Diabetes can impact the eye in various ways, and one of the consequences is an increased susceptibility to cataract formation. Consequently, people with diabetes are thought to be at a higher risk of developing cataracts (a condition described as diabetic cataracts).
Many studies have shown a clear statistical association between diabetes and cataracts; according to the American Diabetes Association, individuals with diabetes are 2–5 times more likely to develop cataracts than those without diabetes.
Here we’ll look into what signs and symptoms to look out for if you’re suffering from diabetes and are concerned about developing cataracts.
What is the Connection Between Diabetes and Cataracts?
The underlying mechanisms causing cataracts due to diabetes involve various biological processes driven by high blood sugar levels, also known as hyperglycemia. Here’s a detailed explanation of the link for cataracts in diabetic patients:
Changes in Lens Proteins: Cataracts occur when the proteins within the eye’s natural lens become altered and start to clump together, ultimately clouding the lens. In diabetes, the persistently elevated levels of glucose in the blood can lead to the accumulation of sorbitol within the lens cells. Sorbitol is a sugar alcohol formed when excess glucose is metabolized. This accumulation of sorbitol can alter the structure and function of lens proteins, contributing to cataract formation.
Osmotic Changes: Hyperglycemia leads to an increase in osmotic pressure within the lens, causing the lens to swell. This change in size and shape can lead to changes in the transparency of the lens, further promoting cataract development.
Oxidative Stress: Diabetes is associated with increased oxidative stress, characterised by an imbalance between free radicals and antioxidants in the eye. This oxidative stress can damage lens proteins and other structures, making them more susceptible to cataract formation.
Advanced Glycation End Products (AGEs): High blood sugar levels can lead to the formation of advanced glycation end products (AGEs), which can accumulate in the lens and promote cataract development. AGEs are compounds formed when glucose molecules react with proteins in the body, causing them to become less flexible and more prone to damage.
Inflammation: Chronic low-grade inflammation is a common feature of diabetes. Inflammation in the eye can contribute to cataract formation by altering the lens’s microenvironment and promoting protein clumping.
Are Cataracts a Sign of Diabetes?
While cataracts are not a direct sign of diabetes, the presence of cataracts can sometimes prompt further investigation for diabetes or can be an indicator of the need for improved diabetes management.
Whether a person is diabetic or not, they should be aware of the following symptoms that could indicate signs of cataract formation.
Diabetics who suspect they have cataracts may experience a range of symptoms related to their vision. The most notable symptoms include:
Blurred Vision: Vision becomes progressively cloudy or blurry, making it difficult to see fine details.
Reduced Colour Perception: Colours may appear faded or yellowish, leading to a diminished ability to distinguish between certain colours.
Glare Sensitivity: Increased sensitivity to glare from lights, especially noticeable when driving at night or in bright sunlight.
Halos Around Lights: Seeing halos or rings around light sources, which can be particularly pronounced at night.
Double Vision: Experiencing double vision in one or both eyes, which can interfere with daily activities.
Poor Night Vision: Difficulty seeing in low-light conditions, such as in dimly lit rooms or at night.
Frequent Changes in Eyeglass Prescription: Needing frequent changes in eyeglass or contact lens prescriptions as vision deteriorates due to cataracts and changes in blood sugar levels.
Decreased Contrast Sensitivity: Difficulty discerning objects from their background, particularly in situations with poor lighting.
Blurred vision – one of several symptoms of possible cataracts
What Type of Cataract is Most Common in Diabetics?
Posterior subcapsular cataracts (PSCs) are a common type of cataract that can develop in diabetics. Unlike other cataract types that typically affect the centre or nucleus of the eye’s lens, PSCs form on the back surface of the lens, near the lens capsule. Here’s an explanation of posterior subcapsular cataracts and their association with diabetes:
Formation of PSCs: PSCs often develop as a result of metabolic changes in the lens caused by high blood sugar levels in diabetic individuals. The elevated glucose levels can lead to the accumulation of water in the lens, causing it to swell and develop small, cloudy opacities on the posterior surface. These opacities obstruct the path of light entering the eye, leading to visual disturbances.
Symptoms: PSCs can cause symptoms such as increased sensitivity to glare, halos around lights, and difficulty with reading or other activities that require clear central vision. The visual impairment associated with PSCs can be particularly bothersome and disruptive to daily life.
Risk Factors in Diabetics: While PSCs can occur in individuals without diabetes, they are more prevalent in those with diabetes, especially in cases of poor blood sugar control.
Can Diabetic Cataracts Be Reversed?
Diabetic cataracts, like other types of cataracts, cannot be reversed or resolved through non-surgical means. Cataracts are characterised by the clouding of the eye’s natural lens, and this cloudiness is typically irreversible.
While maintaining good blood sugar control and a healthy lifestyle can help prevent or delay cataract development in diabetics, once cataracts have formed, they can only be effectively removed through cataract surgery.
Can a Diabetic Patient Go for Cataract Surgery?
While the surgical process for diabetic patients undergoing cataract treatment is broadly the same, the following considerations and precautions should be made:
Control of Blood Sugar Levels: It’s crucial for diabetic patients to maintain optimal blood sugar control before, during, and after cataract surgery.
Additional Preoperative Assessment: Diabetic patients may undergo additional preoperative assessments to evaluate their overall health and assess any diabetes-related complications that could affect surgery, such as diabetic retinopathy. These assessments help the surgical team tailor the procedure and postoperative care to individual needs.
Risks and Complications: Diabetic patients may face slightly higher risks of complications after cataract surgery, including infection or delayed healing. However, at Optegra, we ensure these risks are well managed with appropriate preoperative and postoperative care. Your surgeon will discuss these risks with you before the surgery, and steps will be taken to minimise them.
Medication Adjustments: Diabetic patients should discuss their medications with their surgeon before the procedure. In some cases, adjustments may be necessary, such as temporarily changing the timing or dosage of diabetes medications to accommodate the surgical schedule.
Postoperative Monitoring: The recovery process for diabetic patients may involve more vigilant monitoring of blood sugar levels and a close watch on any surgical site-related issues. At Optegra, our team will work with you to ensure a smooth recovery.
Follow-up Care: Diabetic patients will need to adhere closely to postoperative instructions and attend follow-up appointments as directed by the surgeon. These appointments are essential for monitoring healing, addressing any issues, and ensuring the best possible outcomes.
Your Blood Sugar Levels Must be Under Control Before Surgery
High or fluctuating blood sugar levels can lead to complications, including delayed healing and increased infection risk. Consequently, having well-controlled blood sugar levels before cataract surgery is absolutely vital for several reasons:
Optimal Wound Healing: Elevated blood sugar levels can impair the body’s ability to heal effectively, which is crucial after any surgical procedure, including cataract surgery. When blood sugar is too high, it can affect the function of white blood cells and impair their ability to fight off infection and promote wound healing. Poor wound healing can increase the risk of complications, such as infection or delayed recovery.
Stable Vision Outcomes: Uncontrolled diabetes can lead to fluctuations in vision due to changes in the refractive index of the lens. Stable and well-managed blood sugar levels before surgery can help ensure more predictable and stable vision outcomes post-surgery.
Minimised Diabetic Retinopathy Risk: Diabetic retinopathy is a potential complication of diabetes that can affect the blood vessels in the retina. Elevated blood sugar levels during surgery can exacerbate this condition. Good blood sugar control is essential to reduce the risk of diabetic retinopathy progression during or after cataract surgery.
At Optegra, your experienced cataract surgeon will work with you to ensure your blood sugar levels are well managed before the procedure.
What Can Help to Reduce Cataracts in Diabetics?
Reducing the risk of cataracts in diabetics involves a combination of lifestyle measures and regular eye care. Here’s what diabetics can do to lower their chances of cataracts:
Optimal Blood Sugar Control: Maintaining tight control of blood sugar levels is crucial. High blood sugar can accelerate the development of cataracts.
Healthy Diet: A well-balanced, nutrient-rich diet can support overall eye health. Foods rich in antioxidants like vitamin C and E, as well as those containing lutein and zeaxanthin (found in green leafy vegetables), can help protect the eyes from oxidative damage.
Eye Protection: Wearing sunglasses with UV protection can shield the eyes from harmful ultraviolet rays, which may contribute to cataract formation.
Regular Eye Examinations: Diabetic individuals should undergo regular eye examinations as advised by an eye specialist. Early detection of cataracts and other eye issues, such as diabetic retinopathy, allows for timely intervention and management.
Smoking Cessation: Smoking has been linked to an increased risk of cataracts. Quitting smoking can help lower this risk.
Control of Hypertension and Cholesterol: High blood pressure and elevated cholesterol levels can also impact eye health. Managing these conditions through medication and lifestyle changes may help reduce the risk of cataracts.
Regular Physical Activity: Engaging in regular physical activity not only helps with diabetes management but also supports overall health, including eye health.
You’re in Safe Hands: Meet Our Cataract Surgeons
At Optegra, we are true eye care specialists. Our renowned surgeons typically handle over 30,000 cataract procedures each year, with a success rate of 99.6%. Our dedicated eye hospitals are located nationwide and are best placed to treat all types of cataracts, including people with diabetes. You’re in great hands when you choose us for your cataract treatment.
What next? Get in Touch for Free, No-Obligation Advice.
At Optegra, we carry out tens of thousands of cataract procedures each year, with an impressive success rate of 99.6%. Learn more about cataract surgery at Optegra or book a no-obligation, free consultation for expert help and advice.
By Author: Alex J Shortt
Mr Shortt is a leading ophthalmic surgeon and an expert in the fields of cornea, cataract and refractive surgery.
Medically Reviewed Date: 7th November 2023