Diabetes and Cataracts Explained

A cataract will not damage your eye in any way. It can be operated on safely at any time, thick or thin. A cataract may change the focusing in the eye, and you may need new spectacles now and again. If you think you do, ask your optician or the doctor in the hospital eye clinic.

But glasses themselves do not help you see better if you have a cataract.
Some cataracts get worse quickly, others slowly: most do get worse over months or years. If your sight gets worse very slowly, the cataract is only slowly becoming thick.
The thicker or cloudier the cataract becomes, the worse the sight. A doctor cannot predict with certainty.

Cataracts are one of the sight-related complications of diabetes. The closer you manage your diabetes, the more likely you are to avoid any diabetes complications.

However, understanding more about diabetes and cataracts may help you to identify this complication at an early stage and seek treatment.

What are cataracts?

Cataracts are cloudy opacifications of the lens of the eye. This interferes with your vision, in some cases considerably.

What causes cataracts?

The lens of the eye is made up of fluids that contain protein.

Due to increasing ages and a variety of other factors, over time this fluid may start to cloud over. That said, cataracts have been reported in newborn babies so it isn’t simply down to age.

Cataracts occur as people get older. They are much commoner if you smoke, whether cigarettes, cigars, or a pipe. They occur more often in diabetes, and they can run in families. Steroid tablets may help to cause cataracts if given at a high dose or for a long time.

There are many other causes, including other types of eye disease and eye injury.

Does a cataract damage the eye, or your other eye?

A cataract does not usually damage your eye in any way. A cataract in one eye cannot lead to any damage in the other eye, and you cannot use the good eye too much and damage it.

Similarly, sit close to the television if this helps you see it better: this will not damage your eyes. A cataract often develops in the other eye, but many people only get one in one eye.

Will your sight get worse?

Many cataracts do get worse, especially if you are middle aged and have diabetes. Many people with diabetes do eventually need cataract surgery.

Does diabetes increase the risk of cataracts?

Diabetes is one of the key factors that result in the development of cataracts.

Although the reasons why are still not fully understood, people with diabetes mellitus statistically face a 60% greater risk of developing cataracts.

As with most complications of diabetes, maintaining good control of your blood sugar levels will help to reduce your risk.

In addition, research has shown that people with type 2 diabetes who lower their HbA1c level by just 1% can reduce their risk of cataracts by 19%.

What are the symptoms of cataracts?

Early stage cataract symptoms may barely influence the vision, and a cataract diagnosis may come as a genuine surprise.

Challenging visual situations such as driving at night and bright sunlight may cause your sight to become hazy.

How are cataracts treated?

Cataract treated has advanced considerably in recent years. Surgery is often prescribed, with the lens removed and replaced with an artificial one. Cataract surgery is widely recommended and is commonly performed.

Your ophthalmologist will determine whether you need cataract surgery.

When do cataracts require an operation?

Cataract surgery is generally safe, so the point at which an operation is undertaken depends partly on the individual. Cataract operations are typically day cases, with the local anaesthetic often cited as the most uncomfortable part.

For people with diabetes, there is a slightly greater risk of developing more serious problems such as macula oedema, diabetic retinopathy complications, and infections as a result of the surgery.

Extra risks in diabetes

Unfortunately a few people do develop problems. Without diabetes, there is 1 in 100 risk of severe complications such as needing a second operation, infection, etc. But in diabetes there is a slightly greater risk of such problems as:

Macular oedema

This is fluid collecting at the back of the eye, in the central area of the retina. This blurs the central vision.

Treatment includes:

  • adding non-steroidal eye drops to steroid drops
  • steroid injections under the eye
  • steroid injections in the eye itself.
  • for patients with retinopathy, start topical non-steroidals a week before surgery, and treat with steroid drops for at least 6 weeks post-operatively
  • if macular oedema is present, try and control for 3 months before surgery (laser & Avastin)
  • patchy central vision with macular disease
  • macula oedema…fluid accumulating after cataract surgery, causing reduced central and detailed vision

Proliferative retinopathy & cataract surgery

  • there is an 8% risk of macular oedema occurring if proliferative retinopathy is present at the time of cataract surgery, 8 times normal.
  • unlasered patients with thick cataracts should have intra-operative panretinal (PRP) laser if at all possible
  • intracameral cefuroxime helps to prevent infections…there is a higher risk of infection, and standard precautions are needed. Care draping and cleaning the lids with polvidone iondine, and treating pre-existing blepharitis.
  • there is a high risk of fibrinous uveitis
  • if possible panretinal (PRP) laser should be carried out before surgery.
  • non-steroidal drops should be started before cataract surgery in anyone with retinopathy, but especially proliferative retinopathy.

Source & More Info: Diabetes.co.uk and Diabeticretinopathy.org.uk

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