Macular Edema, Glaucoma and Cataracts
Fluid leaking into the cells of the retina can cause the tissue to swell. One area that is particularly sensitive to this problem is the macula, that area of the retina that allows you to see color and sharp images. When fluid leaks into the macula, you may develop diabetic macular edema. This can occur at any stage of retinopathy—in the early stages of nonproliferative retinopathy or the later stages of proliferative retinopathy. Macular edema accounts for most cases of vision loss, especially in people with type 2 diabetes who do not control blood glucose levels.
DIABETES MACULAR EDEMA
DIABETES MACULAR EDEMA SYMPTOMS
If you have macular edema, you may notice varying degrees of vision loss, including a blurring of both near and far vision. You may also be less sensitive to blue and yellow colors. You may also notice a distortion of straight lines. This can be evident if you close one eye and look at a pattern of floor tile, for example. If you have symptoms of macular edema, you should have a thorough ophthalmologic exam.
Using an ophthalmoscope, your doctor can examine your retina for signs of macular swelling. Your doctor may also conduct a fluorescein angiography exam to locate points in the blood vessels of the retina that may be leaking into the macula, or anything else that may be causing swelling in the macula. Angiography will also tell your doctor whether anything is impairing circulation to the macula, which can also cause loss of vision. You may also be examined using one of several ultrasound techniques, including optical coherence tomography. This gives your doctor an idea of whether there is any swelling in the retina or thickening within the macula, due to macular edema.
What You Should Do
Any time you notice any change in your vision, tell your doctor right away. If you notice any loss of vision, or any other symptoms of macular edema, contact your physician. You should be examined by an ophthalmologist as soon as possible. Blurred vision is often caused by natural aging or poor glucose control, but if it is indeed due to macular edema, you should be treated as soon as possible.
DIABETES MACULAR EDEMA TREATMENT
If fluid is leaking into the macula, your eye doctor will first want to identify the source of the leak. This can be done using angiography or sonography. If a leak or leaks are detected, you may be a candidate for focal laser coagulation. This technique uses a laser to pinpoint specific sites. By aiming a laser at the site of leakage, the tissues coagulates, or closes up, and the leakage is plugged up. The goal is to prevent further leakage and to allow fluid that has already leaked into the macula to be reabsorbed.
If you have macular edema with nonproliferative retinopathy, the goal of treatment may simply be to stop the leaks. If you have macular edema with proliferative retinopathy, you may require several treatment sessions. In the first session, your doctor will want to find sites within the retina that are leaking fluid into the macula. The goal is to fix the leaks and reduce the swelling in the macula. Once the swelling has subsided, you can be further treated to get rid of the growth of new blood vessels that are contributing to your problem
DIABETES MACULAR EDEMA PREVENTION
The best thing you can do to prevent any kind of retinopathy is to control your blood glucose and blood pressure levels. This is important to prevent such problems from happening in the first place and to prevent them from recurring.
DIABETES CATARACTS
Over time, the lenses of your eyes can develop areas of cloudiness. When this happens, you have a cataract. Often, cataracts have no effect on how you see things. But some cataracts interfere with your vision. If this occurs, you may need surgery.
Cataracts happen naturally as you age. But if you have diabetes, they may occur earlier than normal. Often people with diabetes develop cataracts in their 30s or 40s. Early cataracts formation is thought to be due to poor blood glucose control over time. Fortunately, new surgical techniques are available to effectively treat cataracts. The best way to reduce your risk of early cataract development is to control your blood glucose levels.
DIABETES CATARACTS SYMPTOMS
Dulling of vision, decreased reading vision, a need for more light when you are reading, or difficulty seeing when you are driving are all signs that you may have cataracts. If you have cataracts, an oncoming headlight while you are driving at night may look like a bursting star or sparkler
What You Should Do
If you notice any of the symptoms of cataracts, contact your doctor or ophthalmologist. Your eye doctor will examine you to determine whether you have cataracts that are causing your vision problems.
DIABETES CATARACTS TREATMENT
Cataracts that interfere with your vision and prevent you from carrying out your normal day-to-day routines require surgery. Usually cataract surgery is performed in your doctor’s office on an outpatient basis. Before you have surgery, your doctor will evaluate your eyes and take measurements for an artificial lens that is prepared before your surgery. During the actual surgery, your eye doctor will remove the lens from your eye and replace it with a plastic, artificial lens. Usually, the lens capsule or posterior membrane, is left in place.
Sometimes, cataracts will develop in the lens capsule and also interfere with vision. These are called after-cataracts. Your doctor may treat after-cataracts with laser surgery. In this procedure, a laser is used to burn a clear hole in your membrane to remove the cataract that is clouding your vision. Lasers are not used to remove cataracts in your actual lens.
After you have cataract surgery, you will probably still need glasses for reading, distance or both. Your lens naturally focuses on your vision. When you have an artificial lens implanted, your vision is focused for only one distance. Glasses will allow you to focus at different distances. You will need to have your eyeglass prescription reevaluated after cataract surgery.
DIABETES GLAUCOMA
If you have glaucoma, then the pressure exerted by the fluid inside your eye is too high. If this pressure, known as the ocular pressure, remains too high, over time it can damage the optic nerve. Normally, your eyes produce a fluid known as the aqueous humor. The aqueous humor fills the front part of your eye, circulating from behind the iris, through the pupil, and into a chamber between the iris and the cornea. This fluid is normally drained at the same rate it is produced. If something happens to interfere with the drainage of the aqueous humor, glaucoma can result. The draining of the aqueous humor can be blocked for several reasons; thus glaucoma can have several different causes. Not all causes of glaucoma are related to diabetes.
Open-angle glaucoma, or chronic glaucoma, is the most common type of glaucoma. It can be affected by diabetes. It occurs when the drainage network (also known as the filtration angle) that drains the fluid from the eye is blocked. When circulation is poor and the eye doesn’t receive the oxygen and nutrients it need, extra blood vessels grow across the drainage network, fluid can’t leave the eye and pressure within the eye builds up.
Angle-closure glaucoma, also known as acute glaucoma, is caused by a filtration angle that is too narrow, which prevents the drainage of fluid. Angle-closure glaucoma is not affected by diabetes. Your doctor can tell from a complete eye exam whether or not you are prone to angle-closure glaucoma and can treat it before it becomes a problem.
Neovascular glaucoma is also caused by the growth of new, unwanted blood vessels. In this case the blood vessels grow on the surface of the iris and eventually reach a point where they block the filtration angle. Diabetes can increase the risk of neovascular glaucoma, especially if you have proliferative retinopathy
DIABETES GLAUCOMA SYMPTOMS
The symptoms of glaucoma depend on what type of glaucoma you have. If you have open-angle glaucoma, you probably will not notice any symptoms. The only early sign of open-angle glaucoma is a slight loss of small areas of peripheral vision. This loss of vision usually occurs in one eye, on the side near the nose. You may not notice this because the peripheral vision of the other eye makes up for it. Gradually, the extent of loss of peripheral vision increases and the second eye will also be affected. By the time you notice the loss of vision some damage has been done.
The symptoms of angle-closure glaucoma are more noticeable. You may experience an acute glaucoma attack, characterized by blurry vision, the appearance of halos around lights and pain and redness in the eye. Your cornea may also begin to look hazy. Usually preliminary attacks precede a fully developed attack. If you have a fully developed attack, you may also experience excruciating pain in the head as well as the eye. Sometimes the pain is so great that you will vomit. The cornea may look gray and granular and your eyeball may be painful to the touch.
Symptoms of neovascular glaucoma may vary. You may feel no symptoms at all or you may feel symptoms similar to those in angle-closure glaucoma.
DIABETES GLAUCOMA RISK
Acute glaucoma is relatively rare and tend to run in families. Chronic glaucoma, however, is more common. About 1% to 2% of the population over 40 will develop this type of glaucoma, and if you have diabetes, you are twice as likely to develop it. The risk continues to rise with age. If the condition is not caught early, your peripheral vision in both eyes will be lost. If not treated, it can also affect your ability to see straight ahead, and eventually both eyes may become totally blind.
What You Should Do
If you feel the symptoms of an acute glaucoma attack, call your doctor right away. If you are unable to contact your regular doctor or eye care specialist or a physician on call, go to the emergency room at your nearest hospital.
If you have symptoms of open-angle, or chronic, glaucoma, notify your doctor as soon as you notice any vision loss. Unfortunately, you cannot regain the vision lost through this disorder, but you can prevent further vision loss. Because the symptom itself is vision loss, it is important to have your ophthalmologist test you on a regular basis. This is especially true for people with diabetes.
DIABETES GLAUCOMA TREATMENT
Treatment for glaucoma depends on the kind of glaucoma you have. If you have open-angle glaucoma, your doctor will first treat you with eye drops to reduce the pressure in the eye. You may be given eye drops or medication that opens up the drainage vessels or that decrease the rate of production of aqueous humor. Most of these medications must be taken for life. If your condition does not respond to this treatment, you may require laser surgery. In this procedure, your doctor will use a laser to create an artificial drainage channel in the angle.
If you have angle-closure, or acute, glaucoma, you need emergency attention. In the emergency room, you will be given eye drops to encourage the iris, which may be blocking the drainage channel, to withdraw. You may also be given an injection of a drug to block the production of aqueous humor. You may also be treated with a procedure known as a laser iridotomy. Using a laser, your doctor will create a small hole in your iris that allows the aqueous humor to pass through the drainage angle. You will need careful follow-up evaluations after this type of surgery.
Neovascular glaucoma is usually treated with laser surgey to the retina. This is because the blood vessel growth in the iris is the result of problems in the retina. If the problem does not respond to laser treatment of the retina, you may need to take eye drops or have laser surgery performed directly on the abnormal blood vessels in the iris.
With any treatment of glaucoma, it is important to schedule follow-up visits with your ophthalmologist, to make sure that the treatment has succeeded in improving your condition.
DIABETES GLAUCOMA PREVENTION
The best way to prevent the type of glaucoma is triggered by diabetes is to control your blood glucose levels. Also schedule visits with your ophthalmologist on a regular basis to be tested for glaucoma. By catching glaucoma in the early stages, you can prevent the loss of vision that may occur if detected too late.
DIABETES BLURRY VISION
Not every vision problem is a sign of retinopathy. Sometimes you may even develop temporary problems with your vision, such as blurring. This often can happen when your blood glucose levels are out of control. See your ophthalmologist when you notice any change in vision to make sure you don’t have a serious condition that could get progressively worse.
DIABETES BLURRY VISION SYMPTOMS
You will notice blurry vision and changes in how well you see throughout the day. You may notice that your vision is especially blurry when you look in the distance, but your near-range vision may actually improve. If you normally wear reading glasses, you may even find that you don’t need them.
What You Should Do
Notify your doctor or your ophthalmologist if you notice any change in your vision. Blurry vision could be a sign of retinopathy, a serious condition that could lead to blindness if left untreated.
However, your vision could also get blurry when your blood glucose levels get out of control. Blurry vision is a symptom of both hypoglycemia and hyperglycemia. If you have an episode of blurry vision that comes on suddenly, especially if you also have other symptoms of hypoglycemia or hyperglycemia, test your blood glucose level at once. If it is dangerously low or high, take treatment steps right away. If left untreated, hypoglycemia could lead to convulsions and unconsciousness. Hyperglycemia can lead to life-threatening condition such as diabetic ketoacidosis, which is more common in people with type 1 diabetes, or hyperglycemia hyperosmolar state, which is more common in people with type 2 diabetes.
Blurry vision in itself may not necessarily be a sign that you have a sight-threatening condition such as retinopathy. It could be a temporary situation that will go away on its own. But it could signal a low or high blood glucose reaction, situations that require immediate attention.
If you have recently switched from an oral medication, or have started intensive therapy, you may also experience blurry vision. These effects are often only temporary and are likely to go away in 3 to 6 months. However, if you are tightening your control of diabetes or switching medications, it is a good idea to schedule regular eye examinations to make sure you don’t develop any serious eye problems.
The bottom line is that any time you experience a change in the way you see things, including blurry vision, notify your doctor. It could signal an emergency situation, such as hypoglycemia or hyperglycemia. Or it could signal a potentially serious eye condition, such as retinopathy, that should be treated at once to preserve your eyesight.
DIABETES DOUBLE VISION
Diabetes can also cause a condition that makes you see double. This conditions, called diplopia, is caused by damage to the nerves and blood vessels that control the muscles that move the eyes. Your eyes are surrounded by six muscles that control their movements. The movement of these muscles is coordinated by nerves so that they maintain simultaneous focus on whatever you may be looking at. If your nerves are damaged by a poor blood supply, the muscles may not coordinate the movement of the eyes. When this happens you have double vision. This is a type of mononeuropathy.
DIABETES DOUBLE VISION SYMPTOMS
Symptoms of diplopia include double vision, drooping of the eyelid, and sometimes pain over the affected eye.
What You Should Do
Notify your physician if you have any of the symptoms listed above. Usually, the nerves regain function over several months and the eyes regain their coordinate vision. In the meantime, you may be treated with an eye patch to eliminate one of the two images. Or you may be given an optical device called a prism, in a spectacle lens that attempts to align the two visual images. In rare cases, surgery on the muscle of one eye may be performed.
Double vision can sometimes signal a potentially life-threatening situation. Therefore, it is important to tell your doctor right away if you are seeing double. Although it could be due to a neuropathy that clears itself up, you want to rule out something more serious. Tell your physician about any abnormality or change in your vision right away.
DIABETES DOUBLE VISION PREVENTION
The best way to prevent diplopia is to keep your blood glucose levels as close to normal as possible.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Diabetic Macular Edema by Francesco Bandello, Paolo Lanzetta et al
Diabetic cataracts: mechanisms and management by Irina Obrosova, Stephen Chung and Peter Kador
Presence and Risk Factors for Glaucoma in Patients with Diabetes by Brian Song, Lloyd Aiello and Louis Pasquale
Rich Health Editorial Team
Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner
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