Diabetes And Your Eyes

   By Gregory J. Sepanski, MD

Diabetes mellitus affects many different organs in your body including your eyes. Your quality of life and ability to function can change if diabetes starts to threaten your vision, so it is important that you understand what can be done to help. I would like to first discuss diabetes in general and then I will discuss the effects on your eyes.

Diabetes is a disease resulting from an abnormally high glucose (blood sugar) level in your blood stream. The blood glucose remains high in diabetics due to either a lack of or malfunction of insulin in your body (produced by the pancreas). Insulin helps the cells in your body absorb and use the glucose from the bloodstream.

Three types of diabetes have been identified.

• Insulin Dependent usually occurs in the first and second decades of life and arises due to damage of the insulin-producing cells in the pancreas. Patients with this type need insulin.
• Non-Insulin Dependent, which usually occurs after the age of forty and is commonly associated with obesity. It can be controlled with weight loss, oral medication, and/or insulin.
• Secondary diabetes caused by certain drugs or medical conditions.

The first two types of diabetic patients are the most common and are the ones most likely to have eye problems.

The problems that arise in the eyes can be broken down into acute or chronic. The most common acute eye problem is blurred vision from a refractive change. This is most often seen with poorly controlled or newly discovered diabetes, where the glucose level is high and widely fluctuating. The high glucose level causes the lens in your eye to swell and results in blurred vision. This problem is medically correctable and usually resolves within weeks.

Chronic eye problems evolve over years from longtime exposure to elevated glucose levels in the bloodstream. The main cause of these problems, except for cataracts, seems to be a gradual damage of the blood vessels in or around the eyes. The longer a person has diabetes, and the poorer the control, the more likely he/she will have these problems. The most common problem is accelerated cataract formation. Cataracts may result in frequent glasses changes or even surgery if vision is impaired enough. Diabetic patients are more likely to need cataract surgery at an earlier age. Other problems include swelling of the optic nerve, occlusions of the blood vessels in the retina or strokes to the nerves that control the movement of the eyes leading to double vision or blurred vision. Some of these problems will resolve on their own while others may need surgery to improve. Some problems result in poor vision no matter what is done.

Another common and potentially serious chronic eye condition is diabetic retinopathy. The retina can be compared to the film in a camera. When the retina is damaged, the images we see are blurred or not seen at all. In diabetic retinopathy, the blood vessels that supply nutrients to the retina are slowly damaged over years.

Diabetic retinopathy can be either non-proliferative or proliferative. Non-proliferative diabetic retinopathy is described by small areas of bleeding, leakage of fluid, along with some blood vessel irregularities and lipoprotein deposits occurring in the retina. It usually does not affect vision unless diabetic macular edema occurs. In diabetic macular edema leakage of fluid builds up in the area of the retina responsible for your central vision resulting in blurred vision. In-office laser surgery can help.

In proliferative diabetic retinopathy, abnormal blood vessels grow in the retina. This is a very dangerous situation as these vessels may rupture, bleed and scar. The bleeding and scarring can lead to retinal detachment, glaucoma and loss of all vision. Fortunately, an in-office laser surgery can, in most cases, also correct this problem. The procedure can be repeated if necessary.

You should now realize the many ways diabetes affects your eyes and vision. Treatment is available, but prevention is up to you. Routine eye exams with dilation are important and should be done at least once a year. Also, proper medical exams and follow up with the physician caring for your diabetes is important as well. Control of other medical conditions such as obesity and high blood pressure will also help. The more you work to control the diabetes, the more likely you can prevent of the above problems from occurring.

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Gregory J. Sepanski, MD practices at ITEC