The severity of diabetes-related complications can be life-threatening, while others are sufficiently debilitating to curtail daily activities and quality of life. Diabetes-related eye diseases are one such complication. They include diabetic retinopathy (DR), diabetic macular edema (DME), cataracts and glaucoma. All can lead to vision loss, affecting a person’s career, causing financial difficulties and interfering with daily diabetes management.
DR and DME are two of the most common and preventable conditions affecting eyesight.
DR affects over one in three people with diabetes and can cause vision loss, low vision or blindness. The condition usually affects both eyes and results when high glucose levels damage blood vessels in the retina. These damaged blood vessels can swell and leak or stop blood flow, causing blurred or distorted vision. Sometimes, new blood vessels grow, but they are abnormal and can cause further impairment. Other symptoms include the onset of colour blindness or colours appearing faded, poor night vision (night blindness), small dark spots (eye floaters) or streaks in vision, and trouble reading or seeing faraway objects.
Over time, about 1 in 15 people with diabetes will develop DME, a further complication of diabetic retinopathy that affects the middle of the eye. The blood vessels in the macula, located in the retina’s centre at the back of the eye, can become blocked. At first, vision changes can go unnoticed. However, DME can cause central vision to become blurred.
I have had blurry vision since I was diagnosed with type 2 diabetes in 2013. However, I have never been diagnosed with DR so far, as there are no DR units in my state,” Chimezie Anyiam, IDF Blue Circle Voice (Nigeria).
People with any type of diabetes can develop DR, with the risk increasing the longer people live with the condition. Although it can develop at any stage of DR, the risk of DME increases with the severity of diabetic retinopathy.
Some conditions associated with DR that can lead to DME include high glucose and blood pressure, lipid imbalance (dyslipidemia), obesity, sleep apnoea and pregnancy. Nonetheless, lifestyle modifications, including a healthy diet, regular physical activity and weight management, can help maintain healthy blood glucose levels and prevent the worsening of diabetic retinopathy and the development of DME.
Additionally, women with diabetes who become pregnant or develop gestational diabetes are at high risk of developing DR. In both cases, they should have comprehensive eye exams to monitor their condition during pregnancy.
Treating DR and DME depends on the severity of the condition. Laser surgery and intravitreal — injections into the space in the back of the eye called the vitreous cavity — are the primary methods. In some cases, combination therapy using both treatments may be necessary. Eye surgery, known as a vitrectomy, is another treatment option for blurred vision due to leaking blood vessels.
Early detection, regular screenings and appropriate diabetes management are crucial to prevent vision loss and improve the quality of life for people with diabetes. Regular screening for DR, focusing on DME, is recommended for all people with diabetes. Ideally, trained healthcare professionals would perform basic screenings and make appropriate referrals to ophthalmologists when necessary. Still, the screening pathway requires multi-directional communication involving the person with diabetes, the primary care provider and the ophthalmologist.
I deal with several comorbid issues, but DR is the one that affects me the most. If it wasn’t for the skills of my optometrist and ophthalmologist, I could have been blind before I hit 50. I have challenges, but I can still see at 52,” Michael Donohoe, IDF Blue Circle Voice (United States).
In low- and middle-income countries, obstacles to screening are prevalent. Barriers include long waiting periods for appointments and on the day of the visit, and financial burdens associated with health insurance premiums, medical consultations, treatment and necessary supplies. Additionally, the limited availability of services in rural areas or outside major cities and academic institutions often requires extended travel times.
Support groups and educational resources can provide assistance and information. However, healthcare professionals are central to informing people with diabetes on risk factors, symptoms, treatment options and the need for ongoing management of their condition.
Under the guidance of IDF, a team of experts developed a set of clinical practice recommendations for the effective management of DME. These recommendations serve as a decision support tool for general practitioners, opticians, ophthalmologists, hospital physicians and other clinicians involved in managing diabetic eye disease. They result from a collaborative and evidence-based process incorporating the most up-to-date advancements in DME management. Download
Learn more about DR and DME in two free courses from the IDF School of Diabetes.
The course on diabetic retinopathy (DR) presents the complications, risk factors and pathophysiology of DR. You will learn about the different disease stages when screening for DR and DME. The course also addresses recommended diagnostic tests and management strategies for DR.
A second course on diabetic macular edema (DME) covers classification, screening and making referrals for DME. You will have an overview of risk factors, treatment and management of DME. Further learning presents the role patient education plays in prevention and early diagnosis.
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