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November is Diabetes Awareness Month. According to the American Diabetes Association, more than 38 million people have diabetes, and this number has doubled significantly over the past twenty years. With the increase in diabetes diagnoses, it is important to know of its impact on eye health. Diabetes, if left untreated, can lead to vision loss and a host of other eye conditions – including diabetic retinopathy, glaucoma and cataracts.

We spoke with NTERI associate professor, Dr. Raghu Krishnamoorthy, about diabetic retinopathy, how we can prevent it, and what advancements are on the horizon in terms of treatment.

What is diabetic retinopathy, and why is it such a serious risk for people living with diabetes?

The retina is a light sensitive layer of nerve cells within the eye that converts light into electrical signals. These electrical signals are sent through the optic nerve (which acts like an electrical cable) to the brain which converts these signals into images enabling us to see. The retina requires a constant supply of blood to provide glucose, oxygen and nutrients and get this through a network of small blood vessels.

Diabetic retinopathy is a complication of diabetes in which high blood levels of glucose damage blood vessels within the eye. This causes inflammation and sprouting of new blood vessels that are fragile and break easily, leading to leakage of their contents. This could produce serious damage to the retina, leading to loss of vision.

Are there any early warning signs people should look out for — or can vision loss happen without symptoms?

There are some early warning signs of diabetic retinopathy. The most common warning signs are blurred vision, poor night vision and sensitivity to bright light. Other indications include floaters as a consequence of blood cells and cellular debris from leaking blood vessels in the vitreous humor and a decrease in peripheral vision.

How often should someone with diabetes get a comprehensive eye exam, and what should they expect during that visit? 

Diabetes patients should get a comprehensive eye examination at least once every year to test for diabetic retinopathy or related ocular conditions. If diabetic retinopathy has been found, patients should schedule an eye exam more often as recommended by a doctor. During the visit, the ophthalmologist will carry out a dilated eye examination to assess visual acuity, check the pressure in the eye, and examine the optic nerve for signs of damage.

What steps can people take in their daily lives to protect their eyes — from diet and exercise to blood sugar control?

The two major steps to protect your vision are proper nutrition and maintaining a healthy lifestyle. It is important to adopt and follow a diet rich in fruits, leafy greens, oily fish, and nuts, that provide essential nutrients including omega-3 fatty acids, vitamin A, vitamin C, vitamin E, and zinc. It is important to maintain blood sugar levels at the proper levels and follow an exercise schedule. In addition, it is necessary to quit smoking, reduce stress, wear sunglasses, and get your eye examined routinely, particularly if you have diabetes.

For those already diagnosed, what new treatments or technologies are helping people preserve their sight?

The two main approaches to treat diabetic retinopathy are injection with medications that inhibit VEGF (a molecule that promotes growth of abnormal blood vessels) and laser treatment to destroy the newly formed abnormal blood vessels thereby prevent leakage of their contents. New treatments for diabetic retinopathy include implantable drug delivery systems for a long-term release of anti-VEGF medications and corticosteroids, to reduce the damage due to leaky blood vessels and inflammation. Other advancements in the field are leveraging developments in artificial intelligence to facilitate better and more accurate diagnosis of diabetic retinopathy so that treatments can be initiated early on during the course of the disease.

For more information on NTERI, please visit our website to learn more about eye health and research.

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