The office staff is friendly and knowledgeable. Dr. Griffiths is kind and professional, and she effectively helped with my eye problem. Highly recommend her care.
Nancy Halsey
Diabetes and Glaucoma: Understanding Your Risk and Protecting Your Sight
Open-Angle Glaucoma and Diabetes
Open-angle glaucoma is the most common form of glaucoma and occurs more often in people with diabetes than in those without it. It earns the nickname the silent thief of sight because it removes side vision so gradually that most people do not notice until significant damage has already occurred.
The drain inside the eye looks open under a microscope, but fluid still leaves too slowly. Pressure rises a little at a time, and the optic nerve loses fibers in a pattern that begins at the very edges of your sight. Because the brain fills in those blank spots automatically, most people do not realize anything is wrong until a routine exam reveals the damage.
Adults with diabetes face a meaningfully higher chance of developing open-angle glaucoma compared to those without diabetes. Blood vessel damage and changes in the drainage tissue inside the eye both appear to play a role. Poor blood flow to the optic nerve may also leave it more vulnerable to pressure-related harm, even when pressure is not dramatically elevated.
Open-angle glaucoma rarely causes pain or sudden changes in vision. Many people notice no symptoms at all until the disease is well advanced. A few subtle hints can appear earlier, though most people discover them only in hindsight after a diagnosis is made.
- Bumping into objects at the edges of your path or missing steps in dim light
- Needing more light than usual to read clearly
- Difficulty adjusting from bright outdoor light to a darker indoor space
- Patchy or blurry side vision that you only notice when one eye is covered
A thorough glaucoma evaluation involves more than a single pressure measurement. Your eye doctor looks at the optic nerve through a dilated exam and may photograph it so changes can be compared over time. A visual field test maps any blank areas in your side vision. A scan of the nerve fiber layer can detect damage long before you would notice any change on your own.
The goal of treatment is to lower eye pressure enough to slow or stop nerve damage. Most people begin with prescription eye drops taken every day. Some drops reduce how much fluid the eye produces, while others help the drain work better. If drops alone are not enough, laser treatment or surgery may be the next step. Consistent daily use of drops is one of the most powerful things you can do to protect your sight over the long term.
Neovascular Glaucoma: A Serious Complication of Advanced Diabetic Eye Disease
Neovascular glaucoma is a more aggressive and dangerous form of the disease that develops when diabetic retinopathy has advanced far enough to starve the retina of oxygen. It requires immediate attention and a different treatment approach than open-angle glaucoma.
When the retina is deprived of oxygen, it releases chemical signals that trigger the growth of new blood vessels. These fragile new vessels can sprout across the colored part of the eye, called the iris, and spread over the drainage tissue itself. As they grow, they pull scar tissue with them and gradually close off the drain, causing pressure to rise quickly and dangerously.
Unlike open-angle glaucoma, which takes years to cause significant harm, neovascular glaucoma can damage the optic nerve in a matter of weeks. Pressure may climb high enough to cause pain, redness, and sudden vision loss. The new vessels are also fragile and bleed easily, which can cloud sight even further. Without prompt treatment, the damage can become very difficult or impossible to reverse.
Neovascular glaucoma often causes symptoms that are hard to ignore. If you have been diagnosed with diabetic retinopathy and notice any of these signs, contact your eye doctor right away rather than waiting for a scheduled visit.
- Sudden eye pain or a deep ache around the eye socket
- Persistent redness that does not clear on its own
- A sharp drop in vision over hours or days
- Halos around lights or a foggy quality to your sight
- Nausea or headache that begins alongside eye pain
Your eye doctor looks for tiny new vessels on the iris before placing the drops that widen your pupil, since those vessels can be harder to see once the pupil is dilated. A specialized contact lens called a gonioscopy lens allows a direct view of the drain itself to check whether vessels have begun to grow across it. Catching these vessels early provides more time to treat the underlying retinal problem before the drain is affected.
Effective treatment works on two fronts at the same time. First, the underlying retinal disease is addressed to stop the eye from producing more growth signals. This typically involves laser treatment to the retina, injections of medicine that blocks new vessel growth, or both. Second, eye pressure must be brought down using drops, laser, or surgery. Addressing both the cause and the pressure together gives the best chance of preserving sight.
Steroids, Injections, and Their Effect on Eye Pressure
Some of the medicines used to treat diabetic eye swelling and new blood vessel growth can affect eye pressure in ways your eye doctor needs to monitor carefully. Understanding these effects helps you know what to watch for between visits.
Steroid medicines are effective at reducing swelling in the eye, which is why they are sometimes used for diabetic macular edema, the buildup of fluid in the center of the retina. However, steroids can also slow the drainage of fluid in certain eyes, causing pressure to rise. Not everyone responds this way, but the risk is real enough that pressure checks are a standard part of every follow-up visit after steroid treatment.
Some people are more likely to experience a pressure rise from steroid eye treatments than others. Your eye doctor will weigh your personal history carefully before choosing a steroid-based option.
- A past history of pressure rises from steroid drops, pills, or skin creams
- An existing diagnosis of glaucoma in either eye
- A close family member with glaucoma
- High nearsightedness
Injections that block the growth of new blood vessels, called anti-VEGF injections, are widely used for diabetic eye disease. Right after the injection, eye pressure can rise briefly because more volume is now inside the eye. In most people this returns to a normal level within an hour. People who already have glaucoma or advanced eye disease may need a little more time for pressure to settle and should be monitored accordingly.
If you are receiving eye injections or steroid treatments, your eye doctor checks your pressure both before and after each visit. If pressure remains elevated, additional drops may be prescribed, the treatment choice may be adjusted, or extra follow-up visits may be scheduled. Reporting any pain, redness, or change in vision after an injection helps catch problems before they cause lasting harm.
How Often You Need Eye Pressure Checks
The right schedule for pressure checks depends on your individual situation. Knowing what drives those recommendations helps you understand why your eye doctor may ask to see you more often than once a year.
Adults with diabetes are generally advised to have a complete dilated eye exam every year, even when vision feels perfectly normal. That visit includes a pressure measurement, a thorough look at the optic nerve, and a wide view of the retina. Annual exams allow your eye doctor to catch slow changes in both open-angle glaucoma and diabetic retinopathy before they progress.
Certain situations call for visits every few months rather than once a year. If any of the following apply to you, your eye doctor will likely recommend a closer follow-up schedule.
- You already have glaucoma or borderline high eye pressure
- You have moderate or severe diabetic retinopathy
- You are receiving eye injections or steroid treatments
- Your blood sugar has been very difficult to control
- Your vision has changed since your last exam
Eye pressure is measured with a small instrument that gently touches the front surface of the eye after a numbing drop is placed. The test takes only a moment and does not hurt. Some offices use a brief puff of air instead, which can feel surprising but is equally painless. The reading is recorded each visit so your eye doctor can track any changes over time rather than relying on a single number.
A single pressure reading does not tell the whole story. Pressure naturally varies with the time of day, sleep quality, and stress levels. Your eye doctor looks at the pattern of readings across many visits and compares it with the health of your optic nerve over time. A stable pressure that has not risen is reassuring, while a slowly climbing trend may call for a closer look or a change in treatment.
Treatment Options When You Have Both Glaucoma and Diabetes
Managing glaucoma and diabetic eye disease together requires a coordinated plan so that treatment for one condition does not interfere with treatment for the other. Our team works to keep both conditions under control while minimizing side effects and complications.
Most people with glaucoma begin treatment with prescription eye drops taken once or twice daily. Some drops reduce the amount of fluid the eye produces, while others help the drain work more efficiently. The drops only work when used consistently, even when the eye feels completely normal. Pairing the drops with a daily habit, such as brushing your teeth, can make it easier to stay on schedule.
Laser treatments play an important role in managing both conditions. For glaucoma, a brief laser session can improve drainage and lower pressure without the need for surgery. For retinopathy, laser treatment can seal leaking vessels or reduce the signals the retina sends out for new vessel growth. Both types of laser treatment can be performed in the same eye, often during the same series of visits, when the timing is right for your situation.
When drops and laser do not control pressure adequately, surgery may be considered. Some procedures create a new drainage pathway using a small tube or implant. Others address clouding of the lens, called a cataract, that may develop alongside diabetic eye disease. In some cases, our surgical team can plan a single procedure that addresses both eye pressure and cataract at the same time, reducing the number of procedures needed.
Treating glaucoma and diabetic retinopathy together means making sure each step supports the other. Steroid treatments for swelling can raise pressure, while some pressure-lowering drops may cause more irritation in eyes that have recently had a procedure. Clear communication between visits, including reporting new symptoms and side effects, keeps the plan working as it should for your eyes.
Daily Habits That Protect Your Eyes
Medical treatment is the foundation of managing glaucoma and diabetic eye disease, but daily habits play a meaningful supporting role. Small, consistent choices add up over months and years in ways that help your treatments work better.
Keeping blood sugar within the range your care team recommends is the single most important step you can take for your eye health. Stable blood sugar reduces the chance of further blood vessel damage, may slow pressure-related changes in the eye, and helps your medicines work more effectively. Even gradual improvements in blood sugar control can make a real difference over time.
Healthy eyes depend on healthy blood vessels. High blood pressure puts extra strain on the tiny vessels that feed the optic nerve. High cholesterol can narrow those vessels and reduce blood flow. Your primary care provider and your eye doctor are often working toward the same goals from different directions, and keeping all three numbers, blood sugar, blood pressure, and cholesterol, in a healthy range benefits your eyes.
Everyday choices add up over the years and support every medical treatment you receive. None of these steps replace prescription care, but together they create a better foundation for your eye health.
- Regular physical activity, even short daily walks, helps regulate blood sugar and blood pressure
- A diet rich in vegetables, fruits, whole grains, and lean protein supports vascular health
- Quitting smoking, since smoking directly harms the small blood vessels inside the eye
- Limiting alcohol, which can cause blood sugar swings
- Getting enough sleep, since rest helps regulate both blood pressure and blood sugar
Some changes are easy to brush off, but they can signal a problem that needs prompt attention. Calling your eye doctor when something feels off is always a safer choice than waiting to see whether it resolves on its own.
- New floaters, flashes of light, or a shadow or curtain over part of your vision
- Sudden eye pain, redness, or a sensation that the eye feels hard
- A drop in vision that lasts more than a few minutes
- Halos around lights or a sudden increase in glare sensitivity
Frequently Asked Questions
These questions address the details and decisions that often come up after a diagnosis of glaucoma in someone who already has diabetes.
The increase in risk is real and meaningful, which is why annual dilated eye exams are considered essential rather than optional when you have diabetes. Your personal risk is shaped by how long you have had diabetes, how consistently your blood sugar has been controlled, your family history, and your overall cardiovascular health. Rather than focusing on a general number, talk with your eye doctor about your specific risk profile so you know exactly what to watch for and how often to be seen.
No, and the difference matters greatly. Open-angle glaucoma is treated primarily by lowering eye pressure using drops, laser, or surgery. Neovascular glaucoma requires those same pressure-lowering steps but also demands treatment of the underlying retinal disease that triggered new vessel growth in the first place. Standard pressure-lowering drops alone are rarely sufficient. If neovascular glaucoma is suspected, treatment usually moves quickly and involves multiple steps at once rather than a gradual stepwise approach.
Not necessarily. A steroid-related rise in eye pressure is a known risk but does not occur in every patient. Your eye doctor will check your pressure at every follow-up visit after a steroid treatment and can manage a pressure rise with drops if one occurs. If you have a history of reacting to steroids with elevated pressure, your eye doctor may consider a non-steroid alternative such as an anti-VEGF injection. Sharing your full eye history before starting any new treatment helps your doctor choose the safest and most effective option for your eyes.
Yes, and this is one of the strongest reasons to keep your annual diabetic eye exams even when your vision feels fine. Neovascular glaucoma starts when the retina sends out distress signals because it is not receiving enough oxygen. Treating retinopathy before it reaches that point, using laser, injections, or both, can prevent those signals from ever being released and reduce the likelihood that new vessels grow where they do not belong. Early treatment protects not only the retina but also the drain inside the eye.
Yes, and coordinating the two is quite common in our practice. Laser treatments for both conditions can be scheduled in stages during the same series of visits, and certain surgical procedures can address both the drainage problem and a coexisting cataract in a single session. Your eye doctor will plan the order and timing of each step based on which problem poses the more urgent threat at any given point. Clear communication at every visit helps make sure nothing is missed as the plan evolves.
That distinction is one of the most important things a comprehensive dilated eye exam helps to answer. Glaucoma tends to remove side vision first, while diabetic retinopathy can affect central vision, cause distortion, or produce floaters and flashes. Some symptoms overlap, and both conditions can be present in the same eye at the same time. Rather than trying to interpret symptoms on your own, the safest approach is to report any change in vision to your eye doctor promptly and let a thorough exam determine the cause and the right response.
Schedule Your Eye Exam at NewView Eye Center
Managing glaucoma and diabetes together takes expert, personalized care, and that is exactly what we provide at NewView Eye Center. Our team brings advanced diagnostic technology and deep experience in both diabetic eye disease and glaucoma to every appointment. We welcome patients throughout Northern Virginia and are ready to partner with you to protect your vision for the long term. Contact us today to schedule your comprehensive dilated eye exam.
What our Patients Says
Explore More
Find more information about our doctors, services, and technology that keep your eyes healthy and your vision at its best.