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Diabetes Doesn’t Have to Lead to Eye Trouble

Diabetic patients may soon cross blindness off their list of concerns

A diagnosis of diabetes has long meant radical dietary changes, daily finger pricks to measure blood sugar, and the very real risk of blindness. As many as 90 percent of diabetes patients may suffer some loss of vision because the disease affects delicate structures within the eye, leading to a condition called diabetic retinopathy. Fortunately, we now know that you can take steps to prevent the disease from progressing that far.
Diabetic retinopathy progresses through two stages. It begins when high levels of glucose (sugar) in the blood damage tiny capillaries that supply blood flow to the retina, the light-sensitive tissue at the back of the eye. Eventually, the damaged capillaries may leak fluid, causing a condition called macular edema, or become blocked, which can interfere with the retina’s ability to process light and images. During this first stage, called non-proliferative diabetic retinopathy, or NPDR, strict blood glucose control and laser therapy for macular edema may be enough to slow progression of the disease.
If blood sugar levels remain high, however, NPDR can progress to proliferative diabetic retinopathy, or PDR. In this stage of the disease, abnormal blood vessels grow in the retina, which can cause retinal detachment or glaucoma. Unchecked, PDR can eventually cause complete blindness. But it doesn’t have to. “I consider it very much a preventable problem,” says Dr. K. Bailey Freund, clinical associate professor at New York University School of Medicine and clinical correspondent with the American Academy of Ophthalmology. “There has to be a comprehensive approach, and you have to control the disease that causes diabetic retinopathy.”
Prevention strategies vary depending on the type of diabetes you have. In Type I diabetes, usually diagnosed in children and young adults, the pancreas doesn’t produce insulin. For Type I patients, early detection is key. Diabetic retinopathy develops slowly, over the course of decades, and vision changes can be so subtle a young person may not notice them. “Patients diagnosed with Type I diabetes should be seen by an ophthalmologist within the first five years, and then again after adolescence,” says Dr. Jennifer Sun, assistant professor of ophthalmology at Harvard Medical School and chief of the Center of Clinical Eye Research at Beetham Eye Institute, Joslin Diabetes Center. “Because our treatments are better these days, it’s more important than ever to follow up regularly and ask about the status of your retinopathy: What level is it now? How has it changed?”

In Type II diabetes, the more common form of the disease, high levels of sugar build up in the blood because of a problem in the way the body makes or uses insulin, which is needed to move glucose into cells. Type II diabetes occurs slowly over time, but if you've been diagnosed and have been advised not to worry about related vision problems because retinopathy takes so long to develop, think again. In fact, Sun says, "sometimes it’s diagnosed earlier in people with Type II because those patients may have been living with the disease longer than they thought.”

Whether you have Type I or Type II diabetes, follow these recommendations to prevent vision problems:
  • Control your blood sugar. If your doctor prescribes a glucometer, use it regularly. Avoid consuming sugar, and follow a diet rich in vegetables and lean proteins, such as the one recommended by the American Diabetes Association.
  • Maintain a Body Mass Index (BMI) of 19-24. Obesity is the leading cause of Type II diabetes. If you eat healthy, exercise, and lose weight, you can reverse the course of your disease and reduce your risk of developing diabetes-related vision complications.
  • Get eye exams at least once a year. “Regular exams are really important for people with either type of diabetes because it’s so much easier to prevent diabetic retinopathy now,” Freund says. “If you intervene early enough, you can reverse lost vision.”
  • Don’t let a lack of funds stop you from seeking treatment. The Chronic Disease Fund offers financial assistance to patients who meet certain income guidelines, even if they have health insurance. For example, some patients with PDR may qualify for free treatments that normally would cost as much as $1,950 per eye. If your insurance declines your ophthalmologist’s treatment recommendation, ask your doctor about accessing the fund.

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