Diabetes is a complex and challenging condition that affects millions of people in Canada. While the impact of diabetes on blood sugar control and organ health is well-known, one aspect that often goes overlooked is its association with eye complications. Among these complications, cataracts are certainly one of the most common. 

Cataracts cloud the eye's natural lens and can significantly impair vision and quality of life if left untreated. The connection between diabetes and cataracts is multifaceted, with high blood sugar levels playing a central role. 

In this blog post, we will explore the relationship between diabetes and cataracts, exploring the causes, risk factors, and preventive measures individuals can take to protect their vision and overall eye health. Join us as we shed light on this important aspect of living with diabetes.

How Many People in Canada Have Diabetes or Prediabetes

It is estimated that approximately 3.4 million people in Canada have been diagnosed with diabetes. Additionally, many individuals may have undiagnosed diabetes or prediabetes. According to the Diabetes Canada 2018 Clinical Practice Guidelines, it is estimated that over 6 million Canadians have prediabetes, which is a condition where blood sugar levels are higher than normal but not high enough to be classified as diabetes. 

Why Do People with Diabetes Get Cataracts? 

People with diabetes are at a higher risk of developing cataracts due to several factors related to the condition. Here are a few reasons why diabetes can increase the likelihood of cataract development:

1. Elevated Blood Sugar Levels: High blood sugar levels, a hallmark of diabetes, can lead to chemical changes in the eye's lens. The lens requires precise sugar levels for optimal function, and fluctuating or persistently high blood sugar levels can disrupt this balance. The excess sugar can bind to proteins in the lens, causing them to become damaged or clump together, resulting in the clouding characteristic of cataracts.

2. Oxidative Stress: Diabetes can lead to increased oxidative stress, an imbalance between producing harmful free radicals and the body's ability to neutralize them with antioxidants. Oxidative stress can damage the lens proteins and structures, accelerating the development of cataracts.

3. Sorbitol Accumulation: In diabetes, excess glucose can be converted into sorbitol through the polyol pathway. Accumulation of sorbitol within the lens can disrupt the normal fluid balance, leading to lens swelling and opacity, contributing to cataract formation.

4. Advanced Glycation End Products (AGEs): High blood sugar levels can contribute to the formation of advanced glycation end products (AGEs). These AGEs can accumulate in the lens and other tissues, promoting protein cross-linking and structural changes that contribute to cataract development.

5. Longer Duration of Diabetes: The longer an individual has had diabetes, the greater the risk of developing cataracts. Over time, the cumulative effects of sustained high blood sugar levels can increase the likelihood of cataract formation.

It's important to note that not all individuals with diabetes will develop cataracts, and cataracts can also occur in people without diabetes due to other factors such as aging or genetic predisposition. However, the risk of cataracts is higher in individuals with diabetes. 

What are Some of the Most Common Symptoms of Cataracts? 

Common symptoms of cataracts can vary from person to person and may develop gradually over time. Some of the typical symptoms include:

1. Blurred Vision: Blurriness or cloudiness in vision is one of the most common signs of cataracts. Objects may appear hazy or less defined, making it difficult to read or drive. 

2. Sensitivity to Light: Cataracts can cause increased sensitivity to bright lights or glare. Individuals may find it uncomfortable to be in brightly lit environments or experience difficulties with oncoming headlights while driving at night.

3. Reduced Colour Perception: Colours may appear faded or less vibrant. This can make it challenging to distinguish between different shades or hues. People generally feel that whites don't like white. 

4. Poor Night Vision: Cataracts can impair night vision, making it harder to see in low-light conditions. Individuals may experience difficulty seeing clearly in dimly lit areas or driving at night. People find that they need to turn the lights on around the house or need to use the flashlight on their phone to see in dark corners. 

5. Frequent Changes in Eyeglass Prescription: Cataracts can cause frequent changes in vision, leading to the need for updated eyeglass prescriptions more frequently than usual. 

6. Seeing Halos Around Lights: Individuals with cataracts may notice the appearance of halos around lights, particularly in low-light conditions. Some might describe this as glare, while others may feel like lights look like rainbows. 

It's important to note that these symptoms can also be associated with other eye conditions or refractive errors. Cataracts can only be diagnosed through an in-depth dilated eye exam.

How to Prevent or Delay Cataracts If You Have Diabetes

While it is not possible to completely prevent cataracts, there are certain steps you can take to reduce the risk of developing cataracts, particularly for individuals with diabetes. Here are some preventive measures:

1. Manage Your Blood Sugar Levels: Keeping your blood sugar levels under control is crucial in preventing or delaying the onset of cataracts. High blood sugar levels can contribute to the development and progression of cataracts. Follow your healthcare provider's recommendations for managing your diabetes, including monitoring your blood sugar levels, taking prescribed medications, and maintaining a healthy lifestyle.

2. Maintain a Healthy Diet: Eat a balanced and nutritious diet that includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats. Focus on foods rich in antioxidants, such as vitamins C and E, as they help protect the eye's lens from damage. Include citrus fruits, berries, green leafy vegetables, nuts, and seeds in your diet.

3. Protect Your Eyes from Ultraviolet (UV) Rays: Prolonged exposure to UV rays from sunlight can contribute to cataract formation. Wear sunglasses that provide 100% UVA and UVB protection outdoors, especially during peak sunlight. Additionally, wear wide-brimmed hats to shield your eyes from harmful UV rays.

4. Quit Smoking: Smoking has been linked to an increased risk of cataract development. If you smoke, consider quitting. Seek support from healthcare professionals or support groups to help you quit successfully. To learn more, visit the Alberta Quits website. 

5. Limit Alcohol Consumption: Excessive alcohol consumption has been associated with an increased risk of cataracts. If you choose to drink alcohol, do so in moderation. Check out Canada's Guidance on Alcohol and Health. 

6. Regular Diabetes Eye Health Exams: Schedule your annual diabetes eye health exam with our office. These eye exams can help detect the presence of cataracts or any other eye conditions early on, allowing for timely intervention and treatment.

While these preventive measures can lower the risk of developing cataracts, it is important to remember that age and genetic factors also play a role. 

Are Diabetes Eye Exams Covered in Alberta? 

Yes. In Alberta, diabetes eye exams are covered by Alberta Health Care Insurance Plan (AHCIP). The coverage includes regular eye health examinations for individuals with diabetes to monitor their eye health and detect any signs of diabetic retinopathy or other diabetes-related eye complications such as cataracts. 

Please note that diabetic eye health exams do not produce a prescription for eyeglasses or contact lenses. 

Are Diabetes Cataracts Treated the Same Way As Regular Cataracts? 

Yes, diabetes-related cataracts are treated in the same way as regular cataracts. Regardless of the underlying cause, the treatment for cataracts involves surgical removal of the clouded lens and replacement with an artificial intraocular lens (IOL). This surgical procedure is known as cataract surgery.

During cataract surgery, an ophthalmologist makes a small incision in the eye and uses specialized instruments to remove the cloudy lens. The artificial IOL is then implanted to restore clear vision. This IOL is a permanent replacement for the natural lens and helps focus light onto the retina.

Cataract surgery is usually performed on an outpatient basis and is considered safe and effective. Recovery time is relatively short, and patients can typically resume their normal activities within a few days following the procedure.

It's important to note that individuals with diabetes may have a higher risk of complications during and after cataract surgery due to potential eye health issues associated with diabetes. Therefore, careful monitoring and coordination between the ophthalmologist and the healthcare team managing diabetes are essential to ensure optimal outcomes.

Cataract Surgery Complications in People with Diabetes

In individuals with diabetes, cataract surgery may carry a slightly higher risk of certain complications compared to those without diabetes. Some of the potential complications include: 

1. Diabetic Retinopathy Progression: Cataract surgery can potentially worsen diabetic retinopathy or lead to its development. 

2. Macular Edema: Macular edema, a condition characterized by fluid accumulation in the central part of the retina, may occur or worsen after cataract surgery in individuals with diabetes. Macular edema can cause blurry or distorted central vision.

3. Delayed Wound Healing: Diabetes can impair the body's natural healing process. As a result, individuals with diabetes may experience delayed wound healing after cataract surgery, leading to an increased risk of infection or other complications.

4. Posterior Capsule Opacification (PCO): PCO refers to the clouding of the capsule that holds the artificial intraocular lens (IOL) in place after cataract surgery. People with diabetes may have a higher risk of developing PCO, which can lead to blurred or hazy vision. However, PCO can be easily treated with a simple laser procedure called a YAG capsulotomy.

It's important to note that although these complications may be more common in individuals with diabetes, they are still relatively rare, and cataract surgery remains a safe and effective procedure overall. Appropriate preoperative evaluation, careful monitoring, and management of blood sugar levels, along with close postoperative follow-up, can minimize the risks associated with cataract surgery.

Does Alberta Health Care cover Cataract Surgery? 

Yes, cataract surgery is covered by the Alberta Health Care (AHC). Alberta Health Care provides coverage for medically necessary cataract surgery, which involves the removal of a clouded lens and its replacement with an artificial intraocular lens (IOL) to restore clear vision.

Under Alberta Health Care, eligible individuals who meet the medical criteria for cataract surgery can have the procedure performed by an ophthalmologist at an approved surgical facility. The coverage includes:

• The surgical procedure.

• The cost of the IOL.

• Postoperative care related to cataract surgery (these visits can be with either your optometrist or with the surgeon).

It's important to note that while Alberta Health Care covers the basic cataract surgery procedure, additional costs may be associated with upgraded or specialized IOLs, certain preoperative or postoperative tests, or specific surgical techniques not considered medically necessary. In addition, patients must purchase both non-prescription moisture drops and medicated eye drops required to help the eyes heal. In addition, you may need a few days or weeks off work to allow your eyes to recover from your cataract surgery. 

It's advisable to consult with the cataract surgeon and the healthcare team to understand any potential additional costs that may arise.

FYI: Are Diabetes Eye Exams Covered in Alberta? 

Yes. In Alberta, diabetes eye exams are covered by Alberta Health Care Insurance Plan (AHCIP). The coverage includes regular eye health examinations for individuals with diabetes to monitor their eye health and detect any signs of diabetic retinopathy or other diabetes-related eye complications such as cataracts. At Stonewire Optometry, our eye doctors are experts in providing comprehensive eye care tailored to individuals with diabetes. We use the latest technology such as Optomap Ultra Widefield Imaging, 3D OCT Retinal Imaging, in addition to traditional dilated eye exams.

Please note that diabetic eye health exams do not produce a prescription for eyeglasses or contact lenses. 

Disclaimer: The content provided by Stonewire Optometry in this blog is intended solely for informational purposes and does not replace professional medical advice, diagnosis, or treatment. No doctor/patient relationship is established through the use of this blog. The information and resources presented are not meant to endorse or recommend any particular medical treatment. Readers must consult with their own healthcare provider regarding their health concerns. Stonewire Optometry does not assume any liability for the information contained herein nor for any errors or omissions. Use of the blog's content is at the user's own risk, and users are encouraged to make informed decisions about their health care based on consultations with qualified professionals.