|
Diabetes
Diabetes is the second leading cause of blindness in the United States. It occurs most in people between young adulthood and age 50, it is the number one cause of irreversible blindness. However, early evaluation and treatment can prevent most of this. Therefore, it is important that patients and concerned family members be aware of how diabetes affects the eye. Diabetics should have a checkup at least once a year and sometimes more, depending on the severity of the diabetes. Remember, prevention is the key.
How does diabetes affect the eye?
Diabetes affects the eye in several major ways. It causes:
- cataracts
- bleeding in the back of the eye
- changes and fluctuations in vision
- double vision
- glaucoma
One or more of these can occur in the eye even if the diabetes is under good control.
What are the symptoms?
Blurred vision is the main symptom. However, in the early stages, this may only be slight or may go unnoticed. There is usually no pain associated with it.
Which diabetic develops eye damage?
The answer is not clear. We believe that those who maintain tight control over the entire span of their disease reduce their risk, but this is not always true. It is not related to one's present blood sugar level. Thus, one can maintain a good blood sugar level, but still have extensive eye damage.
Can you tell me more about diabetes and cataracts?
People with diabetes not only tend to get cataracts, but get them at an earlier age. This type of cataract is also more uncomfortable. It not only causes reduced vision, but often causes glare and light sensitivity. Treatment is cataract surgery. The success rate is extremely high, just as with normal cataract surgery.
Can you tell me more about diabetes and bleeding?
Diabetes makes the blood vessels in the back of the eye (the nerve layer) very fragile, and they tend to bleed. Bleeding not only obstructs vision, but when the bleeding resolves, it can scar and permanently damage the nerve. This can also result in total blindness.
Bleeding is divided into three categories:
- background bleeding
- preproliferative bleeding
- proliferative bleeding
All three can cause blurry vision. However, in the early stages, there may be very few signs or symptoms. Often people do not notice the slight blurriness in vision. Proliferative bleeding requires immediate laser treatment since it is associated with a high degree of blindness. Background and preproliferative may or may not require laser treatment depending on the evaluation by the ophthalmologist. In order to make a proper diagnosis, a fluorescein angiogram (x-ray of the eye) is often taken.
What about fluctuating vision?
People with diabetes whose blood sugar is out of control can experience fluctuating vision. For example, patients may suddenly find that they need stronger reading glasses or that they no longer need glasses to see. Usually, in cases where the patients vision fluctuates as a result of blood sugar, it is important to get the blood sugar under control and stabilized for four to six months before prescribing any glasses.
What about double vision?
In some instances, double vision can arise. This is because the blood vessels to the muscles and nerves of the eyes are very small and fragile. Diabetes causes the breakage in these vessels. Therefore, the muscles and nerves are not adequately supplied with oxygen and can become temporarily or permanently damaged. This will cause imbalances in the muscles resulting in double vision. In some cases, however, the double vision will go away after six months.
Can you tell me more about diabetes and glaucoma?
People with diabetes have a higher chance of developing glaucoma. There is also a very severe type of glaucoma called neovascular glaucoma which occurs in approximately 5% of patients who are diabetics. This glaucoma is very hard to treat and requires multiple lasers and is associated with a high incidence of blindness. The mainstay of therapy is early evaluation, diagnosis, and treatment. Usually, laser treatment is doe in the the office. It is relatively painless and can stop the bleeding and prevent further deterioration of vision. It may not necessarily result in improved vision. If there is too much bleeding, however, or if the glaucoma is too severe, then major surgery is usually needed. This requires hospitalization and general anesthesia.
|
