Common Myths & Misconceptions About Diabetic Eye Disease
For healthy eyes, you have to know fact from fiction
I was recently asked by an interviewer to discuss common myths patients have about their eyes and vision, and it got me thinking. Over the years, I have compiled a mental list of patient (and physician) misunderstandings about diabetes and its effects on the eyes, and thought I might share at least some of them with dLife readers.
Myth #1 – Good vision on a chart means that a patient with diabetes has healthy eyes. Many serious eye diseases do not affect vision until late in their development. I have examined many patients with severe proliferative diabetic retinopathy, diabetic macular edema, and glaucoma, all potentially blinding conditions, who have had 20/20 or better visual acuity at the time of diagnosis. Good eyesight definitely does not mean there is no diabetic eye disease.
Myth #2 – Poor vision means that diabetes has damaged my eyes. The main reason most people with diabetes do not see well on an eye chart test is the same reason other people don't see well on the eye chart – uncorrected prescription. People with poor blood sugar control are notorious for prescription fluctuations, but the majority of them (including many of those with vision threatening diabetic eye disease) are capable of seeing clearly. Such patients need to be educated that the quality of their lens prescription depends, ultimately, on how well they are able to control their blood sugars, as well as the quality and consistency of eye examinations.
Myth #3 – Patients with diabetic retinopathy should not engage in vigorous physical activity. Although there is merit in being cautious, it is important for patients to understand that such restrictions concerning exercise and retinopathy apply to neither the majority of diabetics, nor even to the majority of patients with diabetic retinopathy. In fact, the only patients at significant risk for retinal bleeding associated with exercise are those with untreated, recently treated, or actively bleeding proliferative diabetic retinopathy or significant macular edema. Of course, there may be other contraindications to some forms of exercise, such as severe cardiovascular disease or peripheral neuropathy.
Myth #4 – All patients with diabetes need to see an ophthalmologist, not an optometrist. Optometrists are trained and licensed to diagnose and treat disorders and diseases of the eyes and visual system through non-surgical means, including the use of prescription eye drops and oral medications, as well as to detect the ocular manifestations of systemic disease, and refer patients to other health care specialists for eye surgery and/or further medical evaluation when necessary. Ophthalmologists specialize in the medical and surgical treatment of eye disease. In general, both professions do a fine job of detecting and appropriately managing eye complications related to diabetes, and most cases of vision loss from diabetes could be prevented if patients got a dilated eye exam every year from either of these professionals.
As with any profession, some doctors, both optometrists and ophthalmologists, will have more knowledge, experience, and compassion than others will. No matter which type of eye doctor a diabetes patient sees, the most important consideration is finding someone knowledgeable about and experienced with diabetic eye disease.
Myth #5 – A measurement of eye pressure determines whether or not I have glaucoma. Elevated intraocular pressure (IOP) is now recognized as a risk factor for glaucoma (chronic, progressive damage to the optic nerve resulting in permanent vision loss), not as a necessary or sufficient cause. Fifty percent of all patients with definitive glaucoma will have normal IOP at some point of the day. In addition, at least 10% of all patients with glaucoma will never have high eye pressure readings. People with diabetes are more likely to develop glaucoma, possibly due to poor optic nerve circulation or hardening of supportive collagen protecting the optic nerve caused by high blood sugars.
Myth #6 – Type 2 patients rarely lose vision to diabetes. Although it is true that a higher percentage of type 1 patients experience small blood vessel diabetes complications, including retinopathy, more type 2 patients suffer significant vision loss than do type 1 patients in terms of absolute numbers. Part of the reason, of course, is because type 2 patients outnumber type 1 patients by a factor of nine. In addition, type 2 patients are more likely to develop diabetic eye diseases other than retinopathy (e.g., cataract, glaucoma, and ischemic optic neuropathy – sudden loss of circulation to the optic nerve - in particular) as a function of both age and high blood sugar.
For more information on diabetic eye disease, consult Dr. Chous' book Diabetic Eye Disease: Lessons From a Diabetic Eye Doctor, Fairwood Press, Seattle, 2003.
Read more about Dr. Chous here.
Visit Dr. Chous' website here.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
Picadillo Bacon and Cheese Turnovers Gorgonzola Sauce Home on the Range: Buffaloaf Low Carb Meat Loaf with Wine Salmon Chowder Hawaiian Pineapple Slices Gingersnap and Graham Cracker Crust No Sugar No Flour Peanut Butter Cookies Mediterranean Stock with Fennel
Gone are the days of repelling Mission Impossible-like from the hospital ceiling to retrieve Charlie's medical files before the CDE entered our exam room. It's not that I don't care anymore about his A1c. Of course I care. Maybe in the past I was more consumed by it. For a very long time I so desperately wanted to see an A1c below 8. Now that we've been comfortably in the low to mid-7s for the last couple of years, there's just an expectation. It's become a little anticlimactic....