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Dr. Dragoo Answers Your Questions on Diabetic Eye Care

DiabetesYourEyes 640x350What does the diagnosis of Diabetes or Diabetic Retinopathy mean exactly? I’ve heard there are different types?

Diabetes mellitus is a disease that prevents your body from properly using the energy from the food you eat. It is a disorder where free floating glucose or sugar molecules become problematic for the body’s blood vessels, and eventually the blood vessels do not function properly.

Diabetes occurs in one of the following situations:

  • TYPE I: This is typically called Juvenile Diabetes. The pancreas does not produce enough insulin. Insulin is a naturally occurring hormone, produced by the beta cells of the pancreas, which helps the body use sugar for energy.

OR

  • The pancreas makes insulin, but the insulin is not recognized or used as it could. This condition is called insulin resistance.

OR

  • TYPE II: Insulin resistance becomes great enough to the point where medication is needed to rid the bloodstream of excess glucose.

OR

  • Gestational Diabetes: During pregnancy, the body becomes diabetic, and may resolve when the pregnancy is over.

When the disease is not managed properly, the blood vessels are not able to supply tissue and vital organs the oxygen they need. In the eye, these types of changes can be seen by viewing the retina. Places where blood vessels leak, small hemorrhages can be seen as well as tissue areas where the oxygen is not adequate ( cotton wool spots ) and other signs of retinal disease can be detected and therefore diagnosed.

There are several stages of Diabetic Retinopathy ( Diabetes that effects the eye ) and each stage is treated or managed differently.

 

I understand that Diabetes are common among those over 40 or with weight issues. What causes it? Are there other groups that are at a higher risk?

Type 1 Diabetes is understood to be caused by an autoimmune response. Type 2 can have a genetic component and is also caused by diet and not enough exercise, but not in all cases.

You’re at risk for developingTYPE II Diabetes Mellitus if you:

  • Have prediabetes, or are insulin resistant
  • Are overweight
  • Are 45 years or older
  • Have a parent, brother, or sister withTYPE II
  • Are physically active less than 3 times a week
  • Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than 9 pounds
  • Are African American, Hispanic/Latino American, American Indian, or Alaska Native

You can prevent or delay TYPE II Diabetes with simple, proven lifestyle changes such as losing weight if you’re overweight, eating healthier, and getting regular physical activity.

 

Please describe the typical progression for an individual with Diabetes regarding their eyesight?

Among other problems, diabetes can damage blood vessels in the retina, causing them to leak blood into the retinal tissues. This does not typically happen until a person has Diabetes for more than 7-10 years, but an annual eye exam is required for anyone who has the diagnosis.

 

Symptoms of Diabetic Retinopathy And Other Diabetes-Related Eye Problems:

You first may notice diabetic retinopathy (DR) or other eye problems related to diabetes when you have symptoms such as:

  • Fluctuating vision
  • Eye floaters and spots
  • Development of a or shadow in your field of view
  • Blurry and/or distorted vision
  • Corneal abrasions
  • Double vision
  • Eye pain
  • Near vision problems unrelated to presbyopia
  • Cataracts

 

What happens during a typical Diabetic Eye Exam?

A comprehensive eye examination is expected, that also includes a Dilated Fundus Examination or (DFE). The patient will be sensitive to sunlight and experience blurred vision at near for at least 1-2 hours after the appointment. Some patients are more comfortable bringing someone with them to drive home following the dilation.

 

What treatment options and/or care is available for this condition?

Laser treatment (photocoagulation) is used to stop the leakage of blood and fluid into the retina. A laser beam of light can be used to create small burns in areas of the retina with abnormal blood vessels to try to stop the leaks.

Treatment for diabetic retinopathy depends on the stage of the disease. The goal of any treatment is to slow or stop the progression of the disease.

In the early stages of retinopathy, regular monitoring may be the only treatment. Following your doctor’s advice for diet and exercise and controlling blood sugar levels can help control the progression of the disease.

Injections of medication in the eye can be effective at discouraging the formation of abnormal blood vessels and may help slowdown the damaging effects of diabetic retinopathy.

If the disease advances, the abnormal blood vessels can leak blood and fluid into the retina, leading to a condition called macular edema. Laser treatment (photocoagulation) can stop this leakage.

Widespread blood vessel growth or neovascularization in the retina, which occurs in the stage referred to as proliferative diabetic retinopathy, can be treated by creating a pattern of scattered laser burns across the retina. This causes abnormal blood vessels to shrink and disappear. With this procedure, some vision may be lost in order to safeguard the more central vision.

 

What are the risks and side effects associated with these treatments? What if you don’t proceed with treatment?

DIabetic Retinopathy that goes untreated, will and can result in loss of vision and potentially blindness. DIet and exercise have been known to reverse the disease, but the damage done by diabetic changes cannot be reversed. The damaged retinal cells just like the cell of the heart cannot regenerate. A proactive approach to Diabetes is the best treatment plan to follow.

Will a change in a patient’s diet, exercise routine, or medication help at all?

Yes, dietary changes and increasing exercise as well as medication to regulate blood/glucose levels can dramatically help prevent progression of the disease both within the eye and the entire body.

Regardless of cost or coverage by my insurance, what are some alternative treatments?

Consider a diet of health carbohydrates such as leafy green vegetables, and protein while minimizing sweets, breads, grains, potatoes, rice, that can spike blood/glucose levels. Avoid sugary drinks and snacks, and consult your primary care physician for advice on Diabetic lifestyle changes.

Can you recommend a vitamin/mineral program for me that might be helpful or are vitamin supplements specific to each patient?

Vitamins and minerals can be specific to each patient. Cinnamon is known to help with digestion of sugars, as well as American Ginseng, Vitamin D, Aloe Vera, and Magnesium to name a few. Studies have shown these and a few others have a significant effect on lowering blood/glucose levels.