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How can diabetes affect eyes?

Diabetes can affect different parts of the eye. Diabetic Retinopathy is the most common manifestation of diabetic eye disease followed by Diabetic cataract (snowflake cataract). Recurrent eyelid infections called Stye or “Hordeolum” are also the early presenting signs of diabetes. Advanced diabetic eye disease may lead to intractable glaucoma (neovascular glaucoma) where in the eye pressure progressively increases to cause damage of optic nerve. Diabetic eye disease is now increasingly becoming a major cause of preventable blindness in India.


  • What are the different types of eye problems that one can face?

Redness of eyes with swelling of eyelids is encountered in infection of oil secreting glands (meibomian) present in eyelids

Blurry vision and seeing multiple black spots in front of the eye are the early symptoms of Diabetic retinopathy. Distorted vision or” metamorphosia” is also a common complaint wherein a straight line may appear wavy; this is frequently encountered in type 2 diabetics. Type 1 Diabetics are prone for bleeding inside the eye called vitreous haemorrhage. If this is not treated promptly this can lead to detachment of retina.

Diabetic retinopathy is broadly classified into 2 types Non proliferative and Proliferative. The latter needs immediate attention and treatment.

Cloudy or foggy vision is a manifestation of cataract or clouding of the crystalline lens in the eye.

Glaucoma or eye pressure related vision loss is also seen in diabetics, is initially devoid of symptoms but can lead to progressive contraction of field of vision and irreversible blindness.

  • When should one visit an eye doctor (ophthalmologist)?

If you were 30yrs and younger when your diabetes was detected, then eye exam by an ophthalmologist should be done within 5 yrs of the diagnoses. However if you are above 30 yrs when your diabetes is first detected then you need to be examined by an ophthalmologist within few months.

If you are a diabetic and become pregnant then schedule an eye exam in the first trimester.

If you have already experienced high risk Diabetic complications like diabetic kidney disease or diabetic foot leading to amputation then you need an eye exam immediately by an ophthalmologist.

If you have been examined by an ophthalmologist and found to have non proliferative diabetic retinopathy then yearly review as per the discretion of the ophthalmologist is required. If you have been diagnosed with proliferative retinopathy then monthly review and treatment as per the ophthalmologist advice is necessary to prevent vision loss.

  • How are diabetic eye problems treated?

Diabetic retinopathy once diagnosed is then graded and assessed by the Retina specialist and treated. Initially you need to undergo a retinal scan called SD OCT to asses the extent of diabetic macular edema followed by an Angiogram to grade the severity of your diabetic eye disease.

There are different types of treatment modalities for diabetic eye disease which include:

  1. Laser photo coagulation of retina
  2. Intravitreal injections ( injections given in the eye)
  3. Intravitreal implants( drug eluting capsule implanted in eye)
  4. Surgery ( vitrectomy) for non clearing bleed inside the eye and retinal detachment
  5. Pattern scan and navigated laser treatment of diabetic maculopathy.
  6. Micro incision cataract surgery for diabetic cataract
  7. Eye drops to control your elevated eye pressures
  8. Cryotherapy for advanced diabetic eye disease.

The treatment strategy would be discussed by your retina specialist based on the severity and grade of your diabetic eye disease. All the above treatments are done as day care procedures and don’t require admission.

  • What can one do to prevent damage to eyes?

Optimal control of your blood sugar levels is known to prevent progression of diabetic retinopathy . HbA1C levels which is indicative of 3 month glycemic control should be below 7.

You should also be aware that hypertension (High BP), anemia (low hemoglobin ) and kidney disease can worsen diabetic retinopathy and should consult your physician regularly.

The old adage “Prevention is always better than cure”  is very true for diabetic retinopathy.  Hence regular exercise, diet ( as prescribed by nutritionist) and periodic eye check up by an ophthalmologist can help you preserve your vision.


About Author

Dr Name: Jinadas & Atheeshwardas

Credentials: MD & DO DNB FRCS(Glasgow) FMRF(Sankara Nethralaya)


The World Health Organization says that India and other middle-income countries are facing the third epidemic of ROP.

Extrapolating the government data (primarily from northern India) every two hours in India, three babies have reached the threshold for ROP treatment. Up to 24% of childhood blindness in India is due to retinal pathology and ROP is one of the most important cause. Prevention was never so better than cure when it comes to treating ROP.

There are multifactorial reasons for terming ROP as a pending epidemic. With the advent of improved facilities in Neonatal Intensive Care Units (NICU), preterm low/very low birth weight neonates now survive and are exposed to the risk of developing ROP. These babies who would not have survived otherwise in the past two decades, in small towns, are now surviving in greater numbers and many develop ROP.

The awareness of ROP among the medical fraternity is very low as a result of which the babies are referred to a retina specialist only late in the course of ROP. There are many myths among the paediatricians regarding ROP. One among them is that, babies who have never received supplemental oxygen therapy do not develop ROP. This myth has been busted now and it has been proved that supplemental oxygen therapy is not the only causative factor for ROP, though it plays some role. 20% of babies who never received oxygen in postnatal period still develop ROP.

As per the Western data, ROP occurs in babies who weigh less then 1500 gms. However in India, we tend to see ROP in babies who weigh more than 1500 grams. If we had applied the western criteria for screening babies, we would have missed 20% of the ROP cases. Western developed countries guidelines do not apply to Indian context as the neonatal and postnatal care vastly vary.

There is a tendency to see a large number of ROP cases in the rural areas in India,probably due to neonatal care practices prevalent there. Gestational age or post conceptional age as a screening tool is ineffective in rural area as it is almost impossible to date the pregnancy. ROP once diagnosed early is graded according to the set guidelines and treatment initiated as per protocol.

Early treatment of ROP can go a long way in preventing blindness. ROP can be effectively managed with laser photocoagulation. The immature retina in a pre-term neonate when exposed to very high concentration of ambient oxygen is susceptible to develop new blood vessels, which have a tendency to bleed. If the treatment is initiated early, these new blood vessels regress and the retina attains maturity subsequently. On an average for every 10 preterm neonates I screen, 4 would have ROP and among them 2 or 3 require treatment.

All this, calls for a clarion call among pediatricians; neonatologists and ophthalmologists who need to counsel the parents, screen for ROP more aggressively and to frame guidelines for screening Indian babies.  Already there has been initiative in this context in the form of tele-ROP screening with help of Ret-cams, which can be transported to remote rural areas.

Hence with an extensive co ordination amongst neonatologists and Retinal specialists, and making ROP screening mandatory for Pre term babies, we can combat and prevent this avoidable blindness.

About author:

Dr.Atheeshwar das

MBBS, DO, DNB (GoldMedallist),FRCS(Glasgow),FMRF(Sankara Nethralaya)

Consultant Ophthalmologist

Apollo Specialty Hospital OMR

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Copyright by Medicare Eye Hospital 2018. All rights reserved.

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