High Blood Sugar Can Affect Your Eyes: Early Signs of Diabetic Retinopathy

Thanks to advancements in early detection and treatment options, it's possible to live a long and healthy life after being diagnosed with type 1 or type 2 diabetes. But since the chronic condition can affect your total-body health, doing so may require some additional check-ups—including regular eye exams to screen for early symptoms of diabetic retinopathy. 

Diabetic retinopathy occurs when high levels of blood sugar (a common marker of diabetes) damage the tiny blood vessels in the retina, a layer of tissue in the back of the eye that helps detect light, explains Philip Ferrone, MD , a retina specialist at Vitreoretinal Consultants of New York. This leads to vision changes, and if it goes untreated for long enough, it can even cause vision loss. 

Anyone with type 1 or type 2 diabetes is at risk of diabetic retinopathy. In fact, the National Eye Institute says that up to 50 percent of people with diabetes will eventually develop diabetic retinopathy symptoms, which can range from mild to severe. 

Luckily, diabetic retinopathy treatment can help halt symptoms before they progress to the point where the condition significantly affects your vision. That's why it's essential to know the early warning signs.  

Diabetic retinopathy symptoms you shouldn't ignore

Since diabetic retinopathy develops due to chronically-high blood sugar levels, people with undiagnosed or unmanaged diabetes tend to be most at risk. It also doesn't cause noticeable symptoms in the earliest stages, which means people are more likely to notice general diabetes symptoms than diabetic retinopathy symptoms at first, Dr. Ferrone says. These may include: 

• Uncontrollable thirst

• Excessive urination 

• Extreme hunger 

• Weight loss 

• Intermittent blurred vision 

In more advanced stages of diabetic retinopathy, symptoms may also include: 

• Worsening blurred vision

• Distorted vision 

• Floaters 

• Dark spots 

• Total or partial vision loss 

How doctors diagnose diabetic retinopathy

After being diagnosed with any type of diabetes, your healthcare provider should recommend a visit to an eye doctor—ideally a retina specialist, Dr. Ferrone says. During your exam, the doctor will dilate your eyes to examine your retina and look for early stages of diabetic retinopathy. And you should continue getting eye exams at least yearly to keep tabs on the condition's development or progression, he says. 

"If you're diagnosed with diabetes, come hell or high water, you should have a dilated eye exam every year by someone who's familiar with diabetic changes and can treat you or refer you appropriately," Dr. Ferrone says. "Just getting a check [like what you'd get to determine if you need] glasses is not the same thing. They have to dilate your pupil and really examine the eye well."

 "If you have diabetes, come hell or high water, you should have a dilated eye exam every year." —Philip Ferrone, MD

There are a few tests used for diabetic retinopathy diagnosis. One is called a fluorescein angiogram, during which a vegetable-based dye is injected into a vein in your arm, says Dr. Ferrone. A special camera is used to take pictures as the dye travels through the small blood vessels in your eye, allowing a specialist to look for signs of diabetes-related damage or changes. 

Another test is the OCT or optical coherence tomography, Dr. Ferrone says. This uses light waves to create detailed images of the eye, which can then be examined for swelling. This test is less invasive than the fluorescein angiogram, but also newer. Your physician can help you determine which one is best for you. 

Diabetic retinopathy stages explained

Diabetic retinopathy is categorized into several stages depending on progression. Ranging from the least to most severe, there are: 

• Mild non-proliferative diabetic retinopathy.During this stage, there's evidence of microaneurysms, or small bulges in the blood vessels.

• Moderate non-proliferative diabetic retinopathy.There are microaneurysms and the damaged blood vessels are leaking blood and liquids into the retina.

• Severe non-proliferative diabetic retinopathy.The retinal hemorrhages (blood leaks) are more significant.  

• Proliferative diabetic retinopathy.There's evidence of new blood vessel growth in the eye, a marker of eye disease and a risk factor for vision loss.  

Effective diabetic retinopathy treatments 

If you've been diagnosed with the condition, don't panic. There are a handful of diabetic retinopathy treatment options that can help protect your vision.

First, it's crucial to adhere to your diabetes treatment plan as closely as possible, since that's the underlying cause of diabetic retinopathy. Dr. Ferrone says patients are typically asked to try to keep their hemoglobin A1C test result (a blood test that measures your average blood sugar levels over the past three months) below seven percent, as well as follow any medication and lifestyle protocols recommended by their doctor. This includes treating any other conditions you may have, such as high blood pressure, since many can contribute to diabetes or diabetic retinopathy progression. 

Additionally, your healthcare provider may recommend anti-vascular endothelial growth factor (anti-VEGF) drugs, Dr Ferrone says. These decrease swelling and liquid buildup in the retina and help prevent additional blood vessel changes. "They work very well, but they have a limited duration of action. So you need to get re-treated with these drugs every four to 12 weeks or so," Dr Ferrone says. 

For more progressed diabetic retinopathy, laser treatment may be an option. This can help clear the buildup and damage interfering with your vision. And as long as you're able to manage your diabetes going forward, you shouldn't need another laser treatment, Dr Ferrone says. 

The most severe diabetic retinopathy may require what's called vitrectomy surgery to remove blood, scar tissue and other buildup from the eye to treat diabetic retinopathy symptoms, he says. 

How to keep your blood sugar stable:

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This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan .