Category: Diabetics

Diabetic Retinopathy Continued

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This is a continuation of my last blog post about diabetic retinopathy. I want to stress that diabetic retinopathy is the number 1 cause of new cases of blindness for adults 20-70 years old. The increasing number of people with diabetes means the number of people who will develop diabetic retinopathy will also increase. This is significant because severe vision loss can be prevented 90% of the time.

It is my job as an optometrist to identify and detect diabetic retinopathy. When I see diabetic retinopathy, I have to decide when to refer for further evaluation and/or treatment.

PREVENTING VISION LOSS

The most important thing you can do to prevent vision loss from diabetes is have a dilated eye examination every year.
If you notice changes in your vision or it seems blurry, call your eye doctor immediately. To read more about preventing eye complications from diabetes click here.

TREATMENT

If I think treatment is indicated, I will refer you to a retinologist. A retinologist is an ophthalmologist, who treats conditions of the vitreous and retina, both effected by diabetic retinopathy. He or she will chose the best treatment option.

A laser may be used to stop blood vessels from leaking. It may also be used over a larger part of the retina to reduce the growth of abnormal blood vessels. Laser maintains sight, but the side effects can include, blind spots in the vision and reduced vision.

Corticosteroid injections into the eye provide a temporary treatment. To maintain control of the retinopathy, repeated injections are necessary every 6-8 weeks. The continued use of corticosteroids increases the risk of developing cataracts and glaucoma.

Another treatment is the injection of anti-vascular endothelial growth factor (anti-VEGF) to prevent the blood vessels from leaking. This treatment also needs to be repeated every 6-8 weeks.

The retinologist will often use a combination of the above treatments to yield the best results.

Researchers continue to look for therapies with long-term results and minimal side effects.

Diabetic Retinopathy

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Westside Optometry continues to recognize November as Diabetes Awareness Month, although diabetes is something that deserves attention all 365 days of the year.  If you have diabetes, I will dilate your eyes at least once a year. Diabetes can affect many organs of the body, in the eyes it causes blindness.

Many problems develop in the retina due to diabetes. The possibilities include abnormal blood vessel growth, hemorrhages and lipid leakage. If these problems are allowed to continue without treatment they will cause scarring which leads to detachment of the retina. Another complication is the leakage of fluid under the macula which will severely reduce vision.

Not all these conditions will have symptoms. Only when the bleeding or fluids reach a certain size will you notice blur or dark spots. The earlier changes in the retina are detected, the better treatment results will be.

The picture above shows some of the changes diabetes causes in the retina. There is bleeding and some areas where blood isn’t flowing properly (ischemia). This patient did not notice any changes in his vision. If you have diabetes, don’t wait until you have vision changes, it may be too late.

How to Prevent Eye Complications due to Diabetes

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There are steps you can take to avoid eye problems due to diabetes.

First and most important, keep your blood sugar levels under tight control. In the Diabetes Control and Complications Trial, people on standard diabetes treatment got retinopathy four times as often as people who kept their blood sugar levels close to normal. In people who already have retinopathy, the condition progressed in the tight-control group only half as often.

These impressive results show that you have a lot of control over what happens to your eyes. Also, high blood sugar levels may make your vision temporarily blurry.

Second, keep blood pressure under control. High blood pressure can make eye problems worse.

Third, quit smoking.

Fourth, see your optometrist at least once a year for a dilated eye exam. Having your regular doctor look at your eyes is not enough.

Fifth, see your optometrist if:

  • your vision becomes blurry
  • you have trouble reading signs or books
  • you see double
  • one or both of your eyes hurt
  • your eyes get red and stay that way
  • you feel pressure in your eye
  • you see spots or floaters
  • straight lines do not look straight
  • you can’t see things to the side as you used to

Don’t procrastinate. If you have diabetes and haven’t had a dilated eye exam in the last 12 months, schedule an eye exam now.

For more information, check out the American Diabetes Association.

 

 

 

 

Diabetes Myths

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November is Diabetes Awareness Month.

To begin the  month of diabetes awareness, let’s start by dispelling some myths:

Myth: Diabetes is not that serious of a disease.

Fact: Diabetes causes more deaths a year than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke.

Myth: If you are overweight or obese, you will eventually develop type 2 diabetes.

Fact: Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role. Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor for type 2 diabetes. Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight.

Myth: Eating too much sugar causes diabetes.

Fact: The answer is not so simple. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors.

Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories from any source contributes to weight gain. Research has shown that drinking sugary drinks is linked to type 2 diabetes.

The American Diabetes Association recommends that people should limit their  intake of sugar-sweetened beverages such as soda, energy and sports drinks and fruit drinks, to help prevent diabetes. These beverages will raise blood glucose and can provide several hundred calories in just one serving!

 

Myth: People with diabetes should eat special diabetic foods.

Fact: A healthy meal plan for people with diabetes is generally the same as a healthy diet for anyone – low in fat (especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain foods, vegetables and fruit. Diabetic and “dietetic” foods generally offer no special benefit. Most of them still raise blood glucose levels, are usually more expensive and can also have a laxative effect if they contain sugar alcohols.

Myth: If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta.

Fact: Starchy foods are part of a healthy meal plan. What is important is the portion size. Whole grain breads, cereals, pasta, rice and starchy vegetables like potatoes, yams, peas and corn can be included in your meals and snacks. The key is portions. For most people with diabetes, having 3-4 servings of carbohydrate-containing foods per meal is about right. Whole grain starchy foods are also a good source of fiber, which helps keep your gut healthy.

Myth: People with diabetes can’t eat sweets or chocolate.

Fact: If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. They are no more “off limits” to people with diabetes than they are to people without diabetes. The key to sweets is to have a very small portion and save them for special occasions so you focus your meal on more healthful foods.

Myth: You can catch diabetes from someone else.

Fact: No. Although we don’t know exactly why some people develop diabetes, we know diabetes is not contagious. It can’t be caught like a cold or flu. There seems to be some genetic link in diabetes, particularly type 2 diabetes. Lifestyle factors also play a part.

Myth: People with diabetes are more likely to get colds and other illnesses.

Fact: You are no more likely to get a cold or another illness if you have diabetes. However, people with diabetes are advised to get flu shots. This is because any illness can make diabetes more difficult to control, and people with diabetes who do get the flu are more likely than others to go on to develop serious complications.

Myth: If you have type 2 diabetes and your doctor says you need to start using insulin, it means you’re failing to take care of your diabetes properly.

Fact: For most people, type 2 diabetes is a progressive disease. When first diagnosed, many people with type 2 diabetes can keep their blood glucose at a healthy level with oral medications. But over time, the body gradually produces less and less of its own insulin, and eventually oral medications may not be enough to keep blood glucose levels normal. Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one.

Myth: Fruit is a healthy food. Therefore, it is OK to eat as much of it as you wish.

Fact: Fruit is a healthy food. It contains fiber and lots of vitamins and minerals. Because fruits contain carbohydrates, they need to be included in your meal plan. Talk to your dietitian about the amount, frequency and types of fruits you should eat.

For more facts check out the American Diabetes Association.

 

Save your Vision

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Here we are closer to the end of March than the beginning and I have not talked about Save-Your-Vision month yet. March is Save-Your-Vision month. The American Optometric Association (AOA) selects a theme for Save-Your-Vision month and this year the theme is the importance of annual eye examinations. Having an eye exam every year can, ..well…, save your vision.

There are a number of eye conditions that do not have symptoms, like glaucoma, diabetic retinopathy and brain lesions. In most cases, early detection and the proper treatment can prevent blindness, disability or death. Some conditions do have symptoms, but they are still ignored. Blurred vision, eye strain and red eyes can be treated to make your life much more comfortable.

If you have not had a comprhensive eye examination in the last 12 months, make that call (707)762-8643, it can save your vision.

What to Expect from your Eyes when Expecting

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During pregnancy a woman’s body undergoes miraculous changes, some good, some uncomfortable and some that are puzzling. Everyone experiences different things as every pregnancy is unique.

The eyes do not escape the wild hormonal ride during pregnancy. The lens and/or cornea respond to fluctuations in hormones. Not every pregnant woman will see vision changes but for those who do the impact is significant. Ocular structures swell and deswell causing refractive changes. The result of these changes is blurry vision. The women I have treated with vision changes notice shifts in their vision for most of their pregnancy. Some woman experience increased dry eye and/or contact lens intolerance.

The good news is I can usually help patients through their pregnancy with temporary vision corrections. And the best news is that most symptoms resolve post-partum.

Another ocular concern during pregnancy is the exacerbation of pre-existing conditions such as Graves disease and diabetes. Although these are systemic diseases, they have significant effects on the eye health.

Dry Eye and Diabetes

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November is National Diabetes Month. Last year and in previous blog posts, I wrote about diabetes and the eye. Today I want to talk about dry eye disease (and diabetes).

Dry eye can lead to decreased vision, corneal scarring and secondary bacterial infections. Not to mention the general discomfort and reduced quality of life from the symptoms.

There are 8 Risks Factors for the Development of Dry Eye Disease:

  • AGE The older you are the greater the risk for dry eye.
  • GENDER Women are twice as likely to develop dry eye than men.
  • ENVIRONMENT This includes smoking, airplane travel, computer use, low humidity environments and several other considerations
  • LID MARGIN DISEASE This is especially true of meibomian gland dysfunction. Meibomian, an icky sounding word on its own, but you should see the glands under a microscope when they are plugged or inflamed. It’s not pretty.
  • CONTACT LENS WEAR Contact lens wear contributes to dry eye and increased symptoms
  • OCULAR SURGERY Surgical procedures  such as LASIK or cataract removal can cause temporary dry eye in patients who have predisposing risk factors.
  • MEDICATIONS Many drugs including oral anti-histamines or anti-acne medications like (Isotretinoin)

And for the risk factor that ties this all in with Diabetes Month…

  • SYSTEMIC CONDITIONS This includes not only diabetes but also rheumatoid arthritis and thyroid disease.

The mechanism responsible for dry eye disease in diabetic patients is unclear, but many studies have been done. One study found that the rate of dry eye disease was higher if the HbA1c values were higher. Yet another good reason to maintain diabetic control and lower HbA1c values.  Another study showed that the tear proteins of diabetic patients are different from those of healthy subjects. More than half of the people who have diabetes experience dry eye symptoms and suffer from ocular dryness. Controlling the diabetes and managing the dry eye disease can lessen or alleviate the discomfort of ocular dryness.

Diabetic Retinopathy

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In the previous blog post I wrote about the reasons I dilate patient’s eyes. If you have diabetes, I will dilate your eyes at least once a year. Diabetes can affect many organs of the body, in the eyes it causes blindness.
Many problems develop in the retina due to diabetes. There is abnormal blood vessel growth, hemorrhages and lipid leakage. If these problems are allowed to continue without treatment they will cause scarring which leads to detachment of the retina. Another complication is the leakage of fluid under the macula which will severely reduce vision.
Not all these conditions will have symptoms. Only when the bleeding or fluids reach a certain size will you notice blur or dark spots. The earlier changes in the retina are detected, the better treatment results will be.

The picture above shows some of the changes diabetes causes in the retina. There is bleeding and some areas where blood isn’t flowing properly (ischemia). This patient did not notice any changes in his vision.

National Diabetes Awareness Month Conclusion

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The most important thing you can do if you have diabetes, is educate yourself about the disease. There are some excellent resources available. Start with the National Diabetes Education Program (NDEP) sponsored by the National Institute of Health. http://ndep.nih.gov/ . In addition to information about diabetes and other resources, you can order free pamphlets about controlling your diabetes and preventing type 2 diabetes. Information is available in English and Spanish.

Another resource is the American Diabetes Association, http://www.diabetes.org/. There is information about food, fitness and medications.

Most American are aware that being overweight and physically inactive increases the risk for type 2 diabetes. Unfortunately, that awareness does not translate into action. The NDEP was created to provide tools and resources to help people be proactive in preventing and controlling diabetes. If you have a family history of diabetes, had gestational diabetes and/or are overweight, you are at risk.  Take action. Check out the NDEP website and educate yourself.

Diabetic Retinopathy Continued

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As November is diabetic retinopathy month, I want to continue sharing information about the condition. Let me repeat that diabetic retinopathy is the number 1 cause of new cases of blindness for adults 20-70 years old. The increasing number of people with diabetes means the number of people who will develop diabetic retinopathy will also increase. This is significant because severe vision loss can be prevented 90% of the time.

It is my job as an optometrist to identify and detect diabetic retinopathy. When I see diabetic retinopathy in a patient I have to decide when to refer for further evaluation and/or treatment

PREVENTING VISION LOSS

Have a dilated eye examination every year if you are diabetic.
If you notice changes in your vision or it seems blurry, call your eye doctor immediately.

TREATMENT

If I think treatment is indicated, I will refer you to a retinologist. A retinologist is an ophthalmologist, who treats conditions of the vitreous and retina, both effected by diabetic retinopathy. He or she will chose the best treatment option.

  • A laser may be used to stop blood vessels from leaking. It may also be used over a larger part of the retina to reduce the growth of abnormal blood vessels. Laser maintains sight, but the side effects can include, blind spots in the vision and reduced vision.
  • Corticosteroid injections into the eye provide a temporary treatment. To maintain control of the retinopathy, repeated injections are necessary every 6-8 weeks. The continued use of corticosteroids increases the risk of developing cataracts and glaucoma.
  • Another treatment is the injection of anti-vascular endothelial growth factor (anti-VEGF) to prevent the blood vessels from leaking. This treatment also needs to be repeated every 6-8 weeks.
  • The retinologist will often use a combination of the above treatments.

Researchers are looking for therapies with long-term results and minimal side effects.