Diabetic Eye Disease
Eye disease is a troubling reality for people with type 1 diabetes.
Over 40 percent of people living with type 1 diabetes (T1D) develop diabetic eye disease, sometimes resulting in blindness. But early detection and timely, appropriate treatment can reduce the risk of blindness by over 95 percent.
How T1D Affects Eye Health
The retina is a thin layer of specialized nerve tissue on the back wall of the eye. It converts light into electric signals that are transmitted to the brain where the images we “see” are generated. The center of the retina, called the macula, is responsible for the sharp clear vision needed for reading and other daily tasks. Abnormal leaking from blood vessels damaged by fluctuating blood sugars in T1D can lead to swelling of the macula and vision loss.
Diabetes can damage the blood vessels that feed the retina, causing leakiness and decreased blood flow. These changes stimulate the development of abnormal blood vessels, which are fragile and can bleed and further destroy the nerve tissue around them, scarring the retina and putting people at high risk for low vision and blindness. High levels of blood sugar can damage the blood vessels and exacerbate the process.
Types of Diabetic Eye Disease
Diabetic Retinopathy
Diabetic retinopathy (DR) is one of the most common complications of T1D. DR is a progressive condition, often the result of chronic high blood-sugar levels, which can damage the blood vessels in the retina of the eye and cause excess blood vessel growth.
Symptoms of diabetic retinopathy include:
- Blurred vision
- Eye floaters
- Reduced night vision
In advanced stages, contracting scar tissue may cause the retina to detach, which can lead to permanent vision loss. Symptoms of retinal detachment include rapid increases in floaters, flashes of light, and sudden, painless vision loss. To decrease the risk of permanent vision loss, consult a healthcare professional immediately if this occurs.
Diabetic Macular Edema
Diabetic macular edema (DME) is a severe complication of diabetic retinopathy. DME is the buildup of fluid at the back of the eye near the center of the retina (called the macula). The fluid causes the macula to swell and thicken, negatively affecting vision.
Symptoms of diabetic macular edema include:
- Blurry or double vision
- Eye floaters
- Trouble seeing colors or in bright light
- Blind spots or partial vision loss
How to Prevent Diabetic Eye Disease
Keep your blood sugar in range
Schedule annual eye exams with a retinal specialist
Manage blood pressure and cholesterol
Consult your doctor about early treatment options for preventive measures
Treatments for Eye Disease
There are now many effective therapies for diabetic eye disease, many of which were made possible by Breakthrough T1D-funded research. Treatments for diabetic retinopathy and diabetic macular edema include:
Vascular endothelial growth factor (VEGF) is a protein whose function is to promote the growth of new blood vessels. In people with diabetic retinopathy, VEGF becomes overactive, and the new, fragile blood vessels can rupture and leak fluid. Breakthrough T1D played a critical part in clinical studies that led to the approval of two therapies—Lucentis® (ranibizumab) and Eylea® (aflibercept)—that inhibit VEGF and allow healthy regrowth of damaged blood vessels in the eyes. Most recently, Susvimo is approved to treat both DR and DME with fewer injections compared to other therapy options.
Laser treatment removes damaged parts of the retina that can cause the abnormal blood vessels to grow. While these treatments cause some vision loss, they can help to prevent progressive vision loss, which can lead to blindness.
Research in Eye Disease
Breakthrough T1D is supporting additional research to find new ways to prevent the development of diabetic eye disease, stop its progression to preserve visual function, and restore lost vision through the Mary Tyler Moore Vision Initiative, a special initiative of the Mary Tyler Moore and S. Robert Levine, M.D., Charitable Foundation and Breakthrough T1D, to honor Mary’s contributions to diabetes awareness and research.
Diabetic Eye Disease FAQ
Adults with T1D should have an eye exam beginning 5 years after diagnosis. Those without any evidence of retinopathy who are reaching blood sugar and A1c goals can have repeat exams every 1-2 years after discussion with their healthcare team. Those with eye disease should have an eye exam at least once a year.
Women who are planning a pregnancy should have an eye exam before becoming pregnant and again during the first trimester. Additional monitoring is required in the first year after giving birth.
Children with T1D should have an eye exam beginning 3-5 years after diagnosis once they reach 11 years of age or start puberty. Repeat exams should be obtained every 2-4 years in discussion with your healthcare team.
Early stage diabetic eye disease often does not have any symptoms. Common symptoms of more advanced diabetic eye disease include blurry vision, eye floaters, and trouble seeing at night or in very bright conditions.
Diabetes can damage the blood vessels that feed the retina, causing leakiness and decreased blood flow. These changes stimulate the development of abnormal blood vessels, which are fragile and can bleed and further destroy the nerve tissue around them, scarring the retina and putting people at high risk for low vision and blindness. High levels of blood sugar can damage the blood vessels and exacerbate the process.
Treatments for diabetic retinopathy and diabetic macular edema include anti-VEGF therapy and laser treatment. Your eye care provider will determine which treatment is best suited for your condition.
More Guidance on T1D Complications
Cardiovascular disease (CVD) is a long-term complication of type 1 diabetes. CVD includes coronary heart disease, cerebrovascular disease, and peripheral artery disease.
Nearly one out of three people with T1D develop kidney disease. Fortunately, most people with type 1 diabetes and kidney disease don’t end up with kidney failure.
Improving Quality of Life
Breakthrough T1D is tackling the complications of T1D, including eye, kidney, and heart disease—where we have the opportunity to make short- and long-term impacts on people’s lives—strategically investing in developing treatments that can improve outcomes of T1D.
