Diabetes Forecast

5 Sure Steps to Better Eye Care

John Dunn was focused on his children's health, his wife, the approaching tax season … stuff piled up. And when he finally got to a doctor (after much cajoling by his wife), Dunn's blood glucose levels were in the 400s and his blood pressure was 240/180. The 58-year-old tax compliance specialist from Blackwood, N.J., had been living with type 2 diabetes for years, but knew he had been putting his management on the back burner. He began to take metformin and started losing a significant amount of weight. Not until a routine eye exam, though, did Dunn realize the full extent of the complications diabetes had wrought upon his health.

Dunn was losing his vision due to retinopathy, says Allen Ho, MD, professor of ophthalmology and director of retina research at Wills Eye Hospital in Philadelphia. Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes. In Dunn's case, he was dealing with diabetic macular edema: a swelling in the part of the eye that focuses vision. When blood glucose levels rise, blood vessels in the eye swell and become blocked, depriving parts of the eye of nutrients in the blood. New blood vessels are formed, but they are abnormal and can leak blood, which leads to vision loss.

Using an injectable eye drug, coupled with lifestyle changes that brought his A1C down from more than 10 percent back to 6, Dunn was able to regain his vision. Sometimes macular issues can be resolved when pressure is taken off the eye and blood leaked into the eye is reabsorbed. But a vision-loss scare was enough to remind him: Diabetes can affect all parts of the body. That's why diabetes management, including getting regular eye exams, can help a person with diabetes (and his or her health care team) be proactive in preventing and minimizing complications.

Ho says eye doctors, because they're treating patients for vision issues, can help people stay motivated to keep up healthy lifestyles. "[Dunn] is the poster boy for it. He went from someone who didn't care, and was in a little bit of denial … really dropping off a cliff, to this path that we wish for all our patients with diabetes," Ho says.

So what can you do to protect your vision? These steps will help you keep health in sight:

Visit your eye doctor regularly. Optometrists and ophthalmologists can both detect signs of retinopathy, but only ophthalmologists can treat it. A. Paul Chous, MA, OD, FAAO, is an optometrist who specializes in diabetic eye care—and has lived with type 1 diabetes for more than 30 years. He says people with diabetes should see their eye doctor once a year, or as directed if eye problems are present. A full exam should include pupil dilation. That will ensure your doctor gets a full, 3-D view of your eyes and any problems that might be lurking under the surface, specifically on your retinas, says Ho. The eye dilation drops don't hurt, but it can take several hours for dilated pupils to return to their normal size, so you may experience some sensitivity to light.

Know the risk factors. "Every 1 [percentage] point of your A1C increases your risk of retinopathy by 40 percent," says Chous. "But don't blame the victim. A lot of people with good A1Cs still develop eye disease." Beyond retinopathy, dry eyes, cataracts, and glaucoma are all more common in people with diabetes. Obesity also increases your chance of developing retinopathy. So does a family history of both diabetes and eye problems. Talk with your eye doctor to discuss your risk factors.

Maintain your diet and exercise plans. You may have noticed that as your blood glucose fluctuates, so does your vision. It's important to get your eye exam when you're as close to a normal blood glucose reading as possible, so that your prescription for glasses or contacts works for you.

Pay attention to changes. Eye exams can help some people realize they are already living with diabetes. Often, Ho sees patients with the symptoms of diabetic retinopathy ("Keeping an Eye on Your Vision" ) who don't know they have diabetes—and they get an initial diagnosis at the eye doctor, with a referral to their general practitioner. "We still have many people who walk in and see us … who don't know they have diabetes mellitus, or they know they have diabetes mellitus but they're not in control," Ho says. "There are some treatments that can reverse or control some of the manifestations of diabetic eye disease. Prevention and early detection is the key."

Get everyone on the same page. Chous says he wishes each person with diabetes could meet with his or her whole diabetes care team once a year, all in the same room. That's not always possible, so make sure you share your medical history with each doctor you see—and provide updates if there are changes. "You just have to be proactive in taking care of [yourself]," Dunn says. "I probably did everything wrong until I had the right people in my life to do things right. You have to stay disciplined." Now, he says, that means exercising every day, watching what he eats, and making timely visits to the doctor.

For more information about eye health, visit diabetes.org/eyecare.



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