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Save Your Sight: Preventing Vision Loss from Diabetes

By Christine Haran

While senior citizens can expect some decline in their sight, vision loss is rarely a problem for younger people. But now that people are being diagnosed with diabetes at younger ages, diabetes-related vision loss is also occurring in middle-aged people. Sometimes vision problems are even the first sign of the disease.

A study published in the April issue of the Archives of Ophthalmology found that more than 4 million US adults aged 40 or older have diabetic retinopathy, a leading cause of blindness. Retinopathy occurs when high blood sugar levels damage blood vessels in the retina, which is the tissue at the back of the eye.

"The results of our study are important for public policy because they demonstrate that there's a large need for management and detection of eye disease in people with diabetes," says John H. Kempen, MD, PhD, an assistant professor of ophthalmology and epidemiology at the Johns Hopkins University and coordinator of study, which was authored by the Eye Diseases Prevalence Research Group.

Below, Dr. Kempen discusses the effectiveness of laser treatments and the importance of regular eye exams and consist control of blood sugar levels.

What kinds of vision problems do people with diabetes experience?
People with diabetes can develop a progressive condition called diabetic retinopathy, and it can cause either moderate or severe vision loss. Diabetic retinopathy is caused by high blood sugar levels. These high levels of sugar lead to a lack of blood supply to parts of the retina and also to leakage of fluid through the blood vessels in the retina. The leakage of fluid can cause swelling in the retina called macular edema that can lead to mild to moderate vision loss.

In the advanced stage of retinopathy known as proliferative retinopathy, the lack of blood supply can cause new, abnormal blood vessels to grow. It can also cause secondary damage such as retinal detachment or bleeding into the eye, leading to severe vision loss.

What are the risk factors for diabetic retinopathy?
High blood sugar is perhaps the most important factor, but high blood pressure and high lipid levels such as cholesterol also substantially increase the risk of getting diabetic retinopathy. So all three need to be controlled.

Because the prevalence of diabetes increases with age, diabetic retinopathy is more common in older people. But the other diseases we studied that are typically diseases of elderly people (cataracts, glaucoma and age-related macular degeneration) are strongly related to increased age, whereas diabetic retinopathy is more related to time with diabetes. So often people are diagnosed with diabetes at a young age, and therefore we see diabetic retinopathy in people aged 40 and older.

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