Eye Conditions Complicated by Diabetes

In our previous blog, we discussed various eye conditions that can affect our elderly population. In addition to those conditions, having diabetes only further complicates eye health. Because diabetes in itself is such a prevalent disease, Assisted Living Education has devoted an entire blog to diabetic eye disease and some preventative measures we can take to maintain good eye health for our elderly residents.

Diabetic Eye Disease

Diabetic eye disease refers to a group of four eye conditions caused by diabetes:  diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma.  People who have diabetes are at risk for developing diabetic eye disease, which can lead to extreme vision loss or blindness, and the risk increases as they age.  To prevent loss of vision, it is very important for people with diabetes to have a dilated eye exam at least once per year.  According to the National Eye Institute (NEI), somewhere between 40%-45%  of diabetic Americans already have diabetic retinopathy, but only 50% of those people are aware they have it.  In fact, the most common cause of blindness in American adults with diabetes is diabetic retinopathy.  Fortunately, early detection, treatment, and careful management of diabetes can prevent or delay the onset of vision loss caused by diabetic eye disease.

Types of diabetic eye disease

  • Diabetic retinopathy affects the blood vessels of the retina, a light-sensitive tissue that lines the back of the eye. It is the most commonly occurring form of diabetic eye disease, and it is initially asymptomatic.  By the time symptoms emerge, the eyes have already sustained a significant amount of damage.  Diabetic retinopathy is caused by consistently high blood glucose levels, which, over time, damage the retina’s blood vessels.  These blood vessels may swell, leak, or bleed; eventually they can become blocked.  This typically distorts vision; the patient may see spots that appear to be floating across their path of vision.  As the condition advances, irregular blood vessels begin to form on the retina’s surface in order to compensate for the other blood vessels that have become unable to transport blood due to swelling and distortion.  If the condition remains untreated, these irregular blood vessels will become more abundant; they begin to grow into the vitreous fluid in the center of the eye and leak or bleed.  Scar tissue is often also present at this advanced stage, posing a risk of retinal detachment, which results in an irreversible loss of vision.
  • Diabetic macular edema (DME) is an accumulation of fluid in the macula that occurs as a result of diabetic retinopathy. The macula is the most sensitive area of the retina, and it is associated with the kind of highly accurate, central vision that allows a person to see straight ahead, recognize faces, read and write, etc.  This accumulation of fluid produces swelling, which results in blurry vision.  Of all patients who already have diabetic retinopathy, half of them will experience DME (NEI,) and it can occur during any stage of diabetic retinopathy.
  • Cataract is a condition of cloudiness in the lens of the eye.  The lens is clear and composed mainly of water and proteins.  Those proteins are positioned in such a way that light can pass through the lens.  Cataract forms when, over time, some of the proteins bunch up together in the lens. This makes it difficult for light to pass through.  Cataract is typically removed with surgery.  For an adult who has diabetes, developing cataract is two to five times more likely than for adults who do not have diabetes.  Cataract also tends to appear at an earlier age for people with diabetes.
  • Glaucoma refers to a group of diseases that cause damage to the optic nerve, which sits at the back of the eye and connects to the brain.  Increased eye pressure causes most types of glaucoma.  When fluid inside the eye builds up but is not able to drain quickly enough, the resulting pressure can damage the optic nerve.  People with glaucoma lose their peripheral vision first; their vision will become more and more centralized over time and eventually be lost. There is no cure for glaucoma, but its progression can be slowed with medication, laser treatment, and surgery.  People who have diabetes have two times the risk of developing glaucoma than people who do not.

What can be done to prevent or delay the onset of diabetic eye disease?

The most effective way to prevent or delay the onset of diabetic eye disease is for people with diabetes to have a comprehensive dilated eye exam at least once a year.  Exams are crucial for early detection, because early stages of diabetic eye disease do not always exhibit symptoms right away.  If diabetic retinopathy has already been diagnosed, patients should have eye exams more frequently, depending on how advanced their diabetic retinopathy is.  People who experience any changes in vision, particularly blurred vision or floating spots, should see a doctor as soon as possible.  In a comprehensive dilated eye exam, the doctor looks for changes in the lens or blood vessels, leaking of the blood vessels, nerve tissue damage, and swelling of the macula.

Also effective in preventing or delaying the onset of diabetic eye disease is keeping blood sugar levels within a normal range as much as possible (according to the Diabetes Control and Complications Trial, NEI.)  Keeping blood pressure and cholesterol under control can also help lessen the risk of diabetic eye disease in people with diabetes.

Working together as a team in an assisted living facility can help ensure that we stay on top of our residents’ health. For those diagnosed with diabetes or other health conditions, frequent visits with the attending doctor or the residents’ physicians or specialists can help catch any new developments in their early stages. Dieticians are also helpful in monitoring the residents’ diets and making the appropriate accommodations are made for their nutritional health. It is important for CNAs, nurses, and other staff to develop good rapport with their residents, and get to know their ‘normal’ or baseline disposition to make any changes in behavior or physical appearance easier to note and subsequently evaluated.

Assisted Living Education is committed to the top care and services for the assisted living community. We are a premier provider in RCFE classes, continuing education, products, licensing, and other services for assisted living. Explore our website for more information, visit our contact page, or give us a call (714) 747-0725 or Toll Free 1-855-200-0188 for immediate assistance.


About Assisted Living Education
Assisted Living Education has been operating in and improving the growing senior care industry for over 15 years. Founded by certified RCFE administrators, Jane Van Dyke-Perez and Bill Perez, we have licensed more than 1,100 assisted living facilities and built close relationships with the California Department of Social Services, assisted living managers, owners and industry professionals. As senior living care educators ourselves, we strive to contribute our knowledge and skills to continually improve senior care and the satisfaction of those working in the industry.