Diabetes

DIABETES AND THE EYE

If you have diabetes you unfortunately are much more susceptible to eye disorders such as glaucoma, cataracts and retinopathy.

You need to have your eyes checked annually at a minimum if you have been diagnosed with diabetes. The changes that can cause a loss of vision with diabetes are mostly related to swelling of the macula, and that's not often perceived by the patient. You should ask your doctor to check for any changes in the blood vessels of the eyes due to diabetes.

There are many early treatments with medicine or laser to reduce fluids leaking from blood vessels and preserve vision. If we examine a patient who already has loss of vision because of diabetes and fluid we can only treat in an attempt to stabilize it. Early diagnosis is critical to maintaining your vision.

The best thing patients can do to protect their vision is to keep their blood glucose under good control with their endocrinologist or regular physician. HbA1c is a measure of your average blood sugar over the preceding three months. That number is between 5 and 12, and there's less likely to be progression of eye problems when that number is less than 7.

How much does diabetes increase my likelihood of eye problems?

According to the American Diabetes Association, patients with diabetes are 60 percent more likely to suffer from cataracts and 40 percent more likely to suffer from glaucoma.

People with diabetes also tend to get cataracts at a younger age then the general population, and typically they will progress faster. A cataract is a cloudy area in the lens of the eye.

To help deal with mild cataracts, you may need to wear sunglasses and use glare-control lenses. For cataracts that interfere greatly with vision, doctors remove the lens of the eye and replace it with a "progressive implant, a multifocal interocular lens. With diabetic patients, retinopathy often gets worse after removal of the lens, and glaucoma may start to develop.

All of this points to the need for regular eye exams for patients with diabetes.

What is diabetic retinopathy?

Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes. There are two major types of retinopathy: non-proliferative, which is the most common form, and proliferative.

To understand retinopathy let's talk a little bit about the eye. One specialized area of the retina is the macula. It's the most sensitive part of the retina and it provides our sharp, straight-ahead or central vision. Many blood vessels in and behind the retina nourish the macula. The smallest of these blood vessels are the capillaries.

In non-proliferative retinopathy, those capillaries swell and can become blocked. Sometimes the capillary walls break down and may lose their ability to control the passage of substances between the blood and the retina. Fluid can leak into the macula, causing loss of vision.

Proliferative retinopathy is the more serious form and represents a progression after several years of going undetected. In this form, the blood vessels are so damaged they close off, and new blood vessels start growing in the retina. These new vessels are weak and often leak blood, blocking vision. This is known as a vitreous hemorrhage. The new blood vessels also can cause scar tissue to form. After the scar tissue shrinks, it can distort the retina or worse yet, cause a detachment.

Unfortunately the retina can be badly damaged before you notice any change in vision. Most people with non-proliferative retinopathy have no symptoms. Even with proliferative retinopathy, the more dangerous form, people sometimes have no symptoms until it is too late for them to be treated with the reasonable expectation of positive results. For this reason, you should have your eyes examined regularly by an eyecare professional.

How is diabetic retinopathy treated?

Huge strides have been made in the treatment of diabetic retinopathy. In both types, non-proliferative and proliferative, early laser treatments and/or anti-inflammatory medicine have been found to decrease the change of vision loss or other complications. In addition, the Diabetes Control and Complication Trial (DCCT) has proven that strict control of blood sugar can greatly reduce the potential for vision loss associated with diabetes.

To hammer home the point, early detection is critical to maintaining your eye health. Patients with diabetes need to be especially aware of scheduling regular eye exams and working closely with their general physician and/or endocrinologist to maintain an appropriate blood-sugar level.

 

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