VOL. 129 | NO. 99 | Wednesday, May 21, 2014
Diabetes and Importance of Eye Care
DR. CHRISTOPHER BORGMAN | Special to The Daily News
Diabetic retinopathy is the leading cause of blindness within the working population (age 20-65 years old). It’s estimated that 20.8 million people in the U.S. have diabetes and of those, 6.2 million are unaware they even have it.
It’s estimated that 12,000-24,000 people go blind from diabetes every year. Unfortunately, with obesity, lack of exercise, and poor diet control running rampant in America, diabetes is increasing in prevalence among Americans of all ages.
There are two main types of diabetes. Type 1 is the rarest form and is typically defined as insulin dependent as patients with Type 1 cannot make their own insulin. Insulin is the molecule responsible for naturally decreasing blood glucose levels in our bodies.
Type 2 is by far the most common, at more than 95 percent, and typically is due to poor responses to insulin secondary to obesity, lack of exercise, and poor diet.
Diabetes results in elevated blood glucose/sugar levels that poison blood vessels everywhere in the body, especially the eyes. As the elevated blood sugars weaken the walls of the blood vessels substances such as proteins, fat and blood leak into the retinal tissues, which can cause swelling of the retina responsible for our central (20/20) vision. As blood vessels are slowly poisoned, they can seal off entirely leading to retinal tissues being irreversibly damaged. This can result in new, weaker blood vessels that grow and leak blood. This just compounds the overall problem leading to further vision loss, and in worst-case scenarios, can lead to blindness via retinal detachments.
Diabetics should religiously have yearly dilated eye exams at a minimum. Some diabetics should even be followed every two to three months by an eye care provider depending on their risk factors and blood glucose control, although this certainly is not for all diabetics.
Two things every diabetic should have committed to memory are their daily blood glucose range and their HbA1c numbers. Both of these numbers are extremely important for the primary care physician as well as eye care providers as this provides an overall picture of how well the blood glucose is being controlled and helps determine overall risk of progression. Obviously, regular follow up with a person’s primary care physician is extremely important for continued care.
Treatment is nearly always maximizing blood glucose control, as well as blood pressure and cholesterol control as these can increase the risk of vision deterioration even further. Weight loss and diet control can significantly reduce and sometimes eliminate diabetes, however there are oral medications and daily injections of insulin that are used to manage this disease as well. Treatment for eye issues related to diabetic retinopathy typically is continued blood glucose control, low vision devices, laser procedures, ocular injections and in rarer cases surgery.
Prevention for diabetes and diabetic retinopathy in general always starts with the primary care physician as they are the ones who treat and monitor the diabetic process. The more proactive diabetics are with their health and well-being, the better the outcomes and the longer they can maintain their vision.
Dr. Christopher Borgman is a clinical instructor at The Eye Center at the Southern College of Optometry, www.tec.sco.edu.