Diabetes is becoming much more prevalent around the globe. According to the International Diabetes Federation, approximately 425 million adults were living with diabetes in the year 2017 and 352 million more people were at risk of developing type 2 diabetes. By 2045 the number of people diagnosed is expected to rise to 629 million. This is due to the increased prevalence of obesity, in part.
Diabetes is a leading cause of blindness as well as heart attacks, stroke, kidney failure, neuropathy (nerve damage) and lower limb amputation. In fact, in 2017, diabetes was implicated in 4 million deaths worldwide. Nevertheless preventing these complications from diabetes is possible with proper treatment, medication and regular medical screenings as well as improving your diet, physical activity and adopting a healthy lifestyle.
Dr. Emil Chynn, Scientific Advisor to the American Council on Science & Health (ACSH) offers some wise tips for diabetics to preserve their vision!
What is Diabetes?
Diabetes is a chronic disease in which the hormone insulin is either underproduced or ineffective in its ability to regulate blood sugar. Uncontrolled diabetes leads to hyperglycemia, or high blood sugar, which damages many systems in the body such as the blood vessels and the nervous system.
How Does Diabetes Affect The Eyes?
Diabetic eye disease is a group of conditions which are caused, or worsened, by diabetes; including: diabetic retinopathy, diabetic macular edema, glaucoma and cataracts. Diabetes increases the risk of cataracts by four times, and can increase dryness and reduce cornea sensation.
In diabetic retinopathy, over time, the tiny blood vessels within the eyes become damaged, causing leakage, poor oxygen circulation, then scarring of the sensitive tissue within the retina, which can result in further cell damage and scarring.
The longer you have diabetes, and the longer your blood sugar levels remain uncontrolled, the higher the chances of developing diabetic eye disease. Unlike many other vision-threatening conditions which are more prevalent in older individuals, diabetic eye disease is one of the main causes of vision loss in the younger, working-age population. Unfortunately, these eye conditions can lead to blindness if not caught early and treated. In fact, 2.6% of blindness worldwide is due to diabetes.
Diabetic Retinopathy
As mentioned above, diabetes can result in cumulative damage to the blood vessels in the retina, the light-sensitive tissue located at the back of the eye. This is called diabetic retinopathy.
The retina is responsible for converting the light it receives into visual signals to the optic nerve in the brain. High blood sugar levels can cause the blood vessels in the retina to leak or hemorrhage, causing bleeding and distorting vision. In advanced stages, new blood vessels may begin to grow on the retinal surface causing scarring and further damaging cells in the retina. Diabetic retinopathy can eventually lead to blindness. This is why it’s crucial for diabetics to have regular eye exams!
Signs and Symptoms of Diabetic Retinopathy
The early stages of diabetic retinopathy often have no symptoms, which is why it’s vitally important to have frequent diabetic eye exams. As it progresses you may start to notice the following symptoms:
- Blurred or fluctuating vision or vision loss
- Floaters (dark spots or strings that appear to float in your visual field)
- Blind spots
- Color vision loss
There is no pain associated with diabetic retinopathy to signal any issues. If not controlled, as retinopathy continues it can cause retinal detachment and macular edema, two other serious conditions that threaten vision. Again, there are often NO signs or symptoms until more advanced stages.
A person with diabetes can do their part to control their blood sugar level. Following the physician’s medication plan, as well as diet and exercise recommendations to achieve control of blood sugar levels (as monitored by H1c levels) can help slow the progression of diabetic retinopathy.
Retinal Detachment
Scar tissues caused by the breaking and forming of blood vessels in advanced retinopathy can lead to a retinal detachment in which the retina pulls away from the underlying tissue. This condition is a medical emergency and must be treated immediately as it can lead to permanent vision loss. Signs of a retinal detachment include a sudden onset of floaters or flashes in the vision, or a “curtain coming down” and loss of one part of the visual field.
Diabetic Macular Edema (DME)
Diabetic macular edema occurs when the macula, a part of the retina responsible for clear central vision, becomes full of fluid (edema). It is a complication of diabetic retinopathy that occurs in about half of patients, and causes vision loss.
Treatment for Diabetic Retinopathy and Diabetic Macular Edema
While vision loss from diabetic retinopathy and DME often can’t be restored, with early detection there are some preventative treatments available. Proliferative diabetic retinopathy (when the blood vessels begin to grow abnormally) can be treated by laser surgery, injections with new, effective (but expensive) drugs to prevent new blood vessel growth, and/or a procedure called vitrectomy in which the vitreous gel in the center of the eye is removed and replaced. This will treat bleeding caused by ruptured blood vessels. DME can be treated with injection therapy, laser surgery or corticosteroids.
Can Diabetics Safely Get LASEK?
Dr. Chynn’s uncle is a prominent retinal surgeon at Harvard’s Massachusetts Eye & Ear Infirmary, and helped train Dr. Chynn there from 1993-1997. Dr. Chynn thus is very attuned how to successfully and safely perform LASEK in patients with both insulin-dependent and non-insulin dependent diabetes.
As long as their blood sugar is reasonably well-controlled, there’s no reason why a diabetic can’t enjoy the full benefits of LASEK laser vision correction! The only caveat is that healing may take 1-2 days longer—that’s it!
Prevent Vision Loss from Diabetes
The best way to prevent vision loss from diabetic eye disease is early detection and treatment. Since there may be no symptoms in the early stages, regular diabetic eye exams are critical for early diagnosis. In fact diabetics are now sometimes monitored by their health insurance to see if they are getting regular eye exams and premium rates can be affected by how regularly the patients get their eyes checked. Keeping diabetes under control through exercise, diet, medication and regular screenings will help to reduce the chances of vision loss and blindness from diabetes.
If you know a diabetic who’s interested in laser vision correction, have them call us & set up an appointment for a dilated fundus examination of their retina, so Dr. Chynn can confirm that person is a good candidate for LASEK!
