune system’s attack on the membrane lining the joints.
Together, these types of arthritis are called rheumatic diseases and are considered to be one of the most common chronic health problems. (For more about immune system and inflammation, see the chapter “Diabetes and Body Connections.”)
Are people with diabetes more prone to arthritis?
According to the Arthritis Foundation, as of this writing, 47 percent of adults with arthritis also have another chronic condition. And of the 52.5 million American adults with arthritis, 16 percent (around 7.3 million) have type 2 diabetes, and 47 percent of adults with diabetes (both type 1 and type 2) have arthritis.