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Saturday, May 30, 2015

Diabetes and Eye Care

Diabetes and Eye Care

Here’s the issue on Diabetes and Eye Care. Once you receive a diagnosis of diabetes, it will be necessary to have a medical follow-up where the doctor will determine the most effective treatment for you. You will have a diabetes team to help take care of you which may include a certified diabetes educator, a podiatrist for the feet, social worker, ophthalmologist for the eyes and a dietitian.

What You’ll Learn:

• Diabetes Retinopathy
• Cataracts and the Symptoms
• Breaking News That Matter to Diabetics

Diabetes Retinopathy

Diabetes can affect the body organs including the blood vessels, heart, nerves, kidneys and eyes. These complications can develop gradually and could disable a person or threaten his life. But the good news is they can be avoided by keeping the blood sugar level as close to normal as possible, at least most of the time. The risk for the complications can then be reduced.
One such complication is damage to the eyes. You see diabetes can damage the retina’s blood vessels which could lead to blindness. There are other serious vision conditions that diabetes can cause or increase the risk of developing cataracts and glaucoma. For this section we will concentrate on diabetic retinopathy.
Here’s a video on Understanding Proliferative Diabetic Retinopathy

What is Diabetic Retinopathy?

Diabetic retinopathy is a complication affecting the eyes of a diabetic. What happens is that the blood vessels of the tissue at the back of the eye or the retina is damaged. There may not be any signs at the beginning and the affected person may only feel mild and minor visual problems, but the condition could lead to blindness.
How does the tissue at the back of the eyes damaged, you asked? You see, the high blood sugar level can pull fluid from the tissues and the lenses of the eyes thus affecting your ability to focus. If this is not treated, it can lead to the formation of the new blood vessels in the retina. This may not cause vision problem, perhaps just blurry vision at first but could lead to blindness if not treated.
Anyone with type 2 or type 1 diabetes can develop diabetic retinopathy. Those with uncontrolled blood sugar level and have had diabetes for a long time are the ones who are likely to develop this condition. That is why it is important to get on top of maintaining the blood sugar level as close to normal as possible.

What Are the Risk Factors of Diabetic Retinopathy?

How long have you had diabetes.
Uncontrolled blood sugar
High cholesterol and blood pressure levels
Being a Native American, Hispanic or Black

What Are the Symptoms of Diabetic Retinopathy?

Both eyes are usually affected by diabetic retinopathy. At the start, you may not feel any symptoms but as the condition continues to progress some of the symptoms may be the following:
Vision is blurry.
There are dark or empty parts in the vision.
Vision is irregular.
There are floaters in the vision.
The color vision is impaired.
Vision is lost.

What Tests Are Employed in the Diagnosis of Diabetic Retinopathy?

Go to the doctor for the diagnosis where he will do a dilated eye examination. He will place drops in your eyes to dilate or widen them so he can see better the inside of your eyes. This may cause you a blurry vision for several hours until the drops wear off. Meantime the doctor will be able to look for some of the following:
Swelling and blood deposits in the retina
Irregular blood vessels
Development of new blood vessels and scar tissue
Retinal disconnection
Filling of jelly-like substance in the centre of the eye
Irregularities in the optic nerve
The doctor will do a fluorescein angiography where he will take pictures of the insides of the eyes while they are dilated and inject into your arm a special dye which will enable him to take more pictures as this dye goes through your eyes. These pictures will then show him the blood vessels that are closed or broken down and leaking fluid. The doctor may also check for cataracts and glaucoma and test your vision as well.
The eye doctor may also ask to have an OCT exam, which is short for optical coherence tomography. This will show the eye doctor a cross-sectional image of the retina that shows its thickness. This will help find out if there is leakage into retinal tissue. This same exam will also help see how well the treatment is working.

When Do You See the Doctor for Diabetic Retinopathy and How Do You Prepare For It?

Carefully managing the diabetes is the best way not to go blind so if you have diabetes, get an annual eye exam. Do this even when you feel there is nothing wrong with your eyes. Depending on the situation, the doctor may even suggest additional eye exams. Anyway, contact your doctor as soon as your vision becomes hazy, spotty and blurry.
You will have plenty of questions so write them down as they happen so that just before your appointment with the doctor, you could summarize them in a list. This way, you will make the most of your time. Clarify with him how often you should monitor your blood sugar level as well as the timing when you should do so.
You may also need to know about insulin therapy (Types of insulin, the timing and the amount of dose as well as how to administer the insulin – which is best for you, pump or shots?) In addition, there are questions on the testing and treatment of ketones, the types of food affecting the blood sugar level and how to do carb counting.
You may also want to ask him how to adjust the insulin and food consumption for exercise and any other activity, how to manage your sick days, how to recognize and treat low and high blood sugar and the frequency of your visits to your doctor and other specialists.
Also write down all personal information or a short outline of your diabetes history and include the date of the diagnosis, the medications you took and are taking, the current average blood sugar levels and the past few A1C readings and the symptoms even if they are not related to eye problems plus any crisis in your life that stress you.
List down all vitamins, supplements and medications including the dosage you’re taking.
Bring the glucose values you recorded on your blood sugar level check-up, and ask how to make adjustments to your medication, diet and exercise to reflect the changes in your blood glucose levels.
Get a friend or a member of your family to go to your appointment with you to help you remember what the doctor will tell. This is a win-win situation because you will need a drive home with your dilated eyes from the doctor’s tests.

Now List the Questions to Ask Your Doctor

Questions you may want to ask about diabetic retinopathy may include the following:
How does diabetes affect my vision?
What tests will I have to undergo? Are there other tests I need?
Is my vision problem permanent or temporary?
Can you recommend some treatment?
Are there side effects from those treatments?
Will my symptoms disappear if I control my blood sugar better?
To protect my eyes, what should my blood sugar goal be?
How can I best manage all my conditions better if I have other health conditions?
Can you recommend other services for those who are visually handicapped?

Be Ready to Reply to What the Doctor May Ask You

Are you feeling some symptoms like blurry vision?
How long have you been feeling these symptoms?
What was the result of your last hemoglobin A1C?
How often do you experience low blood sugar episodes?
Can you tell when your blood sugar is getting low?
Are you comfortable in managing your diabetes?
How much exercise do you do?
What is your diet like?
How much insulin, on the average, are you using each day?
What other health conditions do you have like high cholesterol and high blood pressure?
How about eye surgery, have you ever had it?

What are the Causes of Diabetic Retinopathy?

The tiny blood vessels that nurture the retina are blocked by too much blood sugar thus cutting off the blood supply. To compensate, the eye tries to develop new blood vessels but they don’t develop correctly and can easily leak. Diabetic retinopathy is of two types. Determine what type you are.

Causes of Early Diabetic Retinopathy

The early diabetic retinopathy is also called nonproliferative retinopathy or NPDR that occurs when the blood sugar walls have become weak. This sometimes leads to leakage of blood and fluid into the retina. As more blood vessels are blocked, the NDPR can advance from mild to severe. The nerve fibers may start to swell and sometimes so do the central part of the retina.

Causes of Advanced Diabetic Retinopathy

The advanced diabetic retinopathy is also called proliferative diabetic retinopathy and occurs when the damaged blood vessels close off leading to the growth of new blood vessels that are abnormal. This can leak into the center of the eye filled with jelly-like substance.
The scar tissue caused by the new blood vessels may lead to the detachment of the retina from the back of the eye. Pressure can then build up which can damage the optic nerve that carries the image from the eye to the brain. This can lead to glaucoma.

Complications of Diabetic Retinopathy

The irregular development of blood vessels in the retina caused by diabetic retinopathy can lead to more problems. Yes, it is very irritating, isn’t it? Here we already have a complication in diabetic retinopathy and they tell us this has a complication all its own? Give us a break, please!
1. Hemorrhage – There may be bleeding by the new blood vessels into the clear substance that is in the center of the eye. It is not too bad with small bleeding because then we will only see not much floaters or dark spots. The trouble is that when there is too much bleeding, the blood could fill the cavity and block our ability to see.
This is not permanent, thank heavens for in a few weeks or months, the blood frequently clears the eye so as long as the retina is not damaged, the vision will come back. Thank heavens for small mercies.
2. Glaucoma – If the new abnormal blood vessels form in the front of the eye, it will impede the normal flowing of fluid from the eye. This will lead to build-up pressure in the eye called glaucoma that could harm the optic nerve that carries the picture from the eye to the brain.
3. Detachment of the retina – The irregular blood vessels that grow due to diabetic retinopathy cause scar tissue to form. This scar tissue can pull the retina away which could cause one to see light flashes, floaters and even vision loss.
4. Blindness – can eventually be the result from having glaucoma and diabetic retinopathy or both.

What are the Treatments and Drugs for Diabetic Retinopathy?

Treatments depends on the type of diabetic retinopathy you have. It depends on how severe the condition is. The goal for the treatment is to slow down the diabetic retinopathy or just stops its advancement. Let us take this one at a time, shall we?

Treatment for Early Diabetic Retinopathy

You may not need immediate treatment if you have mild or mediocre type of diabetic retinopathy. But the eye doctor will keep an eye on your eyes to see if the treatment is necessary down the road. Meantime get your diabetes care team to help improve the way you manage your diabetes because at this early stage, maintaining blood sugar control will slow the progression.

Treatment for Advanced Diabetic Retinopathy

Advanced diabetic retinopathy will need surgical treatment without delay. Based on the problems in the retina, the options may include:
1. Scatter laser treatment is also known as panretinal photocoagulation and it can reduce in size the abnormal blood vessels. What the doctor will do is that he will treat with scattered laser burns the area of the retina away from the macula. The burns can make the new abnormal vessels shrink. This is done in the doctor’s office in two or more sessions.
What can you expect to happen after the procedure, you asked? For a day after the procedure, you will have blurry vision. On top of this, there is a chance you might lose some peripheral vision. It is also possible to lose night vision after the surgery.
2. Focal laser treatment, known as photocoagulation, can either stop or slow down the blood leakage in the eye. What the doctor will do is treat with laser burns the leaks from the abnormal blood vessels. This procedure is done in the doctor’s office in one session.
If your vision is blurry from macular edema before the procedure, your vision may not return to normal from this procedure but at least the odd the macular edema may get worse is likely reduced.
3. Vitretomy is the type of procedure that uses a tiny incision in the eye. The purpose of this is to remove blood from the vitreous or middle of the eye. It will also remove the scar tissue on the retina. Local or general anesthesia is used and the procedure is done in the hospital or surgical centers.
Surgery is not a cure but rather it just stops the progression or slows it down. Future damage to the retina is still possible because diabetes is a lifelong condition. Vision loss is still possible and regular eye exams are needed and so it may be recommended to have additional treatment.
There are a lot of researches that study the treatment for diabetic retinopathy. Some are promising like the medications that stop the formation of abnormal blood vessels in the eye. Some are injected right into the eye to treat the swelling but more researches are necessary.
There are some alternative therapies that are helpful but none has been fully substantiated. What is important in this case is not to delay the treatment because you want to try unproven ones. Another important thing here is to tell your doctor the herbs and supplements you’re taking are some of them may interact with other medications or cause excessive bleeding in surgery.
To get early treatment is still the best way to prevent loss of vision. The thought of losing your vision is scary to say the least. You need a support group to see you through. Ask your doctor to refer you to such groups and for low-vision products like magnifiers and other services that will make your everyday life easier.

How Can You Prevent Diabetic Retinopathy?

No one can at all times prevent diabetic retinopathy but there are things one can do to avoid serious loss of vision. For example, There are things you can do like having control of blood pressure and blood sugar, regular eye exams plus early intervention of eye problems.. The risk for diabetic retinopathy can be reduced when you do the following:
Quit smoking as this increases the risk for complications as well as diabetic retinopathy.
Manage your diabetes by eating healthy, exercising regularly and taking insulin or oral medications as prescribed.
Ask the doctor for an A1C test for this will show the average blood sugar level the previous 2 or 3 months before the test. It should be below 7% so the test will guide you and your doctor to adjust your treatment plan.
Check and record your blood sugar level a number of times a day.
Be aware of changes in your vision and tell the doctor about it if it becomes foggy, blotchy or shadowy.
Maintain healthy levels of blood pressure and cholesterol by eating healthy, moving more and losing weight.


Cataracts and the Symptoms

A cataract is the clouding of the lens of the eye. When you have cataract, it is like looking through a window that is frosty and fogged-up. This condition can make it hard to read or drive. The condition may develop slowly but will eventually interfere with your vision and you may then need cataract surgery. Here are the signs and symptoms of cataracts:
You become sensitive to light and glare.
Your vision becomes dim, cloudy and blurry.
You are experiencing more difficulty with your vision at night.
You feel double vision in one eye.
You feel you have to change your eyeglasses prescription more often.
You see fading or yellowing in colors.
You are seeing halos around lights.
The cataracts are formed in the lens behind the iris or the colored part of your eye. The lens directs the light that passes into the eye producing clear images but the cataract scatters this light thus preventing the sharp images to reach the retina. Aging makes the lenses thicken and less flexible. See your doctor as soon as you detect changes in your eyesight.

What are the Types of Cataract?

Nuclear cataracts affect the center of the lens and may at first make one nearsighted but can turn more densely yellow and with time will affect your ability to see. They may even turn brown as the cataract progresses making one unable to distinguish between shades of color.
Cortical cataracts affect the lens edges and start as wedge-shaped whitish streaks on the outer side of the lens cortex. As the condition progresses, the streaks spread out through the center of the lens. Those with cortical cataracts have problems with glare.
Posterior subcapsular cataracts affect the back of the lens. This form of cataract starts as a tiny, opaque area in the back of the lens and interferes with your reading, causing glare around night lights.
Congenital cataracts are those you’re born with that may have been caused by the mother contracting an infection while pregnant. These may also be due to such conditions as Lowe’s syndrome or rubella, and myotonic dystrophy galactosemia. They usually do not affect vision.

What are the Risk Factors That Increase Your Risk of Cataract?

Having diabetes
Getting older
Drinking too much alcohol
Getting exposed to too much sunlight
Having a family history of cataracts
Being overweight
Having blood pressure
Being exposed to ionizing radiation
Having had eye surgery
Using corticosteroid medications for a long time
Having had injury or inflammation in the eye
If your doctor finds you have cataracts, he will refer you to an eye doctor (ophthalmologist) who will do a cataract surgery. The appointment will be short so be prepared for the questions the doctor will ask you. The next section will help you get ready for your appointment:

How To Get Ready for Your Cataract Appointment

Write down all the symptoms you’re experiencing.
Include all medications like vitamins and supplements.
Add the main stress in your life.
Take a member of the family or a friend to your appointment for some support.
List down all the questions you want to ask the eye doctor. You don’t have much time with the ophthalmologist so preparing the questions will be an efficient way to get the most out of your time with the doctor. For list of questions you may want to ask, please go to the next section.

Questions You May Want to Ask the Eye Doctor

Is it the cataract that is causing problem to my ability to see well?
Are there other reasons why I am having vision problem other than the cataract?
What tests do I have to take for this condition?
Will my vision problem go away if I undergo cataract surgery?
Do I need to undergo cataract surgery?
What possible risks will I go through if I undergo cataract surgery?
How much will the cataract surgery cost me?
Will my health insurance cover the cost of cataract surgery?
Will I be able to drive myself home after cataract surgery?
How long will I recover from cataract surgery?
Will there be activities I will be restricted after the cataract surgery?
How long will the restriction last?
Do I need new eyeglasses after surgery? How long after surgery before I get them?
Will Medicare cover both the cataract surgery and the eyeglasses?
How soon should I decide to undergo surgery?
If I delay the cataract surgery, will I suffer from it?
Will waiting to have cataract surgery make it difficult to restore my vision?
What do I do with my vision while waiting to decide to have cataract surgery?
Is there a way for me to know if my cataract is getting worse?
How can I manage both this cataract and my other health conditions like diabetes?
What restrictions do I need to follow?
Do you have brochures I can take with me?
Will you recommend websites for me to peruse?
Should I make plans for a follow-up visit?

Be Ready to Answer Questions the Eye Doctor May Ask You.

Here are the questions your eye doctor may want to ask you. If you are prepared to answer them, you will be able to cover all the points in your agenda. If there is something you don’t understand, ask the doctor for clarification.
When did you start feeling your symptoms?
Do you feel the symptoms all the time or just sometimes?
Do you find it hard to see when the light is bright?
Are the symptoms severe?
Are you having difficulty driving because of your vision problem?
Are you having difficulty reading because of your vision problem?
Are you having difficulty doing your job because of your vision problem?
Have you injured your eyes?
Have you had eye surgery?
Have you received radiation treatment in your neck or head?
Have you been diagnosed with eye problem?
What medications, vitamins and supplements are you taking?

Tests and Diagnosis the Eye Doctor May Do

The eye doctor will review your symptoms and medical history, do an eye examination and several tests.
1. He will do a visual acuity test which is basically asking you to read a chart which has progressively smaller letters one eye at a time.
2. He will do a slit lamp to examine your eyes that will enable him to see the structures under magnification.
3. He will do a retinal examination where he will first puts dilating drops in your eyes to open them wide so he can examine the retina or the back of your eyes with a slit lamp or an ophthalmoscope. He can then examine the lens to see if you have cataract.
It is sad to say at this point that surgery is the only treatment for cataracts. But there’s hope in the future. I read the following with interest “B.C. doctor says perfect vision possible with Bionic Lens”. He said we can see three times better without glasses or contacts. This is possible with the help of bionic lenses implanted in the eyes. He further said these people would never get cataracts. I will try to write more on this in the alert section of this report.
Dr. Garth Webb, a British Columbia optometrist who invented the Ocumetic Bionic Lens, says patients would have perfect vision and that driving, progressive and contact lenses would become a dim memory as the eye-care industry is transformed.
Webb says people who have the specialized lenses surgically inserted would never get cataracts because their natural lenses, which decay over time, would have been replaced.

What and How To Consider Cataract Surgery

While the cataracts usually do not harm the eyes, still it might affect your quality of life. You might not be able to drive at night , read or even perform normal every day activities. Talk to your doctor about this. Usually doctors recommend cataract surgery once it starts to interfere with your activities. Only you and your doctor can decide when to undergo cataract surgery.
You should take time to consider the pros and cons, the benefits and risks, that is. Waiting to have it done will not likely make you lose the chance to recover your vision. If you decide not to have cataract surgery, your doctor will probably recommend to have you come for periodic exams to see how the cataracts are coming along. The frequency depends on you.

How is Cataract Surgery Done

Cataract surgery is usually done on you as an outpatient so there will be no need for a hospital stay. What the doctor will do is remove the cloudy lens and replace with artificial lens in the same place where your natural lens were. He will use local anesthesia to make the part around the eye numb but usually patient will be awake while the doctor is working on the surgery.
The artificial lens cannot be used with some other eye problems so once the cataract is removed, corrective glasses may be used. Generally, cataract surgery is safe but there is the risk of infection and bleeding. Also, it raises the risk for the detachment of the retina. You will be uncomfortable for a few days after surgery but people are usually healed within 8 weeks. If you need the cataract removed in the second eye, it is usually done after a month or two of the first surgery.

Lifestyle and Things to Do at Home While Waiting to Decide on the Surgery

Magnifying glass can help you read.
Ensure that you have the most accurate prescription for your contact lens and eyeglasses.
Wear wide-brimmed hat and sun glasses when you’re out during the day to avoid glare.
Use brighter lamps at home.
Reduce the times you drive at night.
While the above self care will help, the cataracts may progress to the point you can no longer do your daily activities. There are no preventive measures that we know of but doctors have strategies that may help as follows:
Go for a yearly physical check up. In addition, go for regular eye examinations as they detect problems early on. Ask your doctor how often you should go for an eye examination.
Don’t smoke and if you have a hard time quitting ask for help. This may help. Some people asked me about how to quit smoking fast. might help you to quit smoking. Smoking increases the risk of diabetes complications like stroke, heart attack, nerve damage and kidney disease.
Wear sunglasses as the sun’s ultraviolet light may help with the development of cataracts. Use sunglasses that block ultraviolet B (UVB).
Limit alcohol use as excessive use can increase the risk of cataracts. It can also lead to high or low blood sugar depending on your consumption of food and alcohol at the same time. Drink in moderation and with a meal and please check your blood sugar before going to bed.
Eat a healthy diet with plenty of fruits and vegetables.
Keep a healthy weight by moving more.
Manage other health issues as some can increase the risk of cataracts. Make a commitment to take care of yourself.
Wear a tag or bracelet to let people know you have diabetes. Have a glucagon kit ready in case of an emergency with the low blood sugar. Make sure your friends and family know how to use it.
Take extra care of your feet and make sure to check for blisters, sores, cuts redness and swelling. Tell the doctor if something does not heal.
Maintain healthy levels of cholesterol and blood pressure by eating healthy and moving more.
Make sure your immunizations are up to date. Check with your doctor about a flu shot every year and find out whether you need pneumonia and hepatitis B vaccination.
Manage your stress or else it may prevent the insulin from doing its job.

Breaking News That Matter to Diabetics

1. B.C. Doctor Says Perfect Vision Possible With Bionic Lens

“B.C. doctor says perfect vision possible with Bionic Lens”. He said we can see three times better without glasses or contacts. This is possible with the help of bionic lenses implanted in the eyes. He further said these people would never get cataracts.
Dr. Garth Webb, an optometrist from British Columbia invented the Ocumetic Bionic Lens, He said patients would have perfect vision and that eyeglasses would be a thing of the past as the eye care industry is changed. He further said that people who have these bionic lenses surgically inserted would never get cataracts.
Dr. Webb is holding a bionic lens on his finger tip while being photographed at Manterra Technologies where they are mass producing the lens in Delta, B.C. starting last May 12, 2015.

2. New Treatment for Common Diabetes Eye Problem

About 25% of diabetics will develop eye problems. These problems could lead to loss of vision. Just recently FDA or the U.S. Food and Drug Administration has given approval to first of its kind therapy. They say this might help those suffering from Diabetic Retinopathy save their sight or make their vision better.
I f you know anybody who lives with diabetic retinopathy which is a long term complication, please let them know of this so they can check it out.


There you have more information on diabetes and eye care. Please no matter what happens, continue taking good care of yourself. It will be worth it because you can see how many diabetics are surviving with little or no complications at all. You can do it; we know you can! Eat healthy, exercise, sleep well and manage your stress for optimal health.

Your Turn

What do you think of all of these? Did you learn something new? Do you have any information on this issue to contribute? What strategies do you use so you can keep on taking good care of your eyes? What’s your view on this? Share it with your friends! Love to hear your thoughts. Leave us a comment below so we’ll know.
By Roger Guzman, M.D. and Evelyn Guzman


3. Cataracts
1. The 7 Step Diabetes Fitness Plan Living Well and Being Fit with Diabetes, No Matter Your Weight Marlowe & Company, 2006
2. 9 Exercise Myths You Need to Forget
3. How to Start a Diabetes-Friendly Exercise Plan
6. B.C. doctor says perfect vision possible with Bionic Lens 7. FDA Approves First Eye Drug to Treat Eye Damage (Diabetic Retinopathy) Disclaimer: This is not a medical advice column. We are PWDs or long time interested on learning as much as we can and freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches.. You still need the professional advice, treatment, and care of a licensed medical professional.