Why Regular Eye Exams are So Important if You Have Diabetes
High blood sugar can trigger changes to your eyes. Fortunately, a simple screening can detect problems before they become serious
Diabetes-related eye disease is no joke. By 2050, as more Americans are diagnosed with diabetes, the number of adults with diabetic retinopathy—a condition that can erase your eyesight—is expected to almost double, to more than 14 million cases, according to the Centers for Disease Control and Prevention (CDC).
This is a big deal because diabetic retinopathy is also the most common cause of vision impairment and blindness in the working-age population.
Interestingly, a team of researchers from Vanderbilt University who published a report in 2016 in the journal Circulation Research, noted that retinopathy can occur as early as seven years before the onset of type 2 diabetes—when a person is prediabetic but may not even know it. According to the CDC, approximately 84 million Americans are prediabetic, and 90 percent of those individuals have no idea that anything is up with their health.
What may seem odd, at first glance, is that something related to your blood sugar can cause problems in your eyes. But the connection is real. Fortunately, so are the steps you can take to save your sight.
How Blood Sugar Impacts Vision
“Basically, when blood sugar goes high, that causes damage to the blood vessels, including ones in the retina,” says Rahul N. Khurana, M.D., a vitreoretinal surgeon with Northern California Retina Vitreous Associates Medical Group and clinical spokesperson for the American Academy of Ophthalmology.
The retina is the part of the eye that senses light and sends signals to the brain about what we see. “When these blood vessels are damaged, they can swell, leak fluid, or close up,” says Dr. Khurana. “All of these changes can steal your vision.”
Here’s how these three symptoms can mess with your vision:
1. Your eyeglass prescription can change more often.
Initially, high glucose levels can cause fluid levels to change in the body, causing the lens of the eye to swell, resulting in blurry vision. Luckily, this type of swelling can ease after about six weeks, once blood sugar is brought down to healthy levels.
But you may actually need a different prescription for eyeglasses or contact lenses after your blood sugar levels have stabilized. The old prescription may have been better suited to the swollen eye lens.
That’s why diabetes experts at Kaiser Permanente Health Foundation encourage people with diabetes to hold off on getting new glasses or contact lenses until their blood sugar has been under control for at least two months.
2. Driving might become dodgy.
Over time, poorly managed diabetes can lead to a weakening and thinning of the walls of blood vessels. Sometimes, weak blood vessels can start to leak a fluid called exudate, which is made of proteins, cells, and solid materials, into a part of the retina called the macula, which is responsible for central vision—what you see right in front of you. It’s a condition called macular edema.
And, no surprise, poor central vision can put a serious crimp in your ability to read, drive, do your job, take care of your family, and generally enjoy your day.
“People don’t realize it, but diabetes is the leading cause of vision loss among working adults,” says Dr. Khurana. “These are not older adults; they are people in the prime of their lives. Obviously, vision is such a precious sense, and to lose it is terrible at any stage of life, but it has even more of a profound impact when you’re younger and you’re working.”
3. You may start to see spots.
As it progresses, diabetes-related eye damage sometimes causes blockages and scarring, which can stop the flow of blood—and therefore nutrients and oxygen—to the retina. The retina tries to grow new blood vessels as a workaround, but these are “abnormal” and weak, and they can leak blood into the jelly-like fluid (vitreous jelly) that fills the inside of your eyes, causing floaters.
Floaters are exactly what they sound like: floating dark spots, specks, or cobweb-like shapes that dart in and out of your field of vision as you move your eyes. No fun! And a sudden occurrence of floaters may be a sign of a burst vessel.
Good news, a fix is emerging: According to an overview of diabetic eye disease research published in Diabetes Forecast in January 2018, some of the diabetes eye medicines formerly approved to treat macular edema are also proving effective at stopping the growth of these wonky blood vessels.
The Best Way to Save Your Sight
With so much at stake, it’s easy to see why you need to do all you can to protect your eye health.
Fortunately, all three of the scenarios above can be spotted early with a comprehensive yearly eye exam, says Dr. Khurana.
This type of eye check involves more than measuring your prescription: It must also involve a look at your retinas, using a dilated eye exam or retinal imaging.
Retinal imaging allows your eye doctor to scan the retina to create a high-definition digital image. It’s increasingly being used to check for damage to the back of the eye—an honor once reserved for the dilated eye exam. The images can easily be compared from one visit to the next. Plus, you can see for yourself how your condition is impacting your eyes.
Recent research published in the journal Nature Biomedical Engineering notes that retinal imaging scans are also being used to help doctors predict cardiovascular risks among those with diabetes.
You can also do your eyes a favor by incorporating some simple lifestyle changes into your daily routine, like taking more walking breaks and eating more vegetables to help control your blood pressure.
Finding and treating problems early, says Dr. Khurana, may save your vision.
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