Q: I have diabetes. What can I do to protect my eyes? What symptoms should I watch for? When should I worry?

A:Understanding how diabetes affects the eye is the first step to protecting your eyes. Diabetes causes two major eye problems: early onset cataracts and diabetic retinal disease (retinopathy). Of these two problems, it is diabetic retinopathy that can lead to irreversible vision loss.

Diabetes and your eyes
All diabetics will eventually have some degree of retinopathy. Fortunately, not all patients with retinopathy will experience vision loss. We know from scientific studies that patients with very good diabetic control compared with 'average' control will have less overall retinopathy, slower progression, and less risk of vision loss. Control of high blood pressure and high lipid (fat) levels has also been shown to reduce the risk of vision loss in diabetics. Stopping smoking can also reduce the risk of vision loss.

Symptoms to watch for
The most common symptoms of retinopathy are blurred or distorted vision. This is due to swelling in the centre of the retina (macula) associated with blood vessel damage. Laser surgical treatment and injections of various medications can help reduce the swelling, but usually are not able to fully reverse the loss of vision.

A less common symptom is the appearance of large floaters or cobwebs in your sight. This can be due to bleeding in the clear space (vitreous) between the retina and lens. This is treated with laser surgery, and in some cases surgical removal of the blood and vitreous.

How to protect yourself
To summarize, most diabetics should have an annual eye exam, including a dilated examination of the retina. They should strive for excellent diabetic control, keep the blood pressure and lipids at normal levels, and not smoke. This is the best advice to ensure that the eyes remain healthy.

Colour picture of Dr. Mark Bariciak

The Expert:
Dr. Mark Bariciak is a retinal specialist from Sault Ste. Marie. He is one of CNIB's Eye Van ophthalmologists, traveling to remote communities in Northern Ontario, and a member of the Eye Van's Medical Advisory Committee.

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