January 2025, excerpt from The Ophthalmologist article The Unseen Link Between Diabetes and Retinal Diseases by Alun Evans
Evans interviewed Zujaja Tauqeer, adult and pediatric vitreoretinal surgeon at the Cincinnati Eye Institute, an EyeCare Partners practice, and Cincinnati Children’s Hospital.
How might the risk of glaucoma developing from diabetes be monitored?
The glaucoma/diabetes connection is quite complex. First there is neovascular glaucoma, which is a bit more straightforward. Essentially, the eyes become starved of oxygen, new blood vessels form, and these new blood vessels grow in areas that they’re not supposed to, including the trabecular meshwork. Neovascular glaucoma must be managed procedurally – these patients will need injections to get rid of those blood vessels, and they’ll need surgery.
A slightly more nuanced link is the underlying increase in risk for open-angle glaucoma in people who have diabetes. Large-scale studies show a possible link between higher pressure – which leads to glaucoma – and having diabetes. Other studies have shown that people with diabetes may be more likely to have glaucoma (1). We don’t know the exact pathophysiology of this, but it’s important for me, when I see someone with diabetes, to make sure that I’m looking for signs of glaucoma.
Are we any closer to understanding how diabetes might be linked to glaucoma?
We don’t fully understand it, but I think it has to do with how overall health improves our ability to manage different diseases. We’re also realizing that diabetes is not just a sugar/blood vessel problem, it’s a neurological disease. We are starting to appreciate how diabetes damages our neurons progressively, which is surprising as we don’t traditionally think of diabetes damaging the body like neurodegenerative diseases such as Alzheimer’s disease. There are remarkable people – such as Elliott Sohn, Professor of Ophthalmology and Visual Sciences at the University of Iowa – who are currently investigating how diabetes may not be just a vascular disease, but a neurovascular disease. This type of research will be important for understanding diabetes as a whole.
Ophthalmologists can look directly in the eye, which helps us to visualize neurological damage from diabetes in a way that other specialists do not have easy access to. When I look at someone’s retina and I see severe diabetic retinal damage, I know that’s also what their brain looks like, what their liver may look like, what their nerves may look like.
One of the best things about being a retinal specialist is the variety of tools we have for managing conditions like diabetic retinopathy, which can really help to save people’s vision. These tools also help us to understand diabetes at a level that can be beneficial for other practitioners as well.
References
(1) Zhao et al., “Diabetes, fasting glucose, and the risk of glaucoma: a meta-analysis,” Ophthalmology, 122, 72 (2015). PMID: 25283061.
Image credit Getty Images Signature/stuartbur
Read more about factors that put you and your loved ones at risk of glaucoma here.