November is Diabetic Eye Disease Awareness Month
Dr. Arnold Boliday recommends making an eye appointment and visiting your endocrinologist
As the holidays approach, fully vaccinated family and friends are eager to gather and see each other once again. While video calling may have helped us get through our last holiday season as best we could, this year most people are looking forward to the joy of seeing family in real life, in living color. They want to study and cook heritage recipes together, watch the faces of grandchildren as they soak in holiday lights, view treasured movies, read holiday classic tales and look through photo albums of holidays past.
Having healthy eyes is important to make all this holiday joy happen, says Dr. Arnold Bolisay. An endocrinologist with Premier Suburban Medical Group, Dr. Bolisay explains that, for people with diabetes, the holidays can be fraught with poor food offerings, erratic schedules and too many indulgences. These factors can make blood sugar management difficult, endangering eye and vision health.
Why Does Diabetes Affect Vision?
“Too much glucose, or sugar, in your bloodstream damages blood vessels and nerves throughout your body,” explains Dr. Bolisay. “This damage happens everywhere, from the largest veins and arteries in your abdomen and limbs to the tiniest capillaries in your eyes.”
The most common diabetic vision problem is diabetic retinopathy. “Diabetic retinopathy is now the leading cause of blindness in adults in our country,” says Dr. Bolisay. “The retina is a layer of tissue in the back of your eye. The retina receives light from the lens of your eye and converts it into signals that are sent to your brain which then recognizes those signals as visual images. Diabetic retinopathy happens when blood vessels in the retina leak, or when there is a growth of abnormal blood vessels on the retina’s surface.”
The center of the retina is called the macula and provides sharp visual images. Macular edema, swelling caused by leaking blood vessels, will also damage vision.
About 90% of people will develop cataracts by age 65, but people with mismanaged diabetes will form cataracts earlier and at a faster pace. High blood sugar will hasten the progress of the cloudy build up in the eye’s lens.
A rare form of glaucoma, neovascular glaucoma can also be caused by diabetes. “The iris is the colored ring that opens and contracts the pupil, regulating the amount of light entering the eye,” says Dr. Bolisay. “When the abnormal growth of new blood vessels occurs on the iris, it causes an increase in eye pressure, resulting in glaucoma.”
“Your vision also is affected when blood sugar drops,” says Dr. Bolisay. “You may experience blurred vision as your blood sugar quickly goes from low to normal, as the shape of your eye actually changes during this process. When blood sugar stabilizes, your vision should return to normal.”
People with Type 2 diabetes aren’t the only people at higher risk for vision problems and potential blindness. Those with Type 1 diabetes and those who’ve experience diabetes while pregnant, or gestational diabetes, are also at risk for eye and vision problems.
How Can Diabetic Eye Damage Be Prevented?
Dr. Bolisay explains that managing blood sugar levels is the most important tool in eye damage prevention. “Hands down, keeping your blood sugar levels within a healthy range is the very best way to save your vision,” he says. “Managing your blood pressure and cholesterol is also important.”
Quitting smoking and tobacco products is also critical to preventing eye damage. “Smoking also weakens the vascular system, contributing to the formation of the leaks and bulges,” says Dr. Bolisay. “Talk to your doctor about a smoking cessation program if you’re having trouble quitting smoking, chewing or vaping. There are tools that are proven to help that can be prescribed.”
Wear sunglasses when outdoors to slow the progression of cataracts. Stay physically active, which helps to improve blood flow and strengthen the vascular system. “Walking just 30 minutes a day, three times a week, can make an enormous difference in the health of your veins and arteries. It also helps maintain your blood sugar levels, lowers your blood pressure and balances your cholesterol - all of which improves your diabetic status to improve your health.”
At this time of year, diabetic management could mean additional testing throughout the day and a special focus on diet and activity. “Visit your endocrinologist to work out a plan that will work for your health and your lifestyle. Those who plan on avoiding every holiday treat can often set themselves up for failure as it’s so very difficult to pass on your favorite once-a-year sweet. Talking to your endocrinologist can help you see what’s really possible to enjoy within the framework of keeping your blood sugar regulated. Together, we can find a solution that helps you enjoy the holidays without putting your health at risk.”
What Are Early Warning Signs of Diabetic Eye Damage?
“Unfortunately, early warning signs of diabetic retinopathy and other vision problems are not visible to patients,” says Dr. Bolisay. “When patients notice blurry vision, “floaters” such as spots or dark shapes, have dark or empty areas in their vision, have trouble seeing colors or real vision loss, they are typically in the advanced stage of disease and treatment is more difficult. That’s why prevention and regular eye appointments are so important.”
One of the earliest symptoms of diabetic retinopathy is when blood vessels of the retina weaken and bulge, forming microscopic pouches that leak blood. This blood and other fluids can then cause the macula to swell. These leaks cannot be seen without special screening equipment, during an exam with your optometrist. Patients typically will not notice the first signs of slow progression of vision distortion. Dr. Bolisay stresses the importance of annual eye examinations. “Patients with diabetes should be rigorous about their annual eye exam. Your optometrist will be able to detect problems in the very earliest stages of disease, when treatment will be most effective.”
What Are Treatment Options?
In the earliest stages, a patient might be prescribed vascular endothelial growth factor (VEDF) inhibitors, which slow and in some cases, may reverse diabetic retinopathy. Laser therapy, or laser photocoagulation, can create scar tissue which helps slow the growth of abnormal blood vessels. A vitrectomy, which removes and replaces the gel-like vitreous in the middle of the eye, may be needed. Patients may require corticosteroid injections.
Without treatment, complications from diabetes will lead to low vision, vision loss and eventually blindness.
“Vision loss does not have to be inevitable for patients with diabetes,” says Dr. Bolisay. “Proper management of blood sugar is the best way to lower your risk of diabetic retinopathy and other disease. Going to see your optometrist annually - or more often if recommended by your physicians - means you’ll know immediately when treatment is needed to slow or reverse disease. Your endocrinologist and your eye doctor are the very best resources to prevent diabetic vision loss.”