Diabetes and the Eye
Diabetes is a systemic condition that primarily affects the pancreas. It comes in two forms, Type I and Type II. With Type I, the body does not produce enough insulin. While people with Type II produce enough insulin, the body lacks the ability to process it. The chief biochemical result of both forms is an elevation of a person’s blood glucose level. If the glucose level is not tightly monitored and controlled, blood vessels and the tissues that they supply may become damaged.
So what can diabetes do to the eye? Inside the eye are many fragile vessels that operate very well when the blood chemistry is within a normal functional range. When sugar levels are elevated above this range, the eye believes it’s under attack and develops a response. Vessels may begin to leak causing blood to spill across the retina. In more severe cases, the eye secretes a chemical called vascular endothelial growth factor (VEGF). The presence of VEGF triggers a process in the retina known as angiogenesis (growth of new blood vessels in the retina). In some eyes, VEGF is so prevalent that it migrates across the entire eye and causes angiogenesis in some of the structures at the front of the eye. In addition to attacking the eye’s blood vessels, diabetes can damage a key structure known as the macula. This is an area of the retina the corresponds to a person’s sharp, crisp, central vision. If diabetic-related swelling occurs here, a person can have a significant loss of vision that cannot be corrected with glasses or contacts. Some diabetics have visual changes that correspond to a wide and frequent variations in their prescription. In these instances the disease process changes the chemical constituency of the lens leading to large amounts of sugar and water being deposited there. This causing swelling that fluctuates with the body’s blood sugar levels. Although this may seem like a minor inconvenience it can be indicative of blood sugar levels that have the potential to become fatal.
What do you need to do if you develop diabetes? There are 3 major elements that all diabetics MUST follow:
1) Develop a relationship with a family physician or internist to coordinate care. The primary care physician is responsible for ensuring that all treatments are effective and that the disease remains under control.
2) Faithfully control one’s blood sugar through proper diet and exercise. This is absolutely critical. A physician should help determine a safe blood sugar level and direct a patient towards nutritional counseling if necessary.
3) See an optometrist at least once per year for a dilated eye exam. Diabetes is the number one cause of preventable blindness in the United States. With proper care and monitoring, most of the symptoms mentioned above can be avoided.
At Park Slope Eye, Dr. Bazan and I dilate and thoroughly examine every diabetic patient. We take a detailed history on the patient’s condition, look for specific ocular findings of diabetic eye disease, and then develop an appropriate treatment strategy to preserve vision and eye health. We also photograph key areas of the retina to help establish baseline readings and track future disease progression. It’s important that a diabetic’s primary care doctor know of our findings and treatments. At the end of every diabetic exam, we call and fax other the healthcare providers to coordinate care strategies. If secondary or tertiary level care is required, we are fortunate to have excellent relationships with some of the best diabetic eye specialists in New York.
If you or a loved one has diabetes and are not currently under the care of an optometrist, we would be honored to examine your eyes. If you aren’t in the New York area, call the office and we can try to find a doctor in your city. Your eyes and vision are too important to ignore.