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Treating Cataracts and Glaucoma Caused by Diabetes


According to the Centers for Disease Control and Prevention, about one third of adults living with diabetes aged 45 or over have cataracts. While common with aging, people with diabetes are two to five times more likely to develop the disease. Cataracts are also more likely to occur at an earlier age in those with diabetes than those without diabetes. People over 65 with diabetes are twice as likely to develop cataracts, while people under 65 with diabetes are three to four times more likely to develop cataracts than people of the same age without diabetes. This article will discuss cataracts and glaucoma caused by diabetes, along with treatment options.

What are Cataracts?

A cataract is a cloudy area in the lens of the eye. A clear lens in the eye focuses light on the retina, providing sharp vision. As you age, the lens can thicken and become less flexible and transparent, leading to cataracts and blurred vision. Either one or both eyes may be affected. Cataracts can develop slowly and may initially have little effect on your vision, but over time, they can significantly impair sight, making everyday activities like reading and driving more difficult. Regular eye exams can help detect cataracts early and manage their progression.

Who is At Risk for Developing Cataracts?

People with diabetes are also at higher risk for developing glaucoma. People with diabetes have almost double the chance of developing glaucoma compared to those without diabetes. Nearly 80 million people worldwide are living with this disease, with half unaware because it usually has no noticeable symptoms in its early stages. Glaucoma is a leading cause of irreversible blindness globally.

Managing diabetes effectively is crucial for preventing both cataracts and glaucoma. High blood glucose levels can lead to diabetes-related eye diseases that increase the risk of these conditions. Regular eye examinations, proper diabetes management, and awareness of the symptoms and treatments for cataracts and glaucoma can help mitigate the risks and protect vision.

How Does Diabetes Cause Cataracts?

When you have diabetes, high blood glucose (sugar) levels over time can lead to changes in the lens of the eye, causing cataracts to develop faster. The length of time you have had diabetes and how carefully your blood glucose has been managed will affect your risk of cataracts. High glucose levels cause deposits to build up in the lenses of your eyes. Other risk factors include:

  • Having a family history of diabetes
  • Previous eye injury or surgery
  • Having macular edema
  • Spending time in the sun without UV-protected sunglasses
  • Taking medications such as corticosteroids

Cataracts Symptoms

You may not notice symptoms of cataracts in the early stages as they can be minor until clouding affects the center of the eye. More progressed cataracts have been described as looking through a fogged-up window. Symptoms include:

  • Cloudy or blurry vision
  • Seeing double in one eye
  • Light sensitivity, including seeing halos around lights
  • Poor night vision
  • Colors seem less bright and may have a yellowish tint

Cataracts Testing

To diagnose cataracts, an eye care professional will perform a comprehensive eye exam. This exam typically includes:

  • A visual acuity test to measure how well you see at various distances
  • A dilated eye exam to examine the lens and other parts of the eye
  • Tonometry to measure the pressure inside your eye

Cataracts Treatment

Cataracts are treated by minimally invasive eye surgery, usually in an outpatient setting. It is important to have your blood glucose well managed prior to surgery as high blood glucose can affect healing. During the procedure:

  • A small incision is made in your cornea, and an ultrasound probe is inserted to break up and remove the cataract
  • An artificial lens is implanted
  • Your eye will be numbed with eye drops or an injection
  • You will remain awake, but you will not feel or see what is done to your eye

After the procedure, you will need to use eye drops, avoid rubbing your eyes, and may need to wear eyeglasses or a shield to protect your eye. Vision generally improves within a few days, and a new prescription for glasses may be needed after your eye heals.

If you have a mild cataract, you might not need surgery right away. Until then, you can manage symptoms by using brighter lighting, wearing anti-glare prescription glasses and sunglasses, and using magnifying lenses.

What is Glaucoma?

Glaucoma refers to a group of eye diseases that affect the main bundle of nerves in the eye called the optic nerve. The optic nerve carries images from your eye to your brain. In a healthy eye, a drainage system allows fluid to leave the eye to maintain normal pressure. However, in glaucoma, new blood vessels can grow in the front part of your eye, interfering with the normal flow of fluid out of the eye, causing pressure to build and damaging the optic nerve.

How Does Diabetes Cause Glaucoma?

People with diabetes have almost double the chance of developing glaucoma. Over time, glaucoma may cause vision loss and is the leading cause of irreversible blindness worldwide. There are three different types of glaucoma:

Primary Open-Angle Glaucoma

Diabetes is a risk factor for primary open-angle glaucoma, the most common form of glaucoma in the United States. The angle is the location where the aqueous humor (the fluid produced inside the eye) drains out of the eye into the body’s circulatory system. This chronic, progressive condition occurs in both eyes, often with one eye more severely affected. In the early stages, individuals may have no symptoms. As glaucoma advances, patients may notice difficulty with peripheral (side) vision and driving.

Steroid-Induced Glaucoma

This secondary open-angle glaucoma is caused by steroid eye drops or injections used to treat diabetes-related macular edema. Therapy includes eye drops, laser treatment, or surgery to implant a glaucoma drainage device.

Neovascular Glaucoma

In this type of glaucoma, people with advanced diabetes-related retinopathy develop new abnormal vessels on the iris and over the drainage angle, causing scar formation and angle-closure glaucoma. Treatment includes laser therapy and medication injections to stop the growth of these abnormal vessels. In some cases, a glaucoma drainage device is surgically implanted to lower eye pressure.

Glaucoma Symptoms 

Glaucoma usually has no noticeable symptoms in its early stages. An eye exam to detect early glaucoma will include:

  • Eye pressure measurement
  • Dilated exam of the optic nerve and retina
  • Examination of the drainage angle using a special mirrored lens
  • Side (peripheral) vision test
  • Scans or photos of the optic nerve using optical coherence tomography (OCT)

Glaucoma Treatment

There is no cure for glaucoma, but early treatment can often stop or slow the damage. The goal is to prevent vision loss. Treatment options include medical therapies, laser therapies, and surgical approaches. It’s important to review your case with your ophthalmologist and discuss treatment options and their risks and benefits.

Regular monitoring and follow-up appointments are crucial to manage the condition effectively. Adjustments to treatment plans may be necessary based on how well your eye pressure is controlled and any changes in your vision. Staying informed and proactive in your care can help maintain your quality of life and preserve your vision for as long as possible.

Protect Your Eyes

A simple thing you can do to help protect your eyes is to wear sunglasses when you are outside, even on cloudy days. Sunglasses that block 99% to 100% of UVA and UVB radiation can shield your eyes from the sun’s ultraviolet rays and should be worn year-round.


Written by

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Janice MacLeod MA RD CDCES FADCES Diabetes-cardiometabolic consultant and thought leader in digital health and chronic condition management

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