If you’re reading this article, it probably means that you or someone you care about has diabetes, and you have questions or are looking for answers.
The BIG Question
Among the most feared and frequent questions I’m asked is, “Am I going to go blind?” While it is true that diabetes-related retinopathy is a leading cause of visual impairment in working-age adults, it does not mean you are going to go blind if you or a loved one have been diagnosed with diabetes. It has been long understood that the duration of diabetes, combined with glucose and blood pressure control, are major risk factors in the development of diabetes-related retinopathy and potential vision loss. This is true for both type 1 and type 2 diabetes, and means that by maintaining near-normal glucose and blood pressure levels, you can lower the risk of retinopathy developing and/or progressing.
Lowering Your Risk of Vision Loss
Besides doing your best with blood sugars, there is one more very important thing you can do to minimize the risk of visual loss, and that is to have a yearly eye exam. This is so important even if you have good eyesight! Sadly, diabetes-related retinopathy is an asymptomatic condition, until it is not. This means that changes to the walls of blood vessels in the back of the eye start to break down long before your vision begins to decline. So it’s normal to have good vision, yet still have damage that can lead to loss of vision down the road. Fortunately, with early detection and treatment, it’s possible to stabilize and even improve visual function.
What to Expect During an Eye Exam
If you’ve never had an eye exam, don’t worry! It’s not going to hurt, and it will be an enlightening experience. The initial diabetes exam includes all features of the comprehensive medical eye evaluation, with particular attention to those aspects relevant to diabetes-related retinopathy. The typical eye exam begins with an initial screening during which a technician may take a complete medical history, including a full list of your medications and allergies. Both near and distance vision are checked, with and without eyeglasses. After a careful assessment of pupillary reactions, eye drops are placed in each eye to dilate the iris and check the intraocular pressure. Dilation will typically take about 15–20 minutes. Once your eyes are dilated, the doctor will examine them using a microscope. Further examination of the retina may be done with a light source worn on the doctor’s head. Both of these devices allow a view of the ocular structures, including the retina. The light from each instrument may appear very intense, but it will not hurt your eyes. The doctor may also decide to take various photographs of the back portion of the eyes. This may or may not include an injection of a dye (not the type of dye that can hurt your kidneys) to better visualize the eye vessels and circulation. Images of the retina are often displayed on a monitor to help the doctor explain the findings. This is meant as a tool to help you understand your diagnosis and guide treatment, not to criticize or frighten you. Once the eye exam is over, the last thing you need to do is to encourage your eye doctor to have close communication with your primary care physician or endocrinologist. It’s critical that everyone is working together to ensure the best possible outcomes.
If diabetes-related retinopathy has been detected and requires treatment, it may come in the form of an injection, laser treatment, or surgery. With appropriate care, we’re now able to stabilize retinopathy, and ongoing treatment will often lead to an improvement in vision. The wonderful aspect of treating conditions that can affect vision is that the eye is an organ that is easily accessed. Although the thought of placing medications into the eye can be frightening at first for patients, the reality is that, by treating the eye locally, we can minimize complications that may occur if the medication were given systemically (throughout the whole body). In the past decade, eye injections of various medications have become recognized as safe and effective treatments for many ocular diseases, including diabetes-related retinopathy. Although there are multiple ways to give an injection, the basic principles are as follows:
- The patient lies face up in a comfortable position with their head supported.
- Numbing drops (or a numbing injection) will be placed on the eye.
- Topical povidone-iodine (Betadine) drops will be put on the eye.
- A small device may be used to help keep the eyelid open and away from the site of injection.
- The patient will then be asked to look in a given direction, often away from the physician.
- Medicine will then be injected into the eye with a small needle. Patients may experience a pressure sensation, but typically not much pain.
- Afterward, the eye may be rinsed with a sterile eyewash.
The procedure is performed in the doctor’s office and takes less than 15 minutes. Injections may need to be repeated as often as monthly until diabetes-related retinopathy stabilizes.
In conclusion, it’s important to remember that early diabetes-related retinopathy can be asymptomatic, and with annual eye exams, maintaining glycemic control in the target range, controlling blood pressure and lipid levels and avoiding tobacco, we can detect and prevent visual loss.