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How can you tell if diabetes is affecting your eyes?

Diabetes causes changes to blood sugar levels. This can affect the lens in your eye, particularly if your diabetes is poorly controlled. As your blood sugar levels fluctuate during the day, this can cause blurred vision. However, diabetic eye disease does not cause visual symptoms until late in the disease, hence, it is extremely important to have regular eye checks in order to make an early diagnosis.

Diabetes can also have an impact on the blood supply to the back of the eye, which can affect how the retina works. This can cause changes in vision resulting in shapes floating in your vision field (often referred to as “floaters”). Dry eyes are also found to be common in diabetes, these often cause redness and eye pain.

 

What eye diseases are caused by diabetes?

When the blood vessels in the retina become damaged, this causes a condition called diabetic retinopathy. Blood vessels can become blocked, grow incorrectly, or start to leak. This in turn reduces blood supply to the retina, which then affects your vision.

The macula is the centre part of the retina and very important for your best ‘straight-ahead’ vision for seeing detail, reading, driving, and for colour vision.

When the macula of the eye becomes affected by retinopathy, this is known as diabetic maculopathy. This can then develop into diabetic macular oedema.

In some cases, diabetic retinopathy can progress further and new, abnormal blood vessels can start to develop inside the eye. These can cause many problems and require treatment with laser (pan-retinal photocoagulation) and/or injections into the eye. In some cases, surgery may be indicated, for instance, if there is a lot of bleeding in the eye that is not getting better by itself or if the retina becomes unstable and a retinal detachment develops.

 

What is diabetic macular oedema?

Diabetic macula oedema (DMO) is a disorder involving the centre of the retina which is used for sharp vision. Blood vessels damaged by diabetes become leaky, and fluid builds up around and in the retinal cells causing swelling in the retina.

 

What are the symptoms of diabetic macular oedema?

The main symptom of with diabetic macula oedema is blurred or wavy vision. This is usually experienced in the centre of the field of vision. Patients may also find that colours seem to appear faded or not as sharp.

People with macular oedema experience a range of vision loss, from only slightly blurry to a vision loss which is noticeable. It can take longer to notice these symptoms if only one eye is affected.

 

What causes macula oedema?

Macular oedema occurs when there is an accumulation of fluid in the macula, caused by leakage from damaged blood vessels in the retina. This is primarily caused by diabetic retinopathy. It can also be caused by age-related macular degeneration or inflammatory diseases which affect the eye.

Risk factors for DMO include high blood pressure, high cholesterol and smoking. The risk also increases with the length of time you’ve been diabetic and if your diabetes is poorly controlled. The condition is also more likely to occur in pregnancy.

It is very important to ensure that your diabetes, blood pressure and cholesterol are as well-controlled as possible and that you do not smoke. We will advise you to see your GP or diabetes specialist to check all of these factors.

 

Is macular oedema serious?

In the early stages, macular oedema can be reversible. But chronic oedema may lead to irreversible changes in the macular and retina, leading to permanent vision loss. Therefore, if untreated, macular oedema can be extremely serious.

 

Can diabetic macular oedema be cured?

There is no permanent cure, but various medications and procedures as advised by a specialist doctor can help to reverse or slow the damaged caused by this condition.

In mild cases which are not affecting vision, we would advise monitoring closely and ensuring that all the factors discussed above are well-controlled. In some cases, for example, if the patient has uncontrolled blood pressure, the DMO can resolve with improved control. This may require different medication and lifestyle changes.

 

What is the best treatment for macular oedema?

If a patient is experiencing vision changes, there are different treatments that we may suggest. These include laser treatment and injections.

How does laser treatment for macular oedema work?

Laser treatment works by drying up any leaks in the macula area and slowing any further leakage of fluid. This may not improve vision, but it is effective in some cases to stop vision from getting worse.

Prior to treatment, you will be given dilating eye drops. These open up the pupil of the eye and helps the doctor to see the back of the eye clearly during treatment. The drops can cause blurred vision for up to six hours, so you should ensure that someone else drives you home after your appointment.

The treatment usually takes around 15 minutes and is not painful. It’s important to follow the doctor’s instructions during treatment and try to keep the eye and head as still as possible.

Following treatment, you may experience some mild discomfort and vision change. This can last for 24-48 hours. It can take up to four months for laser treatment to fully take effect.

 

How do injections for macular oedema work?

Eye injections may involve a number of different drugs given by a quick injection. There are various drugs available and the doctor will discuss with you which ones are best suited to your circumstances. Patients generally have a course of injections, sometimes over a period of several years.

 

What are anti-VGEF VEGF drugs?

A primary treatment method involves injecting anti-angiogenic (anti-VEGF) drugs into the white of the eye. This treatment can stop abnormal blood vessels from growing and can control the leakages. Drugs used in these injections are Eylea or Lucentis. The timing and review periods for these injections are extremely important.

Avastin is another anti-VEGF medication which may be recommended for macular oedema. It can help to stem the growth of damaged vessels and reduce swelling and leakage.

 

How do steroid injections work for macular oedema?

Some patients do not respond to treatment with anti-VEGF injections, or this treatment is not suitable for them for other reasons. For these patients, treatment with steroid-based drugs is often considered.

There are two different drugs which are used for steroid treatment – Iluvien and Ozurdex. Both are given as an injection into the eye as with the anti-VEGF drugs, but Iluvien is delivered as a steroid-releasing implant which is released slowly over a period of up to three years. Ozurdex is delivered as a pellet of steroid which dissolves over a time span of between three and six months.

 

Does macular oedema go away on its own?

It’s very rare for macular oedema to go away on its own. If left untreated, it can cause serious complications including permanent sight loss. There are treatments available to reverse the damage and slow progression of the disease. Your doctor may decide to combine laser treatment and injections in some cases.

 

If you are interested in seeking treatment for macular oedema or any other eye condition, find out more about our team of experts. We will be delighted to hear from you to discuss how we can help to improve your symptoms and long-term eye health.

Professor Michel Michaelides

Medical Retina & Inherited Retinal Disease Specialist

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Mr Jaheed Khan

Consultant Ophthalmic Surgeon
Medical Retina & Cataract Surgeon

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Ms Esther Posner

Consultant Ophthalmic Surgeon
Medical Retina specialist

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MS EVGENIA ANIKINA

Surgical and Medical Retina Specialist

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