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Guidelines for Preserving Vision

You can have advanced stages of diabetic retinopathy without even knowing it. But, although diabetes is the leading cause of adult-onset blindness, vision loss due to diabetic retinopathy can be prevented.

Joslin Diabetes Center has been on the cutting edge of diabetes-related eye disease prevention since its inception and has set standards across the world for the treatment and care of eyes. At Joslin we have developed clinical guidelines that recommend you take a three-pronged approach to preserving your vision:

  1. Maintain good A1C levels

  2. Keep blood pressure and other health factors in check. 

  3. Be vigilant in getting eyes checked annually through a dilated eye exam (where the doctor places drops in your eyes) or specially validated photographs of your retinas (Joslin Vision Network).

Diabetic retinopathy is the most common eye disease for people with diabetes. It occurs when the small blood vessels in the eye are damaged by high levels of glucose in the blood.

Although there are a variety of treatments to treat diabetic retinopathy, the earlier it is diagnosed, the more effective the treatment.

Take charge of your eye health and make sure that an annual eye exam is part of your comprehensive treatment plan.

Don’t Wait for Symptoms

Diabetic retinopathy occurs when the tiny blood vessels inside the retina—the tissue at the back of the eye that sends images to the brain—become damaged. There are usually no symptoms at this early “nonproliferative” stage. Essentially all people with diabetes will eventually develop some changes in the retina, usually within 20 years of diabetes onset.

In two-thirds of cases, this type of retinopathy progresses to the “proliferative stage,” although research shows that intensive glucose and blood pressure control can delay the onset of disease and slow its progression. In the proliferative stage, the retina forms new vessels in an attempt to circumvent nonfunctioning blood vessels. These new vessels, however, are abnormal, fragile and bleed readily.

If the condition is treated with laser photocoagulation when the abnormal vessels are in their early stages, severe vision loss can be prevented in about 95 percent of cases. The laser scars the retina, causing the vessels to regress, which prevents subsequent bleeding and pulling on the retina. Since the laser destroys some areas of the retina, there may be side effects of treatment—such as reduced side or night vision—but central vision is retained far better than if the patient receives no treatment at all.

Diabetic macular edema, however, is a different story. Diabetes can cause the retinal vessels to leak, leading to swelling of the retina. If this swelling occurs in the small area in the center of the retina called the macula, the condition is called macular edema. Vision can decline because this area of the retina is responsible for central vision. Laser treatment is also used for this condition but is less successful than when used for new vessels. Treatment reduces the chance of vision worsening by only half, and, even when successful, is usually not associated with improved vision.

This is why everyone with diabetes should get annual eye checks and keep blood glucose, blood pressure and cholesterol in good control.

Dr. Deborah K. Schlossman talks about diabetic eye care and its role in preserving vision, and shows us what is involved in an annual dilated eye exam.

Page last updated: July 17, 2018