Diabetes and glaucoma, the silent vision time bomb: Doctor shares how to fight back

In India, we are quick to visit a doctor for fever, stomach pain, or a bad cough. But when it comes to the eyes, most people wait. And wait. And wait some more. Many think blurry vision is just part of getting older. Others assume headaches or watery eyes are due to too much phone use or lack of sleep. So eye problems get brushed aside until they start affecting daily life. There’s also the mindset of “I can still manage.” Reading gets harder, driving at night feels uncomfortable, but people adjust instead of getting checked. For many families eye care feels like a luxury unless something goes seriously wrong.Refractive errors like near-sightedness and far-sightedness are the most common. Kids struggle to see the blackboard. Adults squint at phone screens. Yet many go years without glasses or with the wrong prescription. Then there’s cataract. It’s still one of the biggest causes of vision loss in India. The lens of the eye slowly becomes cloudy, making everything look foggy or yellowish. Since it happens gradually, people adjust to poor vision until it becomes severe.Dry eyes are also becoming very common, especially with long screen hours and pollution. Burning, redness, and a gritty feeling in the eyes are often ignored.And infections like conjunctivitis spread easily, especially during seasonal changes. Most treat it with home remedies instead of seeing a doctor.Diabetes doesn’t just affect sugar levels. It slowly harms blood vessels all over the body, including in the eyes. A condition called diabetic retinopathy is one of the leading causes of vision loss among working-age adults in India.Nipah virus can remain dormant for up to 45 days: Doctors reveal why this silent period is dangerous for healthIndia has one of the largest diabetic populations in the world. And many don’t get regular eye exams.Glaucoma is scary because it steals vision slowly and painlessly. It usually starts with loss of side vision. People don’t notice it early because central vision remains clear for a long time. Pressure builds up inside the eye and damages the optic nerve. Once vision is lost, it can’t be brought back. But early detection can slow or stop further damage. In India, a large number of glaucoma cases go undiagnosed. Many find out only when significant vision is already gone. Millions of Indianslive with some form of vision impairment. Cataract alone accounts for a huge portion of blindness. Diabetic eye disease is rising fast as diabetes increases. And glaucoma affects several million people, with most not even knowing they have it. What makes it worse is that many of these conditions are either preventable or manageable if caught early.Adding more to this problem, diabetes and glaucoma often co-occur, with diabetes raising the risk of primary open-angle glaucoma (POAG) by about 40% due to factors like vascular changes and elevated intraocular pressure. Studies show stronger links in type 2 diabetes and longer disease duration. A 2015 Indian hospital-based cross-sectional studyof 841 type 2 diabetics found 15.6% glaucoma prevalence, with longer diabetes duration as a key predictor. The findings of the study have been published in Oman Journal of Ophthalmology.TOI Health spoke to Dr. Sudhamathi Kalluri, Sr. Consultant Ophthalmologist, Dr Agarwals Eye Hospital, Gurgaon on how to protect vision from the double threats of diabetes and glaucoma.There is a significant risk of developing glaucoma when one is diabetic; the risk is nearly two-fold that of the normal population. Continuous elevated blood sugar levels cause damage to the small blood vessels supplying the optic nerve, influence the drainage of the eye fluid, and increase the pressure level in the eye, all of which lead to glaucoma, particularly primary open-angle glaucoma.Moreover, diabetes that has been long-standing and has never been managed well may impair the tolerance of the optic nerve to even normal eye pressure, causing the disease to develop sooner and at a quicker rate. At a younger age, diabetic patients are thus likely to develop glaucoma as opposed to non-diabetics.In diabetic patients, glaucoma tends to progress without showing any symptoms. The initial symptoms can be characterized by slight alteration of vision, frequent vision changeability, eye soreness, or slow peripheral vision loss. Symptoms are easily missed; thus, eye check-ups are essential to detect them early.We caution that it may be dangerous to wait and experience the symptoms clearly, since glaucoma-related permanent loss of vision is irreversible. The best method of screening is through regular screening to prevent serious damage before the condition is detected.Glaucoma can be risked when it is caused by high and low blood pressure. High BP is capable of inflating eye pressure, which is one of the significant causes of glaucoma. Ocular perfusion pressure is the balance between the blood pressure (BP) and the intraocular eye pressure (IOP).Very high BP and low BP (low night-time BP) may slow the blood flow to the optic nerve, resulting in optic nerve damage and causing progression of glaucoma to a great extent. Chronic high BP may harden blood vessels and give impairments to the flow of blood and supply of nutrients to the optic nerve.Aqueous humour (eye fluid) can be augmented because of hypertension, or it can diminish its drainage, leading to augmented IOP. Gain in BP of 10 mmHg raises IOP by around 0.26 mmHg. Change in blood pressure may also cause abrupt optic nerve damage, which enhances the need to maintain a steady blood pressure in diabetic patients with glaucoma.One such myth is that diabetes can be controlled alone and one can prevent glaucoma. Although the two conditions have common risk factors, like age, genetic factors, and hypertension, glaucoma needs to be monitored and treated separately, regardless of the level of blood sugar control.The other myth is that the vision loss associated with glaucoma is reversible, but the fact is that the optic nerve damage is irreversible and can only be prevented or slowed down by treatment.The effects of glaucoma and its severity are more serious and more common with age and the extent of diabetes. Long-term exposure to high blood sugar increases the rate of optic nerve damage. The complications can be greatly minimized by taking regular eye exams, maintaining good glycaemic control, a healthy lifestyle, and avoiding smoking. Eye screening should be done more often among patients who are older than 40 years and those with long-standing diabetes, to detect glaucoma at an early stage.In patients who have both diabetes and glaucoma, the best treatment should be close regulation of blood sugar levels and frequent eye check-ups to measure eye pressure, the health of the optic nerves, and changes in the retina. Medications for glaucoma should be regularly taken as prescribed, and medical self-medication, in particular with steroids, should be eliminated. Regular exercise, proper dieting, and stress management are also lifestyle interventions that help eye health. In addition, coordinated care between physicians and ophthalmologists is more effective in producing better long-term results.Medical experts consultedThis article includes expert inputs shared with TOI Health by: Dr. Sudhamathi Kalluri, Sr. Consultant Ophthalmologist, Dr Agarwals Eye Hospital, GurgaonInputs were used to discuss how big a problem is vision impairment in India and how to protect vision loss from diseases like diabetes and glaucoma.