From tbrnewsmedia.com
By David Dunaief, M.D.
A serious complication of diabetes is diabetic retinopathy (DR), which is the leading cause of blindness among U.S. adults. DR develops when high blood sugar damages the tiny blood vessels that supply the retina—the light-sensitive tissue at the back of the eye. Over time, this damage can lead to blurred vision and even permanent blindness, often in both eyes.
Despite the risks, many people with diabetes are not getting regular eye care. As of 2023, only about 66 percent of adults with diabetes received the recommended annual eye exam. This is concerning because early detection makes a huge difference. When DR is caught early, treatments are far more likely to prevent or limit lasting vision loss.
A common complication: diabetic macular edema
A serious consequence of diabetic retinopathy is diabetic macular edema (DME). With DME, fluid builds up in the macula, the central part of the retina responsible for sharp, detailed vision. Swelling in this area can significantly impair eyesight, making everyday activities like reading or driving difficult.
People who have had diabetes for many years face the highest risk for DME. Unfortunately, symptoms often do not appear until the condition is advanced. By then, some of the damage may already be irreversible.
How is diabetic macular edema treated?
Treatments for DME often include eye injections of anti-VEGF medications, sometimes combined with laser therapy. These medications block vascular endothelial growth factor (VEGF), a protein that contributes to abnormal blood vessel growth and leakage in the eye. This can slow disease progression and, in some cases, improve vision.
A randomized controlled trial found that injections of ranibizumab (Lucentis), used alongside laser treatment—whether the laser was given immediately or delayed—were effective in treating DME. Other treatment options may include anti-inflammatory eye drops, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids, which aim to reduce swelling in the macula.
Do diabetes medications reduce the risk of DME?
Surprisingly, medications used to treat type 2 diabetes do not necessarily reduce DME risk. In fact, some may increase it. The THIN trial, a large retrospective study, found that a class of diabetes drugs called thiazolidinediones—which includes Avandia and Actos—was linked to a higher incidence of DME compared to patients who did not use these medications.
After one year, 1.3 percent of patients taking these drugs developed DME, compared with just 0.2 percent of those who were not taking them. This increased risk continued throughout 10 years of follow-up. The FDA has also issued warnings about other serious side effects associated with this drug class.
The risk appeared even higher in patients who used both thiazolidinediones and insulin. However, researchers could not determine whether the increased risk was caused by the medications themselves or by more severe diabetes.
Not all studies agree. An ACCORD Eye sub-study did not find a link between thiazolidinediones and DME. That study examined retinal photographs from almost 3,000 participants. Both studies had limitations, including incomplete data on how long patients had taken the medications and how well their blood sugar was controlled. Researchers also noted that not all potential influencing factors could be accounted for.
Can diet and blood sugar control help protect vision?
Better blood sugar control does appear to reduce the risk of diabetic retinopathy. The main ACCORD trial showed that intensive glucose control using medications lowered the risk of DR progression. However, this approach also increased overall mortality and did not reduce major cardiovascular events.
These results suggest an important takeaway: how blood sugar is controlled matters. A nutrient-dense, plant-based diet that helps maintain healthy blood sugar levels may lower your risk of diabetic retinopathy and further vision loss—without the added risks seen with medication-intensive approaches.
Protecting your vision
If you have diabetes, the most effective way to protect your eyesight is to keep your blood sugar well controlled and to schedule yearly eye exams with an ophthalmologist. Regular screenings can identify problems early, when treatment is most effective and vision loss may still be preventable. This is especially important for people taking thiazolidinediones or those who have had diabetes for many years.
Because your eyes are often affected long before you notice symptoms, it’s important to stay proactive. It can make the difference between preserving your vision and losing it.
https://tbrnewsmedia.com/medical-compass-protecting-your-vision-when-you-have-diabetes/
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