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Diabetes is becoming one of the most common diseases in the United Sates, with one study estimating 1 in 10 Americans currently affected (roughly 26 million persons). By 2050, this number is projected to triple. Additionally, another 79 million Americans have pre-diabetes, and without lifestyle changes such as diet and exercise, will more than likely go onto develop Type 2 diabetes.

Diabetes is an epidemic and optometrists are now very familiar with ocular manifestations as we routinely evaluate our patients for diabetic eye disease and common ocular complications associated with uncontrolled blood sugar. These ophthalmic complications rarely occur in isolation as the disease is systemic, affecting many organs like the kidneys, liver, and heart. The optometrists at Southwest Vision have close relationships with specialists in the area and co-manage diabetes with primary care doctors, endocrinologists, and retinal specialists.

Diabetic Retinopathy

Diabetic retinopathy (DR) occurs when the blood vessels in the eye are so damaged by the diabetes that bleeding and swelling will occur in the retina. This damage will occur slowly in the beginning, but once the insult occurs, it is a domino affect. As the retina worsens, the tissue becomes oxygen deprived and new blood vessels will begin to grow to try to correct the problem. With new blood vessel growth, also known as retinal neovascularization, comes the risk of blindness.

DR is one of the nation’s leading causes of blindness with approximately 4.1 million US adults over 40 years having signs. 1 in 12 persons with diabetes have advanced, vision threatening retinopathy. Treatment largely depends on stage of DR. It is very important to be followed yearly by your optometrist if you have diabetes, in order to catch changes to the retina as early as possible. Surgery often slows or stops the progression of DR, but it is not a cure. Even after treatment to DR, it is imperative to get yearly retinal exams to prevent future progression and vision loss, as re-treatment is common.

Other Ways Diabetes Affects your Eyes

Fluctuating Vision

When the blood sugar is not controlled, a temporary increase in myopia (or nearsightedness) can develop and vision will be blurry at distance. If this spike in blood sugar lasts too long, the eye muscles will start to give out and double vision can occur.

These ocular manifestations are typically temporary, and once blood sugar returns to normal, visual symptoms will subside.

Early Cataract Development

Cataracts are a major cause of visual impairment in diabetic patients as the incidence and progression is elevated.

Increased sugar levels in the aqueous (the liquid in the eye) causes increased level of free radicals that damage the lens.

After cataract surgery, diabetics have a higher risk of complications compared to non-diabetic patients.

Dry Eyes

The link between dry eyes and diabetes is strong; approximately 50% of diabetics suffer from dry eye symptoms.

Glaucoma

Diabetic patients are 35% more likely to develop glaucoma; if the patient is hypertensive AND diabetic, the risk of glaucoma increases to 48%.

Type 2 Diabetes: Not Just for Adults Anymore

• 1 in 3 children born in 2000 or later will go on to develop Type 2 diabetes.
• Obesity is the number one risk factor for development of Type 2 diabetes, with up to 85% of children diagnosed are also overweight.
• Family history is also strongly associated with Type 2 diabetes in children, as 45% to 80% of children with diabetes have at least one parent living with disease as well. However, this risk factor is more about family lifestyle than genetics.

Staying Healthy and Living with Diabetes

If you have already been diagnosed with diabetes, it is important you maintain a healthy lifestyle in order to prevent eye damage and vision loss.  Here are some guidelines:

• Follow the healthy eating plan you and your doctor/dietitian have created.
• Be active a total of 30 minutes a day.
• Take your medications as directed by your doctor.
• Check your blood sugar DAILY and record that number in a journal.
• Check your feet every day for cuts, blisters, sores, swelling, or redness.
• Control your blood pressure and cholesterol.
• Don’t smoke!

With diabetes being an epidemic in both children and adults, it is necessary for all members of your family at risk, no matter the age, to have an eye exam yearly including a retinal evaluation. At Southwest Vision our doctors have the most advanced technology and retinal imaging that allow us to look at your eye in fine detail. We spend the necessary time with our patients and require ALL patients to have a retinal evaluation as part of their routine eye exam.

References:

MacDonald T, Chous P. Know the Non-Ocular Complications of Diabetes. Review of Optometry September 2011.

Newman-Casey PA, Talwar N, Nan B, et al. The relationship between components of metabolic syndrome and open angle glaucoma. Ophthalmology July 2011.

Martin CJ. Type 2 Diabetes: Not Just For Adults Anymore. Review of Optometry September 2011.

The Prevalence of Diabetic Retinopathy Among Adults in the US.  http://www.nei.nih.gov/eyedata/pbd3.asp” www.nei.nih.gov/eyedata/pbd3.asp

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