When James, a 54-year-old with type 2 diabetes, began noticing a haze in his vision, he assumed he needed new glasses. Within weeks, he was facing vision loss from neurovascular glaucoma. What could have prevented it? A dilated eye exam.
IN THIS BLOG
What is the main reason diabetic patients lose their vision?
Vision loss in diabetic patients often results from diabetic eye disease (DED) and glaucoma. These conditions can progress without noticeable symptoms until irreversible damage occurs, making early detection critical.
How can diabetic eye disease be detected early?
Annual dilated eye exams are the most effective way to detect diabetic eye disease early and begin treatment before serious vision loss occurs.
What are the types of diabetic eye disease?
Diabetic eye diseases include diabetic retinopathy, diabetic macular edema, neurovascular glaucoma, vitreous hemorrhage, retinal detachment, and cataracts.
Who is at risk for diabetic eye disease?
Risk factors include longer duration of diabetes, poor blood glucose control, high blood pressure, high cholesterol, and smoking. Type 1 diabetes patients are especially vulnerable if they smoke.
What treatments are available for diabetic eye disease?
Treatment varies by condition and severity. Options include laser therapy, anti-VEGF or steroid injections, surgery, and careful blood sugar and blood pressure management.
Can cataracts be treated in diabetic patients?
Yes. Surgery can restore vision lost to cataracts, but diabetic patients face higher surgical risks, especially those who have had other treatments for eye disease.
What can healthcare providers do to help?
Providers should emphasize the importance of annual eye exams, blood sugar and lipid control, smoking cessation, and timely referrals to specialists if diabetic eye disease is detected.
Unfortunately, ophthalmologists like Dr. Lydia Lane of the Little Rock Eye Clinic hear stories like this often. Several diseases can cause vision loss, with glaucoma being the biggie. Often called the “sneak thief of sight,” glaucoma slowly impacts vision without the patient knowing what’s happening. According to the American Academy of Ophthalmology, around half of the 2.2 million Americans with glaucoma don’t know they have it.
Why Early Detection Matters
For patients with diabetes, vision changes are often subtle at first, and by the time symptoms are obvious, irreversible damage may have already occurred. Diabetic eye disease (DED) and glaucoma are among the leading preventable causes of blindness in the U.S., especially for patients with long-standing or poorly managed diabetes.Thankfully, timely screening and referral can significantly reduce the risk of vision loss. Annual dilated eye exams remain the single most effective tool for early detection.“The prognosis is best if the diabetic eye disease is identified and treated early in the disease process,” Dr. Lane emphasizes.
The Diabetes–Vision Connection
Diabetes can damage the blood vessels in the retina and other parts of the eye, leading to a group of conditions called diabetic eye disease. These include:
- Diabetic Retinopathy (DR): retinal hemorrhages due to microvascular leakage
- Diabetic Macular Edema (DME): Fluid buildup in the macula causing central vision loss
- Neurovascular Glaucoma: Abnormal blood vessel growth blocking the eye’s drainage system and increasing eye pressure
- Vitreous Hemorrhage: Blood leakage into the eye cavity
- Retinal Detachment: Traction and detachment due to new vessel growth
- Cataracts: Accelerated clouding of the lens due to elevated glucose levels
“Some patients may also develop abnormal blood vessels that leak or cause a blockage in the eye’s drainage system, leading to glaucoma or retinal detachment,” Dr. Lane says. “Cataracts can also develop quickly in patients with uncontrolled diabetes.”
Know the Signs; Know the Risk
Most patients with early-diagnosed diabetes who manage it well will not develop vision loss from diabetes. However, the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) found that, after 20 years with diabetes, 99% of patients with type 1 and 60% of patients with type 2 show some degree of retinopathy.
“A yearly dilated eye exam for all diabetic patients helps to detect signs of diabetic retinopathy and ensure treatment is not delayed,” Dr. Lane says.
Risk factors for diabetic eye disease include:
- Longer period living with diabetes
- Poor blood glucose control (high A1c)
- Uncontrolled high blood pressure
- High cholesterol
- Smoking (particularly for type 1 diabetes)
“A balanced diet that helps promote weight loss and maintain blood sugar control and lipid levels is beneficial in helping prevent and manage DED,” Dr. Lane suggests. “Smoking cessation is also an important lifestyle change that can be helpful.”
Treatment Pathways and Referral Clarity
Most diabetic eye conditions are treatable, but management varies significantly depending on the disease type and severity. Here’s a high-level guide:
Diabetic Retinopathy
Treatment:
- May be followed with 6-month eye exams if mild and blood sugar is controlled
- If abnormal blood vessels have formed, the disease has progressed to proliferative diabetic retinopathy (PDR)
- Laser to the peripheral retina
- Injections into the eye of anti-VEGF
- Steroids to regress abnormal blood vessels
- Surgery to remove the vitreous
Diabetic Macular Edema
Treatment:
- Laser to the retina
- Injections of steroids or anti-VEGF into the vitreous (repeated every 3 months)
Neurovascular Glaucoma
Treatment:
- Urgent glaucoma surgery
- Injections of anti-VEGF to facilitate blood vessel regression
Retinal Detachment
Treatment:
- Surgery required to reattach the retina
- Aggressive treatment of underlying diabetic eye disease
- Laser to the retina
- Injections of steroids or anti-VEGF
Despite treatment, vision in the area of detachment is lost permanently.
Vitreous Hemorrhage
Treatment:
“If the amount of blood is minimal, observation is usually an option, as the blood will often clear with time,” Dr. Lane says. If there is a significant amount of blood, or if rapid visual recovery is needed like in monocular patients, more aggressive treatment is needed.”
- Surgery required to remove the vitreous and the blood
- Laser treatment to the retina
Cataracts
Treatment:
- Surgery can restore vision loss from a cataract
“Diabetics are at higher risk for surgical complications during or after cataract surgery than the general population,” Dr. Lane says. “This is due in part to treatments received to treat diabetic eye disease, a weakened support system for the lens of the eye, and an increased risk for edema in the macula after surgery.”
Patient Education That Sticks
Clinicians, including primary care providers, play a crucial role in not just referral, but reinforcement of key behaviors that prevent long-term eye damage.
“Yearly diabetic eye exams are the best method to ensure that diabetic retinopathy, if present, is detected early and treated to prevent vision loss,” Dr. Lane emphasizes. Most ophthalmologists and optometrists provide special eye exams to screen patients with diabetes. If patients are found to have diabetic eye disease that requires treatment, they will be referred to a retina specialist for further management.
Other behaviors that can reduce complications include:
- Blood glucose control
- Lipid control
- Well-controlled blood pressure
Final Thoughts
Vision loss from diabetic eye disease and glaucoma is largely preventable—but only if we act before symptoms appear. As trusted providers, you’re not just treating diabetes—you’re protecting sight, independence, and quality of life. Empower your patients with clear guidance: prioritize annual dilated eye exams, reinforce the importance of glycemic and cardiovascular control, and refer promptly when warning signs appear. Because when it comes to saving vision, early detection is everything—and your role as a health care provider is essential.
