Diabetic? Keep Your Eyes In Check
If you have diabetes, you are like 100 millions other Americans living with it.
The Center for Disease Control says that about 10% of the US population has diabetes and another 80 million have pre-diabetes.
How did we get there?
There are two types of diabetes. Type 1 and type 2:
Type 1 diabetes is an auto-immune disease where the body's own immune system attacks cells in the pancreas responsible for producing insulin.
To keep it simple, insulin is a hormone responsible for glucose metabolism throughout the body. Without it, glucose levels in the bloodstream are too high.
You don't acquire type 1 diabetes, it is a genetic disease.
Type 2 diabetes is the most common form of diabetes.
It is the result of a combination of factors: ethnicity, family history and environmental causes such as poor diet, lack of exercise, being overweight and other lifestyle factors.
In type 2 diabetes, there is generally insulin but the body develops resistance to it, meaning that it becomes ineffective at doing its job, and the result is high levels of glucose in the blood. Why we see more and more diabetes is a bit unclear. Some doctors call it processed food disease. Certain additives like high fructose corn syrup certainly play a role.
How does diabetes affect the body?
High levels of glucose are circulating in the body. Glucose is toxic to certain cells and specifically is toxic to the pericytes which are useful to normal blood vessels physiology.
When those cells die, blood vessels become leaky triggering a cascade of events that affect nearly every system in the body.
Diabetes tends to affect small vessels first. Organs very reliant on small vessels are the kidney and the eye, which is why those two organs are some of the first to suffer from diabetes.
How does diabetes affect the eye?
Diabetes is going to affect the eye in two main fashions:
Changes in refractive error (increase or decrease of glasses power needed, when blood sugar is high or goes lower)
Diabetic Eye Disease
Diabetes Affects primary the back of the eye or the retina. The vessels located in the retina start leaking and forming micro-aneurysms.
There are 2 forms of diabetic eye disease or diabetic retinopathy:
Non Proliferative Diabetic Retinopathy (NPDR)
At that stage, small amount of hemorrhages form in different shapes: pin point, dot hemes, blot hemes (which are a bit larger) or flamed shape hemes. Most patients who have Non Proliferative Diabetic Retinopathy (NPDR) are absolutely asymptomatic.
Those small hemorrhages tend to not affect vision. Patients become symptomatic when they develop macular edema, which is an accumulation of fluid in the central part of the eye. This will result in changes, loss of central vision.
About 20% of diabetics are diagnosed during a routine eye exam, where their eye doctor, upon dilated fundus examination sees diabetic eye disease. The patient is then referred to a primary care doctor to confirm the diagnosis via blood work, checking fasting blood glucose levels. Many diabetic patients are asymptomatic at the beginning of the disease and can go years without being diagnosed, sustaining damage to their body.
Every year, it is recommended you get a routine eye exam and a physical exam. Our office in Miami is ready to welcome you for a routine eye exam or a diabetic eye exam if you have already been diagnosed with diabetes.
If Significant Non Proliferative Diabetic Retinopathy (NPDR) or any level of Macular Edema is seen during your routine eye exam, you will be referred to a retinal specialist for further evaluation. The specialist will likely obtain a Fluorescein Angiography (FA) to assess permeability and leakage of your retinal blood vessels. An OCT can be done to check for macular edema. In recent years, new technology became available: an exam know as an OCTA can be done. This Ocular Coherence Tomography with Angiography can be performed. Without injecting any dies, this OCTA allows for visualization of retinal blood vessels integrity.
If Diabetic Macular Edema is seen, your retinal specialist may elect to inject some medicine inside the eye to prevent further damage and for you to regain vision. Those medicine can be either Anti-VEGF (See our page on macular degeneration) or steroids.
Proliferative Diabetic Retinopathy (PDR)
Later in the disease, once blood leaks and not enough oxygen arrives to the retina, new blood vessels or neo-vessels are formed.
This is natural way for the body to fight the lack of oxygen. Unfortunately those blood vessels are incompletely formed, have very weak membranes and sooner than later rupture, leading to vitreous or retinal hemorrhaging.
In that situation there is more blood present resulting in significant visual loss. If nothing is done, scar tissue can form and pull on the retina triggering a retinal detachment. At this stage, it is very difficult to save the eye and visual function.
With Diabetes, prevention is key. Do see your general physician every year for routine blood work. If early signs of diabetes are seen, he may elect to start you on diabetes medicine to prevent or slow down complications. If you have diabetes, get regular eye exams.
What else can be done for patients with diabetes?
Lifestyle changes are paramount. Your health care team will recommend to increase physical activity, lose weight, and keep a healthy diet. That means a diet rich in vegetables and fruits, fish, olive oil... When it comes to sodas, diet sodas are not the solution. Several studies have shown that diet sodas are not healthy. If you need help, you may want to talk with a dietitian who will guide you with those changes, advise you on meal plans and calories intake specifically for diabetic patients.
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