Cataracts are considered to be one of the earliest complications of diabetes mellitus, and they are confirmed as the most common cause of visual impairment in older age diabetics [1] [2]. Some studies report that female patients are more likely to develop a cataract, but the observed gender predilection is yet to be confirmed [3]. Other studies, however, report that poor glycemic control greatly contributes to the development of cataracts, particularly ketoacidosis, which can directly promote corneal damage by reducing the number of viable antioxidant molecules [3]. Compared to classical senile cataracts that have a slow development over a period of years [4], diabetic forms seem to have an earlier onset and a more progressive clinical course [3], with most important features being the development of posterior, anterior, subcapsular or cortical opacities of the cornea [3]. These pathological changes can affect only one eye, but cases of bilateral diabetic cataracts have been documented [3]. Loss of contrast, a necessity for more illumination to maintain adequate vision, issues with distinguishing dark blue from black color, as well as halos around lights, are most common complaints [4]. In severe cases, painless blurring and severe vision impairment can occur, and it is not uncommon for cataracts to cause blindness [3] [4] [5]. Swelling of the cataract may occur in rare cases and cause pain provoked by secondary closed-angle glaucoma, due to mechanical compression of the iris and the trabecular meshwork [4].

• Hypertension

  Diabetic and Hypertensive Retinopathy Diabetes and hypertension, or high blood pressure, are two of the most common systemic health problems that can affect the eyes and vision. [wilsoneyecenter.com]

  In the years after diagnosis of type 2 diabetes the incidence of hypertension is higher than in the age matched general population. In our study 128 (45.7%) of patients with type 2 diabetes were hypertensive. [go.galegroup.com]

  Many patients with diabetes have hypertension, and some of the more severe signs of hypertensive retinopathy are similar to diabetic retinopathy. [care.diabetesjournals.org]

  Hypertension was the most frequent systemic co-morbid disorder in both groups; it was more frequent in diabetics (60.9%) compared with 26.1% in non diabetics (p=0.017). [meajo.org]

• Vascular Disease

  The most common cause is from pressure being too high inside the eye, but vascular disease and other diseases can also cause glaucoma. We always monitor for glaucoma during routine eye examinations. [bifanoeyecare.com]

  Because retinopathy is a microvascular complication of diabetes, a disease of small vessels, this type of retinopathy develops because of an increasing lack of oxygen to the eye from vascular disease. [medicinenet.com]

• Visual Impairment

  Surgical removal of the damaged lens and replace it with an artificial one is usually recommended only in advanced cases to prevent visual impairment. [childhealth-explanation.com]

  Cataracts are considered to be one of the earliest complications of diabetes mellitus, and they are confirmed as the most common cause of visual impairment in older age diabetics. [symptoma.com]

  Prevention of blindness and visual Impairment. http://www.who.int/ blindness/causes/en. [Accessed 7 September 2006]. Klein R, Klein BE, Moss MS. Visual impairment in diabetics. Ophthalmol. 1984;91:1-8. Klein BE, Klein R, Moss MS. [ijmedicine.com]

  Abstract Background As the leading cause of global blindness and visual impairment (VI) by World Health Organization in 2010, cataract has been becoming a substantial public health problem all over the world accounting for almost 40 million blind people [discovery.dundee.ac.uk]

  Cataract is considered a major cause of visual impairment in people living with diabetes as the incidence and progression of cataract is elevated. Cataracts are among the earliest complications of diabetes. [retina-ded.org]

• Corneal Opacity

  […] will confirm the presence of corneal opacities. [symptoma.com]

  […] lens cloudiness or opacity corneal opacity retinal opacity Answer: A What is the symptom of cataract? pain blurring of vision squint Answer: B How do we treat cataract? surgery taking medication taking herbs Answer: A [pendidikanpesakit.myhealth.gov.my]

• Diplopia

  […] cataract include impaired distance vision, blurring of vision, decreased night vision, sensitivity to glare and bright light, a frequent need for new eyeglasses prescriptions, seeing halos around lights, needing brighter lights to read, and monocular diplopia [diabetesselfmanagement.com]

  Patients with extraocular palsies present with binocular diplopia. Pupil sparing is an important diagnostic feature in diabetes-related third cranial nerve palsy, distinguishing it from surgical causes, such as intracranial aneurysm or tumor. [care.diabetesjournals.org]

• Stroke

  National Diabetes Information Clearinghouse: "Keep Your Eyes Healthy," "Diabetes, Heart Disease, and Stroke." CDC: "2011 National Diabetes Fact Sheet," "Take Charge of Your Diabetes," "Diabetes Health Concerns." [webmd.com]

  Along with an increased risk for heart disease, stroke, hypertension, kidney disease and nervous system damage, diabetes increases your risk for eye diseases and even blindness. [yoursightmatters.com]

  Studies show that retinal arteriolar emboli are associated with carotid artery disease, hypertension, other cardiovascular risk factors ( 117 ), and an increased risk of stroke and stroke-related ( 119, 120 ) and all-cause ( 121 ) mortality. [care.diabetesjournals.org]

  Falls in stroke patients: risk factors and risk management. IMAJ-Israel Medical Association Journal, 12(4),216 ^ Vivian Weerdesteyn PhD, P. T., de Niet MSc, M., van Duijnhoven MSc, H. J., & Geurts, A. C. (2008). Falls in individuals with stroke. [en.wikipedia.org]

  Diabetes also may result in heart disease, stroke, kidney failure, and circulatory abnormalities of the legs. [emedicinehealth.com]

Cataracts can be confirmed by a slit-lamp examination that will identify yellow, gray or white opacities in the lens [4]. Other signs may include recurrent corneal erosions and ulcerations, increased autofluorescence and reduced corneal sensitivity, while the examination of the red reflex at a distance of around 30 cm from the affected eye through the use of an ophthalmoscope will confirm the presence of corneal opacities [2] [4]. Pupillary dilation before the eye examination is advocated, to obtain a better view of the entire apparatus and possibly detect other pathological changes, such as diabetic retinopathy [4]. Assessment of visual acuity, gonioscopy, funduscopy, and tonometry are other tests that can be employed, so that the exact type and location of the cataract may be determined [2]. In addition to physical examination, a detailed laboratory workup should be carried out in all patients with an undisclosed cause of cataract development, comprising serum glucose levels and hemoglobin A1C (HbA1c). Obtaining a proper family history that will potentially determine the presence of diabetes mellitus within the family or close relatives is also an important step when assessing patients with cataracts. Moreover, patients should be asked whether they exhibit some of the more common symptoms of diabetes (polyuria, polydipsia or polyphagia), the primary reason being the detection of diabetes.

• Hyperglycemia

  The only hyperglycemia period in her history was the one occurring before diagnosis, as she reported cardinal clinical signs for approximately six months before insulin therapy was started, and baseline HbA1c was 14.5%. [elsevier.es]

  Many of these factors are co-related, for example hyperglycemia (as estimated from HbA1c levels and thus severity of protein glycation) and duration of diabetes (being a measure of exposure to the hyperglycemic insult). [diabetesincontrol.com]

  DESPITE the fact that in the severest cases of hyperglycemia the crystalline lens is clear enough to allow adequate visualization of the deeper structures, there is a deep-rooted belief that a relationship exists between cataract and diabetes. [jamanetwork.com]

  As a consequence of persistent hyperglycemia, sorbitol accumulates within lens fibers, thus creating an osmotic force, drawing water into the lens, leading to subcapsular vacuole formation. [scielo.br]

  This is known as hyperglycemia. Hyperglycemia can negatively affect every part of your body, including your eyes. Blurry vision is often one of the first warning signs of diabetes. [healthline.com]

• Glucose Increased

  High blood sugar ( glucose ) increases the risk of diabetes eye problems. In fact, diabetes is the leading cause of blindness in adults age 20 to 74. [medicinenet.com]

Over three years, the team at CERA tested and compared two treatments injected into the eye of patients with DME undergoing cataract surgery. [cera.org.au]

References ↵ ↵ Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. [care.diabetesjournals.org]

Four of the six patients had at least a six-month history of diabetic symptoms before the treatment was started, and five patients had ketoacidosis at initial admission to hospital. [ncbi.nlm.nih.gov]

Prevention is the best treatment for diabetic retinopathy. [northfloridavision.com]

Ideally, when the cataract does not preclude laser treatment, you should achieve and maintain effective control of retinopathy and maculopathy for at least three months before surgery. [cehjournal.org]

EUROTIMES STORIES Evolution of cataract surgery and management of diabetic retinopathy has resulted in improvement of prognosis following cataract surgery in diabetic patients. [eurotimesindia.org]

[…] non-steroidal anti-inflammatory drugs in addition to routine topical steroid preparations, particularly in those with pre-existing macular oedema. 3 In summary, diabetes patients with mild to moderate diabetic retinopathy and no maculopathy have a good prognosis [cehjournal.org]

What's the prognosis for a person with diabetic eye disease? The earlier diabetic eye disease is diagnosed and treated (if necessary), the better the prognosis. [emedicinehealth.com]

Regardless of treatment, however, the vision prognosis of central RAO is poor ( 128 ). 4. [care.diabetesjournals.org]

Abstract Aldose reductase (AR) has been implicated in the etiology of diabetic cataract, as well as in other complications. [ncbi.nlm.nih.gov]

Keywords: Diabetes mellitus/complications; Cataract/etiology; Hyperopia; Case reports [Publication type] RESUMO Paciente de 13 anos, com história recente de hiperglicemia, desenvolveu subitamente, catarata subcapsular posterior em ambos os olhos, consistindo [scielo.br]

Ophthalmology 108 : 1767 –1776, 2001 ↵ Chen CS, Miller NR: Ocular ischemic syndrome: review of clinical presentations, etiology, investigation, and management. [care.diabetesjournals.org]

Information on possible benefits of putative anticataract agents comes from a variety of approaches, ranging from laboratory experiments, both in vitro and in vivo, to epidemiological studies in patients. [ncbi.nlm.nih.gov]

There is few recent cataract epidemiology study which focus on diabetic population especially in developed countries. [discovery.dundee.ac.uk]

Many epidemiological and clinical studies documented the higher prevalence of cataract in diabetic patients [14, 15]. [go.galegroup.com]

Incidence of cataract surgery in the Wisconsin epidemiologic study of diabetic retinopathy. Am J Ophthalmol. 1995;119:295-300. West SK, Valmadrid CT. Epidemiology of risk factors for age-related cataract. Surv Ophthalmol. 1995;39:323-34. [ijmedicine.com]

Arch Ophthalmol 102:520–526 PubMed CrossRef Google Scholar Klein R, Klein BE, Moss SE et al (1984b) The Wisconsin epidemiologic study of diabetic retinopathy. III. [link.springer.com]

It is the first report of inhibition interaction between AR and iNOS, suggesting a new pathophysiological mechanism and providing a new insight into the therapeutic mechanism of DC. Copyright © 2017 Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]

"The relationship of depression and diabetes: pathophysiological and treatment implications". Psychoneuroendocrinology. 36 (9): 1276–86. doi:10.1016/j.psyneuen.2011.03.005. PMID 21474250. ^ Li M, Fitzgerald P, Rodin G (April 2012). [en.wikipedia.org]

Pathophysiology of the immune system in elderly subjects with or without diabetes and variations after recombinant interleukin-2. Arch Gerontol Geriatr 1989;9:163-80. 27. [egyptretinaj.com]

All the findings above provide encouraging evidence for emodin as a potential therapeutic agent to prevent cataract in diabetic patients. [ncbi.nlm.nih.gov]

The severity of the cataract sometimes prevents adequate examination or treatment of the retina in patients with diagnosed or suspected severe non-proliferative and proliferative diabetic retinopathy. [cehjournal.org]

Diabetic Cataract Prevention of Cataract Progression Retinopathy -- Glaucoma -- Cataract -- Precise cause of diabetic cataract is yet under study. [childhealth-explanation.com]

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2. Javadi MA, Zarei-Ghanavati S. Cataracts in Diabetic Patients: A Review Article. J Ophthalmic Vis Res. 2008;3(1):52-65.
3. Pakhetra R, Jyotsna V. Bilateral Early Cataracts in Type 1 Diabetes. Med J Armed Forces India. 2009;65(1):71-72.
4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
5. Pollreisz A, Schmidt-Erfurth U. Diabetic Cataract—Pathogenesis, Epidemiology and Treatment. J Ophthalmol. 2010;2010:608751.