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There are approximately 29 million Americans age 20 and older that have diabetes and more than half are at risk for vision loss because they do not know they have a disease. During November's Diabetic Eye Disease Awareness, the American Academy of Ophthalmology is urging those with diabetes to protect their vision by having a dilated eye exam every year.

Diabetic eye problems are among the most common complications facing individuals with diabetes. All can cause severe vision loss or even blindness.

- this disease is the leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some patients, retinal blood vessels swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

Symptoms - often there are none in the early stages of the disease. Vision may not change until the disease becomes severe. Even in advanced cases, the disease may progress a long way without symptoms - including pain.

Risk - the risk of developing diabetic retinopathy increases with the number of years one has had diabetes. After 15 years with the disease, almost 80 percent of people with Type I diabetes have some form of diabetic eye disease. Diabetic retinopathy can occur as early as the first year or two after the onset of the disease. Quite frequently, diabetic retinopathy is one of the first signs of diabetes.

Treatment - laser surgery and proper follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery cannot restore lost vision. That is why early detection is the best prevention.

Prevention - diabetic retinopathy cannot be fully prevented; however, one's risk can be reduced greatly. The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar level slows the onset and progression of retinopathy. Early detection and treatment can most often prevent permanent vision loss. Yearly dilated eye exams are crucial.

- known as a clouding of the eye's lens, is a disease diabetics are also at risk of developing. As a matter of fact, a person with diabetes is twice as likely to get a cataract as a person who does not have the disease.

Symptoms - include blurred vision, especially outdoors; sensitivity to sunlight; print appears faded and lacking in contrast; colors appear faded or changed in hue.

Risk - individuals having diabetes 3 to 5 years, aging, cigarette smoking, eye injury, high cholesterol/triglycerides.

Treatment - new eyeglass prescription, stronger reading glasses, better lighting or devices such as magnifiers or telescopes, and, the most effective treatment - laser surgery.

Prevention - wear 100% UV-protected sunglasses to reduce exposure to ultraviolet light. Eating a diet rich in antioxidants or supplementing with antioxidants such as Vitamin A (beta carotene), Vitamin C, Vitamin E, Selenium, lutein and zeaxanthin appear to slow the progression of cataract disease. Receive yearly eye exams.

- when you have glaucoma, a fluid called aqueous humor doesn't drain correctly through channels in the front of the eye. The fluid build-up leads to increased intraocular pressure, which damages the optic nerve. A person with diabetes is twice as likely to develop glaucoma as a person without the disease. The longer one has had diabetes, the greater one's risk for developing glaucoma.

Symptoms - in the early stages, glaucoma has no symptoms - no noticeable vision loss, no pain, which is why it is called the Sneak Thief of Sight. By the time symptoms start to appear, some permanent damage to the eye has usually occurred.

Risk - individuals with a family history, diabetes, history of eye surgery or injury and individuals who have taken steroid medications.

Prevention/Treatment - early detection and treatment is crucial - especially because there are no symptoms. Annual eye exams are a must. Glaucoma may be treated with medications, laser, and other forms of surgery.

In summary, finding and treating the disease early, before it causes vision loss or blindness, is the best way to control diabetic eye disease. If you suffer from diabetes, be certain you receive a dilated eye examination at least once a year and maintain good control of your blood sugar levels through diet and exercise.