What You Need To Know To Prevent Vision Loss
Many individuals within the United States have already been diagnosed with diabetes. In addition, there is also a population of people that have diabetes, but that are currently undiagnosed. This is super scary! In either case, your eye doctor can play a role in diagnosing and managing your diabetes. Ultimately, patients at a risk for diabetes, or those already diagnosed, should be seen by their Optometrist at a minimum basis of one time per year for a dilated eye exam.
How diabetes affects your eyes
Diabetes is a condition that causes elevated blood sugar levels, and this can lead to changes in your vision or damage to specific areas of your eyes.
One of the many changes diabetic patients may notice is that their vision fluctuates as their blood sugar fluctuates. In other words, diabetic patients may notice their vision becomes blurry when their blood sugar readings or A1C are high. This is then followed by the vision returning to normal once their sugar is controlled again. This is due to the interaction that diabetes can have with the lens inside of your eye.
The lens inside of our eyes is naturally clear, but becomes more opaque later in life which leads to cataracts. When blood sugar levels increase, the sugar levels of the fluid produced inside of the eye also increase. The lens soaks in this now sugar-rich fluid within the eye, and this can cause the lens to swell. Anytime the lens swells, patients will experience a temporary change in their prescription which then causes blurry vision. As the blood sugar levels become controlled again, the fluid within the eye becomes comprised of less sugar also, and the lens will return to its normal shape and size. When this occurs, patients notice their temporarily blurred vision has resolved. Lastly, because of the stress this process induces on the lens, patients with diabetes are at a greater risk for developing cataracts sooner than the average population.
Although your eye doctor will likely only monitor you when diabetic lens-related changes occur, it is important for both the doctor and yourself to be aware of these findings in order to begin better controlling your diabetes.
In addition to the lens and fluid within the eye, high blood sugar from diabetes can also damage the retina. The retina is a tissue that lines the inside of the eye and is comprised of millions of nerves and small blood vessels that nourish this tissue. When patients are diabetic, these small blood vessels in the retina are at a risk for becoming damaged and this is referred to as diabetic retinopathy.
When diabetic retinopathy occurs, diabetic patients may experience bleeding within certain areas of their retina. The blood vessels can also become occluded leading to a lack of blood flow to the rest of the retina. These findings can resolve if the diabetes is well controlled, and the prognosis can be fairly well if the patient and doctor begin discussing better ways of managing diabetes.
Diabetic retinopathy is a warning sign
When your Optometrist diagnoses you with diabetic retinopathy, they are concerned for more than just your eyes. Because the blood vessels in the retina are so small, they are often the first blood vessels subject to damage from diabetes. However, the severity of a patient’s diabetic retinopathy can also correlate with their likelihood of having damaged blood vessels in the kidneys, leading to diabetic nephropathy. This is because the blood vessels within the kidney are also small and subject to early damage – like the retina. Eek!
Lastly, if a very specific area of your retina, known as the macula, becomes affected by your diabetes, your Optometrist may have to refer you to a Retinal Ophthalmologist for further evaluation and treatment. The macula is an area of the retina with the highest level of detail-resolving vision and is also responsible for our central vision (vs our peripheral vision).
What you can do
As mentioned, patients with diabetes can control their blood sugar and A1C levels. Healthcare providers recommend an A1C value of 6.5 or less taken regularly every 3 months. Diabetic patients should know that the two most important factors regarding their diabetes and likelihood of developing diabetic retinopathy are: duration and control. In many cases, duration of the diabetes, or how long a patient has been diabetic, is something out of the hands of the patient and their healthcare providers. For this reason, control of the diabetes is often targeted as the main management plan.
If you are diabetic or have a risk of developing diabetes, your Optometrist would like to help you prioritize yearly dilated eye exams to help protect your retina and overall vision. Do you currently see an Optometrist for your diabetes? How often do they recommend you see them?
Dr. Travis Zigler