Diabetes Simplified: Watching Out for Your Eyes
The truth about diabetes and eyesight
By Wil Dubois
I half-heartedly collect vintage anatomical models (along with miniature typewriters). Many of the best – of the models that is, not the typewriters – were originally gifts from pharmaceutical reps to doctors back in the day. One that lives in my clinic office is a 1940s faux stone plaque from the eye care giant Bausch & Lomb. It has a lovely bas-relief of the anatomy of the eye and carved into the fake stone below, in proper-looking Roman letters, the plaque boldly proclaims:
"THE HUMAN EYE—NATURE'S PRICELESS GIFT TO MAN THAT HE MAY ENJOY THE BEAUTIES OF FORM, COLOR AND MOTION, MADE POSSIBLE BY LIGHT."
People just don't talk like that any more. More's the pity. But of all the diabetes complications, going blind seems the most frightening to me. But how likely is that to really happen? And what can we do to ensure that diabetes doesn't rob us of "nature's priceless gift?"
Bad stuff that diabetes can do to your eyes
Actually, if I've said it once, I've said it fifty times: Diabetes doesn't cause diddlysquat. OK, maybe I've never quite said it exactly like that before, but diabetes in and of itself doesn't cause anything. Diabetes ignored, however, can wreak all manner of havoc. And elevated blood sugar is the mover and shaker in at least four different flavors of eye damage: Retinopathy, macular edema, glaucoma, and cataracts.
Retinopathy is the best known, most common, and most complicated of the pack. As it's name implies, it's a complication that damages the retina, which is the projection screen on the back of the eyeball that makes sight possible. Retinopathy is classified as either non-proliferative or proliferative, but the two are really just different stops on the same subway.
In the non-P variety, small blood vessels called capillaries in the back of the eye bulge and swell. Virtually all T1s develop non-P, as do most T2s. Luckily for all of us, at this stage it has no effect on vision. But like the canary in the coal mine that just let out a choked squawk and keeled over dead, it's the early warning sign that the less-common vision-robbing proliferative could be on the way.
In proliferative retinopathy, those swollen capillaries get blocked. To keep the cells in the eye from dying, the body builds detours around the blockages, leading to a tangled network of vessels growing like dense grass roots across the back of the eye. These detour capillaries, like road construction detours, are not of the same quality as the originals. They are weak and thin-skinned, prone to breaking and leakage. And it's these pools of blood in the retina that can rob you of your sight.
Less common but still worth avoiding, macular edema, is essentially broken plumbing inside the eye that leads to blurry vision. Glaucoma is a pressure problem, also related to breakdowns in the fluid supply and drainage systems of the eye. And lastly, the cloudy lenses of cataracts — often thought of as a problem reserved for the elderly — happen both more often and at much earlier ages in people with diabetes.
The most wicked thing about all four eye complications is that they smolder like a forest fire that's yet to catch a breeze: There are no symptoms until the complications are dangerously advanced. Only proper eye exams can catch them in time to treat them, something we'll talk more about in a bit.
The latest data from the Centers for Disease Control shows that 28.5% of dFolks have some sort of serious eye damage, and 4.4% have advanced damage that could lead to blindness. That's 655,000 people. The famous Joslin Diabetes Center reports that depending on the year, between 12,000 and 24,000 people lose their sight each year due to uncontrolled diabetes. All told, badly controlled diabetes is the leading cause of "preventable" blindness in the United States.
So let's get busy with that prevention.
Things you can do to prevent bad stuff from happening to your eyes
What should you do? Well, not to beat a dead horse, but first and foremost you need to do your best to keep your blood sugar in control. If you think you are too busy to properly take care of your diabetes, I submit to you that being blind takes waaaaaaay more time than managing diabetes properly.
The next best thing you can do is to not let the fear of eye complications get your blood pressure up. Just like with the capillaries in your kidneys, the capillaries in your eyes are susceptible to damage from high sugar and from pressure. And as most people with diabetes have problems with blood pressure, you'll want to baby your baby blues by keeping tabs on your blood pressure. Keep the salt in your diet light and take your blood pressure meds if your doctor tells you to.
Anything else? Yep, surprisingly, many experts advise wearing sunglasses, especially if cataracts have started to develop. Apparently, this slows down the progression of the cataract and delays the need for surgery to replace the lenses in your eyeballs that nature gifted you with because while cataract surgery is routine in elders, in people with diabetes it greatly increases the risk of glaucoma! (Some days it feels like we just can't get a break, huh?)
Lastly, take a deep drag on that cigarette, because it's your last puff. Although the exact whys and wherefores aren't clear, clinical data strongly links smoking with an increase in eye trouble for people with diabetes. And hey, now that you are wearing sunglasses anyway, you don't need to smoke to look cool.
But what if it's too late?
Here's the rub when it comes to eye damage from elevated blood sugars: For most people, most of the damage comes before they even know they have diabetes. You can't realistically be expected to control your diabetes if you don't even know you have it. In point of fact, almost all type 2s have some level of eye damage at diagnosis, because the onset of type 2 is so slow and gradual that it's rarely detected early on.
This is why it's the Standard of Care to send the newly diagnosed type 2 out for a dilated eye exam before the ink is dry on the blood sugar-lowering prescriptions. Odds are the damage is there. The next step is to see how bad it is. In type 1s, eye exams are started five years after diagnosis. Why? Because eye damage is a train wreck in slow motion. It takes some time. Even if your blood sugar control is absolute crap, it will likely take five years for damage to show up. That said, we type 1s aren't getting a "pass" on eye trouble. In the long run, our numbers look worse.
The "good" news is that there's never been a better time to develop eye complications. We have "fixes" that range from meds, to lasers, to scalpels (in that order); but they all have one thing in common: The earlier the intervention, the more likely it will succeed.
Which brings us back to the annual (without fail) dilated eye exam. Each year's exam compares your eye health to the previous year. Any changes can be noted, and a plan put into place to deal with them. So the annual dilated eye exam is more than just good medicine. It's the most important thing you can do to continue to enjoy all the beauties of form, color and motion, made possible by light.
Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.
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.
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