Diabetic eye disease

Most common forms are diabetic retinopathy, diabetic macular oedema and Cataracts

Most common diabetes related complication.
Intraretinal microvascular abnormalities (IRMA) - dilated and tortuous capillaries that can act as a shunt
Neovascularization - release of growth factors stimulating new vessel development - proliferative diabetic retinopathy
Damage to the wall of small vessels cause microaneurysms.
Damaged blood vessels leak fluid into the retina. This fluid leaves behind lipids and proteins forming hard exudates
Damage to nerve fibres in to the retina causes cotton wool spots.
These can all be seen on dilated eye exam.
Fluid from leaking vessels in cleared poorly in the macular area due to anatomical differences. Above a certain point it cannot be cleared macular oedema occurs
This distorts and thickens the macula at the retina.
Not visible on exam

If proliferative (neovascularization occurs), measures taken to treat:

Pan-retinal photocoagulation (PRP) – extensive laser treatment across the retina to suppress new vessels
Anti-VEGF medications by intravitreal injection
Surgery (e.g., vitrectomy) may be required in severe disease

Develops earlier in people with diabetes tan the general population
Fluctuations in blood glucose concentration can cause refractive variability as a result of osmotic changes within the lens
Resolves with better control

Presentation

Causes/Factors

Diabetes Mellitus: Prolonged elevated blood sugar levels contribute to the development and progression of diabetic eye disease.
Duration of Diabetes: The longer an individual has diabetes, the higher the risk of developing eye complications.
Essential hypertension: High blood pressure can exacerbate the effects of diabetes on the eyes.

Blurred Vision: Vision may become blurry, especially in the early stages.
Floaters: Dark spots or floaters may appear in the field of vision.
Eye Pain or Pressure: In advanced stages, individuals may experience pain or pressure in the eyes.

Retinal Changes: Fundoscopic examination may reveal abnormalities in the retina, such as microaneurysms or haemorrhages.
Macular Oedema: Swelling of the macula, the central part of the retina, can be a sign of diabetic macular oedema.
Cataracts: Clouding of the eye’s lens.
Increased Intraocular Pressure: A risk factor for glaucoma.

Dilated Eye Exam: An eye care professional examines the retina and other structures after dilating the pupils.
Fluorescein Angiography: A dye is injected into the bloodstream to highlight blood vessels in the retina.
Optical Coherence Tomography (OCT): Imaging technique to assess the thickness of the retina and detect swelling.

Blood Sugar Control: Tight control of blood glucose levels is crucial to prevent and manage diabetic eye disease.
Blood Pressure Management: Maintaining optimal blood pressure helps protect the eyes.
Anti-VEGF Injections: Injections may be used to treat diabetic macular edema.
Surgery: Advanced cases may require surgery, such as vitrectomy for retinal issues.

Vision Loss: Progressive vision loss can occur if diabetic eye disease is not adequately managed.
Retinal detachment: In severe cases, the retina may detach.
Glaucoma: Increased risk of developing glaucoma, leading to optic nerve damage.