By Lan V. Pham, MD, FAAO, Ophthalmology, CareMount Medical
May 6, 2021
Diabetes affects more than 34 million Americans, which amounts to 10.5% of the U.S. population, according to the US Centers for Disease Control and Prevention (CDC) 2020 National Diabetes Statistics Report. For people with diabetes, the body’s cells aren’t able to take in glucose, leading to a buildup of sugar in the blood. The resulting high glucose levels affect the tiny blood vessels in the body, damaging the eyes as well. In fact, the CDC says diabetes is the leading cause of new cases of blindness among adults aged 18-64 years.
As an ophthalmologist, I’d like to explain the main components of diabetic eye disease, and give you some tips for prevention.
Diabetic eye disease includes the following:
• Diabetic retinopathy is caused by damage to the blood vessels of the retina, which is like the wallpaper lining the inside of your eye. Diabetes can cause the retina to leak blood or form abnormal vessels. It’s important to detect this early, to prevent vision loss. I recommend that diabetic patients have their eyes checked regularly (with full dilation) even if they do not feel any acute problems. In cases of diabetic retinopathy, treatment includes: retinal laser, intraocular injections, and/or intraocular surgery.
• Glaucoma occurs from progressive optic nerve damage. If left untreated, glaucoma can lead to peripheral, or side vision loss. Treatment can include: applying topical eye drops, lowering eye pressure with a laser, or performing filtering intraocular surgery. To help patients manage the condition, we monitor eye pressure, and use optic nerve imaging to check whether the glaucoma is progressing. We also evaluate each patient’s peripheral vision with visual field testing.
• Cataract is caused by opacification, or clouding of the eye. Oftentimes, patients have blurred vision, and difficulty seeing both near and far. Some report a glare or see haloes around lights. When a patient’s daily activities (reading, driving) are affected, we recommend surgery to remove the opacified lens and replace it with an artificial intraocular lens. Thanks to new techniques and technologically advanced lenses, visual outcomes continue to improve, lessening the patient’s need for glasses after the procedure.
What You Can Expect at an Eye Exam
During an assessment, your doctor will measure your vision, test your eye pressure, and examine your eyes with a “slit lamp” to detect any small abnormalities. Your doctor will also administer drops to dilate your pupils, and check for fluid buildup, bleeding, or abnormal blood vessels characteristic of diabetic retinopathy. (In some cases, they may also use further imaging, like Optical Coherence Tomography (OCT), fluorescein angiography, or fundus photography.) Finally, your doctor will examine the eye lens for cataract and assess the optic nerve for any glaucoma-related changes.
Your vision will be blurry after the dilation process. You will also be sensitive to light until your pupils resume their original size. So, in addition to having someone drive you home, I’d recommend bringing sunglasses to lessen the glare.
While there is no cure once you have diabetes, there are ways to prevent diabetic eye disease. For instance, you can regulate your blood sugar, blood pressure, and lipids through diet and exercise. I recommend sticking with your prescribed medical therapies. Your primary doctor will check your hemoglobin A1C test periodically to gauge glucose control over the previous three months.
Monitoring your blood sugar levels will help you know whether your diet, exercise, and medical programs are working for you. Educating yourself will decrease your likelihood of having complications from diabetes. I hope this article helps you make the changes you need to prevent diabetic eye disease.
If you have diabetes and are concerned about the health of your eyes, click here to schedule an appointment.