*Ashley Loerzel, 35, a hairstylist with type 1 diabetes, who lives in Orlando, FL, was diagnosed with diabetic macular edema (DME) six years ago and, ever since, she has needed regular eye injections to retain her vision. Read on as she shares her thoughts and feelings. Her goal? To help people with DME cope with the condition and feel less isolated.*

I was 12 when I was diagnosed with type 1 diabetes, and so I've had years of practice learning to manage my condition. I'm careful about my diet (no white flour anything) and taking my medications (though every insulin shot still brings a little anxiety). But what I didn’t expect was for my eyesight to change so suddenly.

When I was 29 years old, one of my friends told me she was going for an eye appointment, and I realized I had missed my annual appointment so I went along with her. I hadn't noticed any blurriness nor did I have any other symptoms like floaters or sensitivity, but when you have diabetes, annual eye exams are important and I learned why first-hand: During that visit, the doctor found signs of diabetic retinopathy in my eyes. Specifically, he saw microaneurysms, which are essentially leaking blood vessels. I needed to see a specialist right away.

That specialist confirmed the [diagnosis of DME](https://www.healthcentral.com/slideshow/dme-risk-factors) in June 2015 and told me I’d need regular eye injections to stop the bleeding and to prevent new blood vessels from forming. Since I was a diabetic, I’d heard of DME, but the idea of a needle going into my eye freaked me out; I was worried about pain and infection. It was horrible at first because I needed them every four to six weeks. I really struggled and cried every time I had to have it done, and I would fall into a deep depression afterwards. It was one of the hardest times in my life.

I started to take anti-anxiety medicine before the appointments, and that helped. And now that I’ve been getting them for some time, the [eye injections](https://www.healthcentral.com/video/what-to-expect-eye-injections) are more uncomfortable than anything else. You will be very numb, so you feel more of a pressure and very minimal pain during the procedure. 

I believe that because I caught it in the early stages and started treatment when I needed to, my eyes do very well with these injections. I now get the injections every seven weeks (instead of every four to six weeks) to maintain the great vision quality I have.

At one point, in 2017, my eyesight started to get blurry, so my doctor tried using a laser to see how I would respond, but it didn’t do much to help. The laser cuts off leaking hemorrhages, but my edema is chronic, so it keeps coming back.  I just do injections now, and they’ve become a regular part of my life, helping me keep my vision.

Having DME affects my life in every way. For example, work: I was in retail management before I was diagnosed. I wanted to change careers but I needed to search for a job that would enable me to have flexible hours because my eyes are so unpredictable. Sometimes I wake up and they’re blurry, and I will need an injection a week or two before my appointment. So, I went to Paul Mitchell and have been doing hair ever since. 

Truthfully, I worry about my DME every day. I base my schedule around my injections. I make my own schedule, so I have all the flexibility I need. If I have an injection on a Friday, I will take that day off so I can rest afterward. I have an incredible doctor (it's very important to find someone you trust) but I still have anxiety with my appointments and they do take an emotional toll.

I’m do worry I will lose my vision (especially when I experience a little bit of blurriness), but my doctor tells me I won’t. He says it’s because I go to every appointment and he’s right: I’m religious about this. I don’t ever change them.

Despite my DME, my life is full. I’m a wife and I love my dogs. I love to exercise outside, I love to sing, I love music and I love to be with my family. 

And, no matter how difficult these injections are, I’m grateful they exist. Without them I’d be blind. That’s why I tell people to always listen to your doctors and get the treatments. You’ll be okay. You’ll get through it because you have to.


iStock-690903702

eye shot-iStock-690903702

One woman shares how she was diagnosed with diabetic macular edema and how she's come to terms with the eye injections required to treat the chronic condition. 

Living with DME

Diabetic macular edema (DME) treatment varies from patient to patient. Typically, you will receive ANTI-VEGF medications, corticosteroids, or NSAIDs.

More Info on Diabetic Macular Edema

DME Treatment

We went to some of the nation’s top vision experts in diabetic macular edema treatment to bring you the most up-to-date information possible. 

Diabetic Macular Edema Treatment

You've got options for treating your DME. This info will help you make those decisions with confidence. 

Let's Talk About Diabetic Macular Edema Treatment

What Are the Treatments for Diabetic Macular Edema?

One woman shares her ongoing battle with diabetic macular edema, a chronic condition that untreated can lead to blindness. 

Diabetic Macular Edema Almost Stole My Sight

Living With Diabetic Macular Edema 

doctor holding model of eye-iStock-815984508

Your complete guide to protecting against—and living with—diabetic retinopathy.

Eyes on Diabetes

Being told you have one chronic condition can be *a lot*. Being told you might be experiencing *another* medical condition as a result of the first one can be downright frustrating. For a portion of people with diabetes, this scenario is all too familiar. 

According to the National Eye Institute, changes in the eyes from diabetes—characterized by elevated blood sugar levels—is the leading cause of new blindness in the United States for adults between 25-64 years of age.  

Diabetes weakens the structure of small blood vessels throughout the body, causing leakage. “The blood vessels in the eye are very small and can easily be damaged by a prolonged period of elevated blood sugar,” says Raghu C. Murthy, M.D., chief of pediatric retinal surgery at Cedars-Sinai Medical Center in Los Angeles. “If these blood vessels begin to corrode, they can leak into the vitreous as well as the retina.” The vitreous is that gel-like substance that sits behind your lens. Your retina is that layer of light-sensitive tissue at the back of your eyeball that’s responsible for converting images to electric signals, which get sent to your brain via the optic nerve.

When the blood vessels leak into the center of the retina—a.k.a. the macula—you can develop diabetic macular edema (DME), which affects up to 10% of people with diabetes. Edema means “swelling,” and DME specifically refers to swelling of the retina. “As fluid builds up within the macula, it can cause blurry or distorted vision and lead to several serious conditions such as a retinal detachment and blindness,” says Theodore Leng, M.D., retina specialist at Stanford Health Care in Stanford, CA. DME is a serious condition, but it can be treated. 

Tests are never fun, but in order to diagnose DME, your doctor will have to run through a series of them to assess the state of your macula and determine the best course of treatment. “The macula's main role is to process information in our central vision,” says Michael Richardson, M.D., medical director of the Boston office of One Medical, a national primary-care practice. “When it’s impaired, like with DME, our central vision starts to deteriorate while our peripheral vision stays intact.” 

If you’re worried about spending an entire day at the doctor’s office, don’t—despite the various tests you’ll need to go through to determine whether you have DME, you’ll be in and out in no time. “Patients will first receive the eye exam, which includes the visual acuity test, amsler grid and dilated eye exam,” Dr. Murthy says. “After this, OCT imaging and fluorescein angiography will be performed to provide further details on the patient's condition.” The eye exam takes about 15 minutes (not counting the typical waiting room, flip-through-magazines-and-scroll-through-Instagram time, of course). OCT, Ocular Coherence Tomography, is just another fancy acronym for a machine that scans microscopic changes to the retina, which then shows if there is DME present. This imaging takes about two minutes, and fluorescein angiography takes about 10 minutes. To officially diagnose DME, your doctor may need to perform all of these, but thankfully, all that testing won’t eat up your whole day. 

Here’s what to expect from each DME eye test:

### Visual Acuity Test

If you’ve ever been to the eye doctor, you’ve probably taken a visual-acuity test. It’s the exam that uses a standardized chart of letters of varying sizes (called a Snellen chart). When you take a visual-acuity test, your doctor will ask you to sit or stand 20 feet (or 6 meters) from the chart and cover one eye while reading certain lines of letters out loud. This test helps your doctor figure out how well you can see through your central vision and whether your vision is getting worse. 

### Amsler Grid

“Visual acuity and the Amsler grid are subjective visual tests used to determine the extent of damage to a patient's vision,” Dr. Murthy says. “The Amsler grid is a grid composed of many identical squares with white lines and a black background. This test is used to determine if the patient is experiencing distorted vision and which regions of their visual field are affected. If you see the white lines within the grid as curved or wavy, this may be indicative of fluid within the macula.” 

### Dilated-eye Exam

If you’ve ever had your eyes dilated, you know what’s in store: giant, Disney character-style pupils and some post-exam light sensitivity (so make sure to pack your sunnies). This painless test involves getting special drops put in your eyes that affects the muscles of your iris, which causes the pupils to enlarge (depending on which dilation drop is used it can cause a certain muscle to contract vs paralyze another, both with the same dilating outcome. The drop used can vary from eye care provider). According to Dr. Murthy, the dilated-eye exam is the only way your eye doctor can get a good look at the peripheral part of your retina, which lets them see if there are other issues affecting it. 

During the test, your doctor will perform what’s known as an “indirect ophthalmoscope,” which is a fancy way of saying they’ll shine a very bright light into your eye to examine the retina. This shouldn’t be too uncomfortable, but you may want to brace yourself for an intense light show.

### Optical Coherence Tomography 

“Several imaging studies like this one are also done to diagnose diabetic macular edema,” Dr. Murthy says. “Ocular coherence tomography (OCT) determines the amount of fluid or swelling in the macula by measuring retinal thickness.” The test uses a special light and a camera that gives detailed views of the retina’s cell layers. Using these tools, your doctor can determine the thickness of your retina, which can help them figure out whether the macula is swollen. 

### Fluorescein Angiogram 

If your eye exam and OTC results have your doctor suspecting DME, you might have to get one more test called a fluorescein angiogram. This one isn’t too bad either, but be warned: It does involve getting a shot (in your arm, not your eye!). Your doctor will use a needle to inject you with a small amount of a yellow dye called fluorescein that reaches the blood vessels in the eye about 10-15 seconds after it’s injected into the arm. Once it reaches the eyes, it causes them to shine brightly, or fluoresce. “Fluorescein angiography is used to directly look at the health of the blood vessels in the eye,” Murthy says. “The injected dye illuminates the blood vessels in the eye and can show if any of the blood vessels are actively leaking within the macula.” 



senior woman getting Dilated Eye Exam-iStock-677455576

Diabetes is the leading cause of new blindness in the United States. Here are the most common tests for diabetic macular edema and what you can expect.

DME Eye Tests

So, your doc suspects you may be experiencing some diabetes-related vision issues like macular edema. Step one is to get tested. Here's what you can expect.

Cheat Sheet: The Eye Tests You'll Take for Diabetic Macular Edema

- __DME Facts:__ Prevent Blindness. (n.d.). “Diabetic Macular Edema (DME).” [preventblindness.org/diabetic-macular-edema-dme](https://www.preventblindness.org/diabetic-macular-edema-dme)
- __Visual Acuity Test Info:__ National Institute of Health. (2019). “Visual acuity test.” [medlineplus.gov/ency/article/003396.htm](https://medlineplus.gov/ency/article/003396.htm)
- __Ophthalmoscopy Overview:__ National Institute of Health. (2019). “Ophthalmoscopy.” [medlineplus.gov/ency/article/003881.htm](https://medlineplus.gov/ency/article/003881.htm)
- __Focus on Macular Edema:__ National Eye Institute. (2019). “Macular Edema.” [nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/macular-edema](https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/macular-edema) 
- __Fluorescein Angiography Tests:__ American Academy of Ophthalmology. (2018). “What Is Fluorescein Angiography?” [aao.org/eye-health/treatments/what-is-fluorescein-angiography](https://www.aao.org/eye-health/treatments/what-is-fluorescein-angiography)
- __Vitreous Degeneration:__ Kellogg Eye Center. (n.d.). “Vitreous Degeneration.” [med.umich.edu/1libr/Ophthalmology/comprehensive/VitreousDegeneration.pdf](http://www.med.umich.edu/1libr/Ophthalmology/comprehensive/VitreousDegeneration.pdf)  
- __Retina Info:__ National Institute of Health. (n.d.). “Retina.” [medlineplus.gov/ency/article/002291.htm](https://medlineplus.gov/ency/article/002291.htm)
- __Diabetic Retinopathy:__ Mayo Clinic. (2018). “Diabetic Retinopathy.” [mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611](https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611)


Areen Hosein, O.D.

Medical Reviewer

Eye Tests for Diabetic Macular Edema

Cheat Sheet: The 5 Eye Tests You’ll Take for DME 

It gets harder to take care of yourself when you start to lose your vision. Here are common questions people have about DME, and advice for maintaining your independence if you have the disease.

DME and Independence

If you’ve been diagnosed with diabetes, losing your eyesight might not be the first thing you’re worried about. But it’s more common than you think: Of diabetics with retinopathy, 50% develop diabetic macular edema (DME)—the most common cause of vision loss for diabetics. 

DME Risk Factors

hand holding glasses with blurred background

hand holding glasses with blurred background-bud-helisson-kqguzgvYrtM-unsplash

Losing your eyesight is one of the most serious complications of diabetes. Early detection can make a difference—here’s what to look for.

8 Risk Factors for Diabetic Macular Edema

Mature blind man with dog-iStock-1083672882

Losing your eyesight means making changes in how you live your life. But with the right setup, you can still take care of yourself.

Dealing with Diabetes-related Vision Loss? Here's How to Maintain Independence

- __Diabetes Prevalence:__ Centers for Disease Control and Prevention. "National Diabetes Statistics Report, 2017." [cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf](https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf)

- __DME and Blindness:__ *American Journal of Managed Care*. (2016). “Overview of Diabetic Macular Edema.” [ajmc.com/journals/supplement/2016/improving-outcomes-in-diabetic-macular-edema-the-impact-of-new-therapies-in-managed-care/overview-of-diabetic-macular-edema?p=1](https://www.ajmc.com/journals/supplement/2016/improving-outcomes-in-diabetic-macular-edema-the-impact-of-new-therapies-in-managed-care/overview-of-diabetic-macular-edema?p=1)

- __DME and Anti-VEGF Injections:__ American Academy of Ophthalmology. "Anti-VEGF Treatments." [aao.org/eye-health/drugs/anti-vegf-treatments](https://www.aao.org/eye-health/drugs/anti-vegf-treatments)

- __DME and Grooming, Eating, Etc:__ MD Support. (n.d.) “A Self-Help Guide to Non-Visual Skills.” [mdsupport.org/guide.pdf](http://www.mdsupport.org/guide.pdf)


Shira Eytan, M.D.

How Diabetic Macular Edema Affects Independence

What Is DME?

If I Have DME, Will I Go Blind?

Are There Tools to Help Low Vision?

Will I Still Be Able to Drive?

How Can I Grocery Shop if I Can’t See?

Are There Ways to Make Daily Tasks Easier?

Will I Have to Move?

Will I Need Help Dressing?

Can I Still Do My Own Makeup?

How Do I Shave?

What If I Embarrass Myself When I Go Out?

Remember: Early Detection Is Key

Dealing with Diabetes-Related Vision Loss? Here's How to Maintain Independence

A few simple strategies can help people with diabetes prevent eye disease and protect their vision. 

Prevent Diabetes Eye Problems

Prevent diabetic eye disease (or keep it from getting worse) with these sight-saving strategies.

9 Tips to Prevent Eye Problems When You Have Diabetes

How to Prevent Diabetic Retinopathy

- __Diabetes, Diabetic Retinopathy, and DME Statistics:__ National Eye Institute. (2019). “Diabetic Retinopathy.” [nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy](https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy)

- __High Blood Pressure and DME:__ NIH: U.S. National Library of Medicine. (n.d.) “Retinal Vein Occlusion.” [medlineplus.gov/ency/article/007330.htm](https://medlineplus.gov/ency/article/007330.htm)

- __Hypoalbuminemia and DME:__ *Digital Journal of Ophthalmology*. (1997). “A Review of Diabetic Macular Edema.” [djo.harvard.edu/site.php?url=/physicians/oa/387](http://www.djo.harvard.edu/site.php?url=/physicians/oa/387)

- __DME and Vision Loss:__ NIH: U.S. National Library of Medicine. (n.d.) “Risk Factors Associated with Diabetic Macular Edema.” [ncbi.nlm.nih.gov/pubmed/23380134](https://www.ncbi.nlm.nih.gov/pubmed/23380134)

- __DME and Hypertension: University of Michigan Medicine:__ Kellogg Eye Center. (n.d.) “Diabetic Retinopathy.” [umkelloggeye.org/conditions-treatments/diabetic-retinopathy](https://www.umkelloggeye.org/conditions-treatments/diabetic-retinopathy)

- __DME and Pregnancy:__ Centers for Disease Control and Prevention. (2019). “Gestational Diabetes.” [cdc.gov/diabetes/basics/gestational.html](https://www.cdc.gov/diabetes/basics/gestational.html)

- __DME and Anemia:__ *Eye*. (2019). “Anaemia and the Risk of Progression From Non-Proliferative Diabetic Retinopathy to Vision Threatening Diabetic Retinopathy.” [ncbi.nlm.nih.gov/pubmed/31586167](https://www.ncbi.nlm.nih.gov/pubmed/31586167)



Amir Marvasti, M.D.

Risk: High Blood Sugar

Risk: Hypertension

Risk: Low Blood Protein Levels

Risk: Smoking

Risk: Pregnancy

Risk: Ethnicity

Risk: Fluid Retention

Risk: Anemia

Your eye health may be the furthest thing from your mind if you have diabetes, but what you might not know is that the disease can directly impact your vision. According to the Centers for Disease Control and Prevention, [diabetic retinopathy—a vision complication from diabetes](https://www.cdc.gov/features/diabetic-retinopathy/index.html) leading to damage or swelling of blood vessels in the retina—is the most common cause of vision impairment and blindness in adults in the U.S. and by 2050 will affect roughly 14.6 million people. 

That's not the only diabetes-related condition that can damage eye health. "Diabetic eye diseases can affect almost all parts of the eye and surrounding structures," says Matthew Gorski, M.D., a Northwell Health ophthalmologist at the Ophthalmology and Ocular Surface Center in Great Neck, NY. "The lens of the eye (where cataracts form) and the retina, the inside wallpaper where light rays are absorbed, are the most common areas where diabetes can cause eye problems." 

Here, experts explain the main types of diabetic eye disease, the role glucose plays in the severity of these conditions, and most importantly, how people living with diabetes can protect their vision.

## The Role of Glucose in Eye Health

High blood sugar can damage the pancreas, harden blood vessels, and over time, increase your risk of heart attacks and kidney disease. But in addition to these health risks, glucose that spikes too high can also harm your sight. "Fluctuations of blood-glucose levels significantly affect vision in both the short term and long term," says Orlin Sergev, M.D., Ph.D., owner of [Equilibrium Endocrinology & Diabetes Center](https://equilibrium4u.com/) in Ladson, SC. 

"In the short term, both high and low blood-glucose levels (especially with sudden changes) can cause vision to become blurry [due to fluid moving in and out of parts of the eye]," he says. "Long-term mismanaged glucose affects the blood vessels in the retina, which can cause permanent vision damage, including blindness." 

This is why it's important for people with diabetes to see their eye doctor at least every nine to 12 months even if they have no symptoms, says Dr. Gorski, as the earliest stages of diabetic eye disease can often be asymptomatic. 

## Diabetic Retinopathy (DR)

Think of DR as the gateway condition to all other diabetic eye diseases. "With DR, elevated blood-glucose levels progressively damage the vessels in the retina, leading to swelling and bleeding that ultimately damages vision," says Dr. Sergev. "The severity is usually dependent upon the length of disease and the level of [glucose] control." 

So while high glucose levels initially wreak havoc on blood vessels surrounding the eyes, affecting your vision by increasing blurriness or interfering with your ability to distinguish between colors, it's the continuous swelling and leaking of these vessels that can lead to other conditions like cataracts, glaucoma, and diabetic macular edema (DME). 

How many people are affected by DR? The overall prevalence of [diabetic retinopathy in adults with diabetes in the U.S. is 28.5%](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945293/). There's also a class of diabetic retinopathy called vision-threatening diabetic retinopathy, and that's about 4.4% of diabetic adults. 

"This means almost one-third of all diabetics have some form of diabetic retinopathy, and about five percent of them are going to have it severely affect their vision," says Dustin French, Ph.D., associate professor of ophthalmology at Northwestern University Feinberg School of Medicine in Chicago. 

Currently, there's no known cure for diabetic retinopathy. However, retinal specialists can preserve sight and may reverse vision loss from diabetic retinopathy through various methods. Those might include injecting medication into the back of the eye, performing laser procedures, and/or retinal surgery.

According to the Mayo Clinic, [symptoms of DR] include (https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611):

- Floaters
- Blurred or fluctuating vision
- Impaired color vision
- Dark or empty spots in your vision
- Vision loss

## Diabetic Macular Edema (DME)

One of the most common eye conditions people with DR encounter (especially those with type 2 diabetes) is DME, which happens when uncontrolled blood sugar causes swelling of the retina, says Dr. French. This causes vessels in the eye to leak out or restrict blood flow, leading to a loss in the central-most part of your vision.

"Over time, this creates black spots in a person's vision as their vessels begin to deteriorate," says Dr. French. And while the thought of your vision being taken away can be terrifying, DME can be easily treated, says Dr. French. (Yet another reason to stay on top of those checkups.) [Eye injections with anti-VEGF medications](https://www.aaojournal.org/article/S0161-6420(19)32176-1/fulltext) can manage the abnormal vessels and help prevent blindness. (OK, yes, they do require shots into your eye, but we can [help you prepare for that](https://www.healthcentral.com/slideshow/wet-amd-eye-injection-fears).)

According to the American Academy of Ophthalmology, symptoms of DME include:

- Blurred or wavy central vision
- Colors appear washed out
- Difficulty reading

## Cataracts and Glaucoma 

Even if you aren't dealing with conditions like DR and DME, it's important to get your eyes checked regularly to stay on top of other eye conditions like cataracts (a clouding of the eye lens) and glaucoma (a group of conditions that damage the optic nerve). "Cataracts are five times more frequent in diabetics and glaucoma is two to three times more frequent," says Dr. Sergev. 

Although the link between diabetes and cataracts is still murky, Dr. French says cataracts or glaucoma are often diagnosed at the same time a person gets screened for diabetic retinopathy, and this diagnosis may be due to certain lifestyle risk factors (such as smoking, excessive alcohol intake, or obesity) in addition to being diabetic. 

What's more, the symptoms of cataracts and glaucoma, like blurry vision, distortion, and other eyesight changes, can often overlap with more serious conditions like DR and DME. This is why in addition to maintaining your glucose levels, eating a well-balanced diet, and not smoking, people with diabetes should closely monitor their eye health with a yearly dilated eye exam to help decrease the chances of developing diabetic eye disease—as well as get proper treatment for any eye issues that do arise as quickly as possible.



glasses and blurry eye chart-david-travis-aVvZJC0ynBQ-unsplash

Diabetes can cause diabetic retinopathy, macular edema, and more. Know the risks and what you can do to protect your sight. 

Diabetic Eye Disease

Diabetes can affect every part of the eye. Know the risks and how to protect your sight. 

Everything You Need to Know About Diabetic Eye Disease

- __Diabetic Retinopathy Basics:__ *Centers for Disease Control*. (2018). "Watch Out for Diabetic Retinopathy."  [https://www.cdc.gov/features/diabetic-retinopathy/index.html](https://www.cdc.gov/features/diabetic-retinopathy/index.html)

- __DR symptoms__: *Mayo Clinic*. (2018). "Diabetic Retinopathy." [https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611](https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611)

- __DME symptoms__: *American Academy of Opthamology*. (n.d.). "Macular Edema Symptoms." [https://www.aao.org/eye-health/diseases/macular-edema-symptoms](https://www.aao.org/eye-health/diseases/macular-edema-symptoms)


Rodrigo Barros, M.D., Ph.D.

Diabetes and Eye Disease: Everything You Need to Know

If you've been diagnosed with diabetes, no doubt you have a lot of questions, especially about how the condition can affect your eyesight. Suddenly you're hearing terrifying phrases like "diabetic retinopathy" and heading down an internet rabbit hole of worry. 

However, there is good news: With careful monitoring and early treatment, there is a lot you can do to protect your vision. Here are questions you can ask your ophthalmologist at your next visit.
 
## What Is Diabetic Retinopathy? 

Diabetic retinopathy (DR) is the most common form of diabetes-related eye disease and the leading cause of blindness in working-age Americans, according to the Centers for Disease Control and Prevention (CDC). 

Usually, the retina receives focused light from the eye's lens and converts it into signals the brain can use to create visual recognition. When people with diabetes have uncontrolled blood sugar, diabetic retinopathy can occur, causing the blood vessels in the retina to leak and distort vision. 

"The most common way diabetic retinopathy causes vision loss is via swelling in the central part of the retina, called diabetic macular edema, or DME," says Frank Siringo, M.D., a retina surgeon at Omni Eye Specialists Denver in Colorado. The macula is responsible for our most detailed vision. Diabetic retinopathy can also cause vision loss as the result of bleeding inside the eye or retina detachment. This is why early detection and treatment is so critical for protecting your sight. 

## What Are My Risk Factors for Developing Diabetic Retinopathy? 

There are few factors that can increase your risk of DR. The first? Having a high A1C level. As many people with diabetes know, hemoglobin A1C is a blood test used to diagnose diabetes as well as monitor how well you are keeping your blood sugar under control over a two- to three-month period. The lower your hemoglobin A1C level, the better your blood sugar control, which lowers your risk of complications from diabetes, including diabetic retinopathy. 
 
"Maintaining the hemoglobin A1c below seven percent is a very important way to lower the risk of diabetic retinopathy and lower the risk of vision loss," says Dr. Siringo. 
 
Another risk factor for developing diabetic retinopathy is the length of time you've had diabetes. Approximately half of people with diabetes for longer than 20 years will have diabetic retinopathy, but they do not all develop vision loss, according to Dr. Siringo. 

And finally, having high cholesterol and/or high blood pressure can also increase the risk of damage to the vessels in your eyes. 
 
## What Are the Symptoms of Diabetic Retinopathy? 
 
According to the Mayo Clinic, diabetic retinopathy symptoms can include: 

- vision that is blurred or fluctuating
- impaired color recognition
- dark or empty spaces in the vision
- spots or dark strings floating in your vision (also known as floaters)
- vision loss

Diabetic retinopathy usually affects both eyes. 
 
## If I Don't Have Symptoms, Does That Mean I Don't Have Diabetic Retinopathy? 
 
Unfortunately, in its early stages, you can have diabetic retinopathy without symptoms. This is why it's important to speak with your ophthalmologist about how frequently you should have eye exams that dilate the pupil and examine the back of the eye, according to ophthalmologist Paula Pecen, M.D., an assistant professor of ophthalmology at the University of Colorado School of Medicine who specializes in vitreoretinal surgery. "Some patients need to be seen every year and some need to be seen more," says Dr. Pecen. "Follow up can prevent vision loss."

According to recent findings from the American Academy of Ophthalmology, currently only about 60% of people with diabetes have annual screenings for diabetic retinopathy. The academy recommends the following screening schedule:

- Those with type 1 diabetes should have annual screenings five years after the onset of their disease.
- Those with type 2 diabetes should have a prompt examination upon diagnosis and at least yearly examinations after that.
- Women who had diabetes before conceiving should be screened early in pregnancy.

## Is Diabetic Retinopathy Reversible? 

While there's no known cure for diabetic retinopathy, retinal specialists can preserve and often restore vision loss from diabetic retinopathy through a variety of methods. These include injecting medication into the back of the eye, performing laser procedures and/or retinal surgery.
 
## Which Medications Can Help With Diabetic Retinopathy?  
 
The severity of diabetic retinopathy can be greatly reduced with medications called VEGF inhibitors, which are periodically injected into the eye by a retinal specialist, says Dr. Siringo. These VEGF inhibitors include:

- Avastin (bevacizumab)
- Beovu (brolucizumab)
- Eylea (aflibercept)
- Lucentis (ranibizumab)

They work by making the blood vessels in the retina less leaky, which allows the swelling in the macula to improve and the vision to become clearer. They have the added benefit of reducing the overall level of diabetic retinopathy. "These medications do not last forever," says Dr. Siringo. "Patients often need treatment every one-to-three months for two or more years to have a successful and lasting outcome." 
 
Steroid implants injected into the eye are a very effective second-line treatment when anti-VEGF is not enough, Dr. Siringo says. "Steroids have the added benefit of providing long-lasting treatment for diabetic macular edema." 

Approved drugs include Ozurdex (a dexamethasone implant), which is effective for three to four months, and Iluvien (a fluocinolone implant), which lasts two to three years. "On the research horizon are newer medications that act in different ways than anti-VEGF or steroids, some of which may not need to be injected into the eye," Dr. Siringo says. 
 
## How Can Laser Treatments Help With Diabetic Retinopathy?
 
Lasers do not reverse diabetic retinopathy, but they can halt the progression of the disease, says Dr. Siringo. 

They are used as an adjunct treatment alongside injections in patients with advanced diabetic retinopathy, or with diabetic macular edema. "New laser platforms are safer and deliver treatment quicker with less discomfort for the patient during and after the procedure," Dr. Siringo says.  
 
## When Is Surgery Best? 
 
Retinal surgery is the treatment of choice when there is severe vision loss from bleeding into the eye (vitreous hemorrhage) or when advanced diabetic retinopathy causes the retina to detach. "Modern surgical techniques employ tiny instrumentation, which often does not require stitches, leading to quicker recovery time and minimal post-operative discomfort," Dr. Siringo says.
 
## What Else Is Important to Know About Diabetic Retinopathy?

According to recent findings from the American Academy of Ophthalmology, maintaining near-normal blood sugar, blood pressure, and cholesterol lowers the risk for developing diabetic retinopathy or having it worsen. Dr. Pecen suggests talking to your doctor about medications and other lifestyle changes that can help with these conditions. 
 
For more information on diabetic retinopathy, visit [The American Society of Retina Specialists](https://www.asrs.org/content/documents/fact_sheet_22_diabetic_retinopathy_new.pdf).



Retinal scan showing diabetic retinopathy

Retinal scan showing diabetic retinopathy-iStock-465947373

Everything people with diabetes will want to know about this surprisingly common condition that can cause blurred vision, black spots, and blindness.

Diabetic Retinopathy

Knowing the signs and symptoms of the three different types of diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes) can aid in diagnosis.

More Info on Diabetes

Diabetes Symptoms

We went to some of the nation’s top experts in diabetes to bring you the most up-to-date information possible.

Despite its common occurrence, signs of this disease can be surprisingly difficult to spot, as many clues are subtle (if visible at all). Learn more about possible ways to tell if you have diabetes.

Let's Talk About Symptoms of Diabetes

Diabetes Signs, Symptoms, and Testing

Despite its common occurrence, signs of this disease can be surprisingly difficult to spot, as many clues are subtle (if visible at all). Learn more about possible ways to tell if you have diabetes. 

Get answers to this and all your other questions about how to best protect your eyesight when you have diabetes.

Can You Cure Diabetic Retinopathy?

- __Diabetic Retinopathy Definition:__ *Centers for Disease Control*. (2018). "Watch Out for Diabetic Retinopathy." [https://www.cdc.gov/features/diabetic-retinopathy/index.html#targetText=Diabetic%20retinopathy%20is%20one%20of,7.7%20million%20to%2014.6%20million](https://www.cdc.gov/features/diabetic-retinopathy/index.html#targetText=Diabetic%20retinopathy%20is%20one%20of,7.7%20million%20to%2014.6%20million)

- __A1C Test:__ *Mayo Clinic*. (2018). "A1C Test." [https://www.mayoclinic.org/tests-procedures/a1c-test/about/pac-20384643](https://www.mayoclinic.org/tests-procedures/a1c-test/about/pac-20384643)

- __Diabetic Retinopathy Info:__ *Mayo Clinic*. (2018). "Diaetes Retinopathy." [https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611](https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611)

- __Preferred Practice Patterns:__ *American Academy of Opthamology*. (2017). "Diabetic Retinopathy PPP." https://www.aao.org/preferred-practice-pattern/diabetic-retinopathy-ppp-updated-2017 


Diabetic Retinopathy: Top Questions to Ask an Ophthalmologist 

Everything you’ll want to ask your ophthalmologist about this surprisingly common condition.

Is Diabetic Retinopathy Curable? + More Qs for Your Eye Doc

Beth Finke, 60, never really liked dogs. In fact, she was somewhat afraid of them until she got her first a Seeing Eye dog 34 years ago, when diabetic retinopathy had left her blind. 

"I had no idea what was involved in taking care of a dog," says Finke, author of *Writing Out Loud: What a Blind Teacher Learned from Leading a Memoir Class for Seniors*. "We never had any animals while I was growing up, and it seemed like a lot of extra work, so the idea of a guide dog never appealed to me."

But Finke had two problems navigating a Chicago sidewalk in one month, and both deposited her in the middle of a busy road. The first time, a driveway got her turned around, and the second time, an insulin reaction left her confused. Each incident could have ended tragically. 

"My fear of dogs suddenly diminished, especially when compared to my fear of ending up on someone's car hood," she says. "If a guide dog could make me safer, more at ease on the streets, and more mobile in general, I thought I should explore that option." 

## Who Should Consider a Guide Dog

A Seeing Eye dog (this name is used only for dogs trained at Seeing Eye in Morristown, NJ) or a guide dog isn't a good choice for every person who is blind. "First and foremost, the person must be willing and able to care for the dog and meet all of its needs," says Seeing Eye spokesperson Michelle Barlak. "It's the bond between the owner and dog that fuels the partnership, so it’s very important that the owner is fully on board." 
 
In fact, Finke's lukewarm feelings for the animals were an obstacle when she applied for her first guide dog from a school in California. "Guide-dog schools interview you before you can train with one," she says. "During my interviews, I was candid about my ambivalence about dogs, and this concerned the school in California enough that they were reluctant to have me come." 
 
But when another unsure candidate backed out of training at The Seeing Eye, where Finke had also applied, the school called her and asked if she could come the following week. "That was perfect for me, because with only one week to prepare to leave for New Jersey, I didn't have enough time to get anxious. I couldn't overthink it and change my mind," says Finke.
 
Ambivalence wasn't an obstacle for Pete Berg, 52, of Naperville, IL, who began losing his vision to diabetic retinopathy in 1993 when he was 25 years old. Instead, the demands of fatherhood took priority. "Training was four weeks, and I had young children at the time," he says. 

Now that his kids are grown, Berg decided this year to get a dog to become more efficient in his travel. "I'm a good traveler with my cane but thought having a dog would make me even better," says Berg. 

Berg researched organizations online and spoke with many guide-dog users, asking about their training experiences, the level of support the orgs provided afterward, and just what life was like with a guide dog in general. 

Ultimately, he chose Guide Dogs for the Blind in San Rafael, CA, and graduated with an 18-month-old black Lab, Lloyd, last August. While the training was mentally and physically exhausting, Berg says, he loves having a guide dog and would do it all over again. "I was a confident cane user, but Lloyd has increased my confidence," says Berg. "I am out traveling and walking more than I ever have since losing my vision."

That active daily routine is essential when you have guide dog. "Much like a person will forget a language they have learned without regular practice, a dog will forget its training if not in a situation where that training is regularly applied," Barlak says. 
 
Also important: The handler should already have independent travel skills, as those are necessary for providing the dog with direction to the intended destination. "Many people are under the impression that the dog is like a GPS. However, it is up to the person to know where they are going and provide directions to the dog. The dog's job is to make sure they arrive safely," Barlak says. 
 
## How Much Does Training a Guide Dog Cost? 

While some organizations say the cost to train each dog can be as high as $50,000, Seeing Eye, which is supported by donations, charges a symbolic tuition of $150 for their constituents' first Seeing Eye dog, $50 for subsequent dogs, and $1 if they are a veteran of the military. 

This is considered the person’s investment into the working partnership with their dog, and while it covers a fraction of the actual total cost, it covers all of the dog's equipment, travel costs for their staff to visit the person's home and perform an evaluation, the cost for the applicant to travel to The Seeing Eye and stay for 18 to 25 days, all the initial training they receive in the care and use of their dog, and follow-up services for the lifetime of the partnership.
 
Typically, the youngest applicants accepted are 16 years old (and many come the summer before leaving for college), but the organization doesn't have strict cut-offs and there have been exceptions. There is no upper age limit for applicants, but instead the organization evaluates individuals on need, physical stamina, and their ability to learn. 

Like Seeing Eye, Guide Dogs for the Blind, where Pete Berg got his, is also supported entirely by donations and provides high-quality student training and extensive follow-up support for graduates.

## The Surprising Benefits of Having a Guide Dog

For Finke, one of the biggest benefits to having a dog is holding a harness rather than the handle of a cane, which she says gives her a feeling of dignity. When she travels with Whitney, her fourth Seeing Eye dog, she says she knows people are looking at the dog, rather than staring at her, which makes her feel better about herself. And while sometimes her dogs have made mistakes, she says, "I feel less embarrassed about mistakes and suffer far less paranoia that people are looking at me all the time." She adds, "And because you always have a dog at your side to talk to, you don't feel so alone."

Berg says thanks to Lloyd, he does a lot more walking and finds his travel to be quicker and more efficient. "A cane helps you find obstructions and a guide dog works you around them," he says. And Lloyd works him around a lot of obstructions as they travel into and out of Chicago's Union Station twice a day, which is teeming with people walking in every direction. "It takes a dog with a certain temperament to handle that type of situation," says Berg. "Lloyd handles it all in stride."

While neither Lloyd nor Whitney are diabetic alert dogs, which are dogs trained to notice the smell a diabetic gives off when blood glucose is too high or low, Berg says having a guide dog has been a benefit to his health and is keeping his diabetes under control: Due to his increased walking, he has lost weight and his A1C, the blood test used to determine the level of blood-sugar control, was the best it has been in years. 

Berg also loves Lloyd’s companionship and natural goofiness when the dog is off the clock. Says Berg, "It is wonderful having a dog that works as hard as he does and then in the evening likes to play like a pup."

## Where to Find a Guide Dog

[Guide Dogs of America](https://www.guidedogsofamerica.org/) 
Sylmar, California 
818-362-5834 
Mail@guidedogsofamerica.org

[The Seeing Eye](https://www.seeingeye.org/) 
Morristown, New Jersey 
973-539-4425 
Info@SeeingEye.org
 
[Guide Dogs for the Blind](https://www.guidedogs.com/) 
San Rafael, California campus 
415-499-4000 
Boring, Oregon campus 
503-668-2100

iStock-516077030

Service dog

Diabetic eye disease is a common cause of vision loss, but having a highly trained guide dog at your side can bring a new level of independence. 

Guide Dogs

If you've lost your vision due to a condition like diabetic retinopathy, one of these highly trained service animals can give you a new level of independence.  

Is a Guide Dog Right for You?

Diabetes Retinopathy: How to Know if a Guide Dog is Right for You

If you've lost your vision due to a condition like diabetic retinopathy, one of these highly trained service animals can give you a new level of independence.

You know how there never seems to be quite enough time to get all of your questions answered during your doctor visits? Well, HealthCentral's "Just One More Question!" video series is here to help! We're asking the top docs in their field to answer all your Qs so you can get a real handle on your condition.

For this edition on diabetic retinopathy (DR) and diabetic macular edema (DME), we asked __Frank Siringo, M.D., O.D., chief of vitreoretinal diseases and surgery at Omni Eye Specialists in Denver__, to demystify these common complications of diabetes. And while these vision problems can be scary, he wants patients to know that they can be treated and even prevented.  We'll let him take it from here.



close-up-photography-of-eye-1069588

Dr. Frank Siringo, chief of vitreoretinal diseases and surgery at Omni Eye Specialists in Denver, answers your most common questions about diabetic retinopathy and diabetic macular edema. 

DME Videos

Diabetic macular edema is one of the most common causes of vision loss, but it doesn’t have to be. For our new video series, Dr. Frank Siringo answers your most common questions about DME and the related eye disease diabetic retinopathy. 

Just One More Question About DME!

Video Series: Doctor Q/A on Diabetic Eye Diseases

Diabetic macular edema (DME) is one of the most common causes of vision loss, but it doesn’t have to be. For our new video series, Dr. Frank Siringo answers your most common questions about DME and the related eye disease diabetic retinopathy (DR). 

Just One More Question About DME (and also DR)!

A few simple precautions can help you prevent slips and fall at home if you're living with diabetes complications like neuropathy or vision loss. 

Diabetes Home Hazards

aerial view of houses-breno-assis-r3WAWU5Fi5Q-unsplash

Diabetes complications like neuropathy and vision loss can increase your chance of falling. We show you how to stay safe. 

Watch Out! Home Hazards for People With Diabetes

Beware These Home Hazards if You Have Diabetes

- __Diabetic Retinopathy:__ *The Lancet*. (2010). "Diabetic retinopathy." [ncbi.nlm.nih.gov/pubmed/20580421/](https://www.ncbi.nlm.nih.gov/pubmed/20580421/)

- __Smoking and Retinal Circulation:__ *Investigative Opthomology & Visual Science*. (2016). "Effects of Habitual Cigarette Smoking on Retinal Circulation in Patients With Type 2 Diabetes." 
[arvojournals.org/article.aspx?articleid=2505737](https://iovs.arvojournals.org/article.aspx?articleid=2505737)

- __Intensive Treatment Study:__ *National Institute of Diabetes and Digestive and Kidney Diseases*. (n.d.). "Blood Glucose Control Studies for Type 1 Diabetes: DCCT and EDIC." [niddk.nih.gov/about-niddk/research-areas/diabetes/blood-glucose-control-studies-type-1-diabetes-dcct-edic](https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/blood-glucose-control-studies-type-1-diabetes-dcct-edic)


Get Your Eyes Screened Regularly

Make Your Appointment for Next Year

Check Your Blood Sugar on the Regular

Eat a Healthy Diet

Exercise Daily

Communicate With Your Healthcare Team

Take Medications as Prescribed

Stop Smoking

Be Your Own Best Advocate

If you have diabetes, an excellent pair of sunglasses is almost as essential to your care plan as your blood-sugar monitor. That may seem like an overstatement, but here’s the truth: Uncontrolled diabetes is the biggest threat to vision for Americans under age 65, leading to problems like cataracts, swelling (diabetic macular edema), and diabetic retinopathy. Know what exacerbates all those complications? Sunlight. "Harmful ultraviolet (UV) light can damage many critical structures of the eye, such as the cornea, lens, and retina. Diabetics are at higher risk, as their ability to repair UV damage is weakened," says Frank Siringo, M.D., a retina surgeon at Omni Eye Specialists Denver in Colorado. 

So we're clear, yeah? UV-blocking sunglasses are non-negotiable. Here's a checklist of what to consider when picking your pair:


## Lens Material: Polycarbonate

Polycarbonate plastic blocks 100% of UVA and UVB rays without the need for any additional coating (they're also lightweight and shatterproof). Even if you opt for a different material, making sure your sunglasses are UV-protected—look for the label "UV400"—is still your number-one priority, says Dr. Siringo.


## Lens Color: Your Choice

The harmful portion of the light spectrum is not in the visible wavelengths, so the intensity of the color of your lenses does not correlate with the amount of protection your eyes receive, says Alan B. Shnay, O.D., an optometrist in Calumet City, IL.  In other words, dark lenses don't block more UV than lighter ones. Darker lenses do, however, allow the pupil to dilate, letting in more light. If the lenses do not block UV, then more of this harmful light will enter the eye. 

That said, the lens color can affect one's comfort level. Dr. Shnay often recommends brown or grey tints if the patient has cataracts, which tend to develop sooner in people with diabetes. "Cataracts decrease contrast sensitivity, and these tints help to minimize the effects of that loss," he says. 


## Polarized Lenses? Yes!

Polarized lenses don't protect against UV rays, but they do minimize glare, which can be particularly uncomfortable for people with diabetic eye disease.  Patients who have had laser treatment for diabetic retinopathy often have particular difficulty with glare and may benefit greatly from polarized lenses, says Dr. Siringo. You can also opt for anti-reflective coating and/or mirrored lenses for further glare protection. If you spend a lot of time outdoors or on the road, the extra investment is worth it. (And don't forget to throw on a wide-brimmed hat to block any stray light.)


## Photochromic Lenses? Maybe

Transitions-brand photochromic lenses, which change from clear inside to dark outside in the presence of sunlight, are completely UV-protective. However, in people with cataracts or diabetic macular edema, they may not be the best choice, says Dr. Schnay.  Even at their clearest, there is a slight reduction in light transmittance, which can adversely affect night driving in those patients. Plus, when driving on a sunny day, the lenses tend not to darken much, since the windshield blocks most of the UV light that cause them to change color. If you're not sure if they're right for you, discuss your options with your doctor.


## Best Shape: The Bigger the Better

Dr. Shnay says wrap-around sunglasses offer the most complete protection for the entire ocular surfaces, including lids. But some prescription wrap-arounds increase distortion due to the extra curve of the lens. 

One reliable choice: "Oakley sunglasses can be made with a limited Rx range and won't have too much, if any, distortion," he says. Otherwise, just choose a frame with the most coverage you’re comfortable with—and a style that suits you!



young man wearing hat and sunglasses-ivana-cajina- 7LbC5J-jw4-unsplash

Protect your vision and help prevent diabetic eye disease with a good pair of shades. We help you figure out what to look for!

Protect your sight with a few simple buying tips before you shop!

Here Come the Sunnies: The Best Shades for People With Diabetes

- __Cataracts in Diabetes Mellitus:__ *World Journal of Diabetes*. (2019). "Cataract in Diabetes Mellitus".  [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422859/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422859/)



Tips for Buying Sunglasses When You Have Diabetes

The Best Sunglasses for People With Diabetes

- __Impact of neuropathy on falls__: *Plos One*. (2016). "The Impact of Diabetic Neuropathy on Balance and on the Risk of Falls in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study." [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154654](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154654)

- __Impact of diabetic retinopathy on falls__: *JAMA Ophthalmology*. (2017). "Association Between the Severity of Diabetic Retinopathy and Falls in an Asian Population With Diabetes: The Singapore Epidemiology of Eye Diseases Study." [https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2663389](https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2663389)

- __Diabetes and falling risk__: UC Berkeley School of Public Health. (2017). "Why Diabetes Raises Your Risk of Falling." [https://www.healthandwellnessalerts.berkeley.edu/topics/diabetes/why-diabetes-raises-your-risk-of-falling/](https://www.healthandwellnessalerts.berkeley.edu/topics/diabetes/why-diabetes-raises-your-risk-of-falling/)


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