Wednesday, September 11, 2013

How diabetes effects eyesight

The other day a patient asked me, Can diabetes have a negative effect on my eyesight?"

I explained that over a long period of time, the high blood glucose levels associated with Diabetes Mellitus can have an effect on many parts of the body. Especially sensitive to damage are small blood vessels, like ones in the retina of the eye and kidneys; and nerve cells. Many eye-related problems can occur with Diabetes, such as fluctuations in eyeglass measurements, lens opacities (cataracts) and retinal complications. Glaucoma problems, corneal problems, even orbital and neurological problems around the eye and orbit area can occur.
During your comprehensive eye exam, the ophthalmologist will look for all of these. Many of these problems appear with noticeable symptoms, such as changes in vision, distorted vision, night glare, sudden unusual floaters but the diabetic retina disease (retinopathy) is typically very slow and sneaks in without the patient’s awareness of it.

Cataracts develop often in younger aged individuals with diabetes. Large fluctuations in blood sugar cause swelling of the crystalline lens inside the eye, which can blur the vision temporarily, but eventually the lens becomes cloudier and affects the clarity of vision. Fortunately, we have effective treatments for cataracts when they become visually significant.

Diabetic Retinopathy is the condition of the retina when it is affected by long term elevations of blood sugar levels. The small arteries of the retina develop weak walls; these can dilate into microaneurysms with early retinopathy. These vessels eventually break, causing dots of bleeding and loss of blood supply to small areas of the retina. Sometimes these microaneurysms leak fluid into the retina, causing it to swell. This alone can cause reduced vision, distorted vision and blind spots.

There are helpful treatments today to reduce the impact on vision. With multiple hemorrhages and poor blood flow from advancing retinopathy, further problems occur as vessels grow inside the eye. Sudden bleeding from these larger weak vessels can cause severe loss of vision, huge floaters and opacities and retinal detachment. With early detection of these impending complications, before they are causing any noticeable symptoms, the treatments for the eye can be quite effective at stopping the progression to blindness.

We recommend eye exams, including dilated retina exam, every year for all diabetic patients, regardless of whether they need glasses or have any vision symptoms or problems. Primary care doctors are usually very good at assuring that their diabetic patients get checked yearly. Good control of blood glucose levels does decrease the chances of these problems dramatically, yearly eye exams allow for earlier detection of retinopathy and therefore earlier treatments if advancing to stages that require treatment.

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