Diabetic Eye Care

Diabetes is the leading cause of blindness in the United States for patients age 20 to 65. Diabetes can affect vision in a variety of ways. Vision loss occurs commonly from two major problems proliferative diabetic retinopathy and diabetic macular edema but other eye diseases may develop secondary to diabetes. 

Dilated Examinations:  Our doctors perform a dilated retinal examination on diabetics at least once a year. Our doctors will check for diabetic retinopathy. If significant retinopathy is found our doctors may monitor the diabetic patient more frequently or refer the patient for other testing with a retinal surgeon.

Fluctuating Vision: Diabetics often experience fluctuations in their vision related to changes in nearsightedness or farsightedness casused by ups and downs in their blood sugar. As a diabetic's blood sugar changes, the shape of the lens of the eye changes. Before prescribing eyeglasses for a diabetic patient, doctors frequently will need to retest the patient on another day to test for these fluctuations in vision.

Loss of Central Sharp Vision:  Macular edema is a swelling of the delicate macular tissue in the center of the retina. It does not cause total vision loss, but causes a loss of visual acuity. Macular edema can be treated with laser if identified in the early stages. Your optometrist or ophthalmologist can detect this swelling through a dilated retinal examination using a microscope and special lenses. Laser can reduce vision loss if caught in time. Vision loss caused by macular edema responds well to magnification.

Our Cirrus Optical Coherence Tomography helps our doctors quickly diagnose diabetic macular edema. On the top below we see a normal OCT scan through the retina. On the bottom is a macula with severe swelling or DME Diabetic Macula Edema

Profound Loss of Vision: Proliferative diabetic retinopathy is the most visually threatening and dangerous condition a diabetic may have to deal with. It has the potential to cause profound vision loss by damaging the small blood vessels of the retina. Then chemicals are released from the retina, which cause abnormal blood vessels to grow. These blood vessels break and bleed creating scar tissue within the eye. As the scar tissue contracts, it may pull on the retina leading to a retinal detachment. Laser treatment can reduce the risk of severe vision loss by 50%. 

The Diabetic Low Vision Patient: Visually impaired diabetics have specific needs to be addresses in the low vision examination. Diabetics must be able to see to fill insulin syringes and take oral medications. They need to see to test their blood sugar. Diabetics need to read labels on food containers to control their intake of carbohydrates. Diabetics, additionally, may have neuropathies affecting their feet. If the patient is unable to see his or her feet, care by their physician, podiatrist or family may be needed to monitor the health of their extremities. Glare and the loss of contrast sensitivity need to be addressed. 

Color Vision Impairment:  Color vision may be mildly affected along the yellow-blue axis.      

Neovascular Glaucoma:  Abnormal blood vessels may also grow into the front portion of the eye, blocking the normal outflow of fluid from the eye, causing a severe painful glaucoma. This form of glaucoma can be prevented by timely laser treatment of the retina. But once this type of glaucoma is established, it is very difficult to control and can lead to profound vision loss.  Our doctors will examine the iris or colored portion of your eyes to check for abnormal blood vessels.

Cataracts:  Diabetics develop cataracts at a much earlier age than non-diabetics. Cataracts may also occur in young diabetic children.  Cataracts cause fogginess or clouding of vision. Additionally, glare outdoors and from oncoming headlights may become worse.

Diplopia or Double Vision

An occasional complication that diabetics may have is double vision. This is usually caused by a temporary paralysis of one of the six muscles in control eye movements. Double vision is very bothersome to the patient, but it often resolves over several weeks to months.

If our doctors diagnose diabetic retinopathy that may require surgical treatment the diabetic patient will be referred to a retinal surgeon.

 Reduced Side Vision After Laser

Laser treatment is crucial in saving the sight of many diabetics. Laser, however, causes other visual problems that should be addressed by the low vision specialist.  Pan-retinal photocoagulation laser treatments require hundreds of laser burns across the peripheral retina. By lasering these peripheral areas, more oxygen is available to the supply the crucial center of the retina, where our sharpest vision exists. Unfortunately, we must sacrifice part of the side vision to save the center vision. Night driving may become more difficult and glare problems may occur.

Loss of Contrast Sensitivity and Glare Problems”

Patients often describe a “hazy-glare” after laser surgery. Contrast sensitivity, the ability to judge subtle differences in images. Our world is one of subtle contrasts. We use contrast sensitivity to see faces or find a dark object on a darker background. Amber filters like the Corning CPF series reduce the glare and may aid contrast.

Reduced Night Vision After Laser

The peripheral retina contains more of the rod cells that we use to see at night. Thus in lasering of the peripheral retina, the diabetic patient lose more rod cells that we need to see with at night. If extensive laser has been performed, night driving may become dangerous. Milder forms of laser called focal laser, may increase glare, but have less effect on the peripheral vision and not decrease night vision as dramatically.


The key to diabetic vision loss is to prevent it through early detection and treatment.  Diabetes can have a vast range of vision problems. Once vision loss occurs, the low vision specialist can aid the diabetic cope with many of these problems.