Diabetes is becoming more prevalent around Calgary and the globe. The number of people with diabetes is escalating. Many are pre-diabetic, unaware that they even have the condition. It is a major concern that is draining Canadian health care dollars. As optometrists, Drs. Leong, Bui and Yan strive to increase awareness of diabetes impact on the eyes during November’s Diabetes Awareness month.
Health is easier to maintain than to regain, and an eye exam can help detect diabetes within the body. Diabetes is a leading cause of blindness in the younger, working-age population, as well as a source of heart attacks, stroke, kidney failure, neuropathy (nerve damage) and lower limb amputation. If detected early, many of these complications of diabetes can be prevented.
What is Diabetes?
Diabetes is a chronic disease in which the hormone insulin is either underproduced or ineffective in its ability to regulate blood sugar. Uncontrolled diabetes leads to hyperglycemia, or high blood sugar, which damages the fine blood vessels within systems in the body such as vessels within the eyes, kidney and the nervous system.
How Does Diabetes Affect The Eyes?
Diabetic eye disease is a group of conditions which include diabetic retinopathy, diabetic macular edema, glaucoma and cataracts. Diabetes increases the risk of cataracts by four times, and can increase dryness and reduce cornea sensation. During pregnancy, diabetes can progress rapidly and affect the baby if not controlled.
In diabetic retinopathy, over time, the tiny blood vessels within the eyes become weakened causing leakage or haemorrhaging, poor oxygen circulation, distorted vision then scarring of the sensory tissue within the retina, which can result in further cell damage and scarring. In advanced stages, new blood vessels grow on the retinal surface. These vessels easily leak and cause scarring over the macula. Diabetic retinopathy is deceptive as it does NOT HAVE PAIN, and often does not affect 20/20 vision unless the central retina is involved. Often peripheral vision changes is not noticed until more advanced stage of retinopathy occurs, and eventually can lead to blindness if left unchecked. This is why annual eye checkups are so important.
Signs and Symptoms of Diabetic Retinopathy
Although early stages of diabetic retinopathy often have no pain or other symptoms, as it progresses you may start to notice the following symptoms:
- Blurred or fluctuating vision or vision loss
- Floaters (dark spots or strings that appear to float in your visual field)
- Blind spots
- Color vision loss
A person with diabetes can do their part to control their blood sugar level, blood pressure and cholesterol levels. Following the physician’s medication plan, as well as diet and exercise recommendations can help slow the progression of diabetic retinopathy.
Diabetes can lead to Retinal Detachment
Scar tissues caused by the breaking and forming of blood vessels in advanced retinopathy can lead to a retinal detachment in which the retina pulls away from the underlying tissue. This condition is a medical emergency and must be treated immediately as it can lead to permanent vision loss. Signs of a retinal detachment include a sudden onset of floaters or flashes in the vision or peripheral vision loss. Treatment requires immediate intervention to seal the detached area before it progresses.
Diabetic Macular Edema (DME)
Diabetic macular edema occurs when the macula, a part of the retina responsible for clear central vision, becomes full of fluid (edema). It is a complication of diabetic retinopathy that occurs in about half of patients, and causes central vision loss.
Treatment for Diabetic Retinopathy and Macular Edema
While vision loss from diabetic retinopathy and DME often can’t be restored, with early detection there are some preventative treatments available. Proliferative diabetic retinopathy (when the blood vessels begin to grow abnormally) can be treated by laser surgery, injections or a procedure called vitrectomy in which the vitreous gel in the center of the eye is removed and replaced. This will treat bleeding caused by ruptured blood vessels. DME can be treated with injection of special anti-growth factors, injection of steroids, or laser surgery or virectomy surgery.
Prevent Vision Loss from Diabetes
The best way to prevent vision loss from diabetic eye disease is early detection and treatment. Since there may be no symptoms in the early stages, regular diabetic eye exams are critical for early diagnosis. Alberta Health Care will cover medical eye exams for diabetics. Drs. Leong, Bui and Yan encourage you to keep diabetes under control by seeing your health care team. For a healthy lifetime, take care of your self by exercise, diet, medication (if needed) and regular checkups.