Diabetes: eye damage (diabetic retinopathy)

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What is it about ?

Diabetes can damage all the blood vessels in the body, including the retina (the thin membrane that lines the eyeball). This damage is called retinopathy and causes loss of vision.

Located at the back of the eye, the retina is responsible for transmitting the images you perceive to the brain.

The retina can be damaged by fluid and fat leaking from the blood vessels in the retina or by the formation of new blood vessels that bleed easily. These new vessels are formed as a result of damage to the old vessels.

Diabetic retinopathy is the leading preventable cause of vision loss.

Where and how often?

One in two type 1 diabetics and one in four type 2 diabetics have some degree of retinopathy.

Diabetic retinopathy can also be inherited. You are more likely to have the disease if members of your family have it or have had it.

How is the diagnosis made?

An eye exam (measuring visual acuity) cannot detect retinopathy. In the early stages of the attack, you can indeed still see normally. But treatment should be started before symptoms appear.

The ophthalmologist will do a fundus exam, which allows him to see the blood vessels in the retina well. He can thus check whether certain blood vessels are damaged, whether new blood vessels have formed and whether the retina is bleeding.

Before doing the fundus exam, you may be given drops in both eyes to dilate the pupils to allow a detailed examination of the inside of the eye. These drops cause some visual blurring and intolerance to bright light for a few hours. You will therefore not be able to drive your car or ride your bike. You will regain normal vision as soon as the effect of the drops ends.

How often are the eyes checked?

People with type 2 diabetes are examined by the ophthalmologist when diagnosing diabetes, and then regularly, for example once every 2 years.

People with type 1 diabetes should also be checked at the time of diagnosis (or at the onset of puberty) and then regularly, for example every 3 years.

In some cases, for example when the sugar level (blood sugar) is not well controlled or abnormalities are found, the examinations should be more frequent.

If you have diabetes and are trying to get pregnant, you should also have your eyes checked. It is recommended to consult the ophthalmologist before and during pregnancy. Pregnancy temporarily increases the risk of retinopathy, but this probably does not influence the course of the disease in the long term.

What can you do ?

The risk of retinopathy may be increased by a few factors, such as poor blood sugar control, too high blood pressure, a excess fat and cholesterol in the blood, theobesity, a anemia, a loss of protein in the urine and an kidney damage from diabetes.

The general practitioner will help you to better control all these elements to avoid retinopathy. If you are diagnosed with retinopathy anyway, proper control of the above factors will help slow or stop the eye involvement.

What can your doctor do?

Early retinopathy does not require treatment, but regular monitoring by the ophthalmologist.

If the condition progresses, the ophthalmologist will begin laser treatment. This will allow him to treat damage to the retina before symptoms appear and vision loss occurs. Laser treatment forms scars on the retina. These scars stop the damage to the retina and the formation of new fragile blood vessels. If this treatment gives good results, they are generally maintained for several years. The disadvantages of the treatment are deterioration of night vision and narrowing of the visual field. In some cases, it may be necessary to operate.

The visually impaired can benefit from an extensive rehabilitation program, measures and a suitable job offer. Ask your doctor for advice.

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