Diabetes is the leading cause of blindness among people between 25 – 74 years old.
Half of people with diabetes are unaware they have it. Of those who are aware only 50% get appropriate eye care.
Most people think that blood sugar levels are the most important risk factors for vision loss in Diabetes Mellitus. However, blood glucose control only accounts for 10% of the risk of vision loss in DM.
Other factors such as sleep apnea, hypertension and kidney disease impact vision risk in a diabetic individual.
There is a complex relationship between the nervous system, the immune system and the circulatory system. These 3 systems interplay in a way which both predicts and allows early diagnosis and effective treatment.
New diagnostic modalities include:
- Wide-field retinal photography and artificial intelligence screening applications.
- Non-invasive OCT angiography (OCT-A)
- Electrophysiologic testing for retinal function (ERG)
These tools allow early diagnosis and treatment with medications designed to limit the growth of abnormal blood vessels in the eye and the swelling of sensitive retinal tissue.
The eye manifest changes in several ways:
- Diabetic retinopathy with leakage and abnormal vessel growth.
- Bleeding into the gel cavity of the eye (vitreous hemorrhage).
- Cataracts may occur as a result of fluctuation in blood sugar.
- Diabetics are at a higher risk of optic nerve swelling due to lack of blood flow to the optic nerve.
- Double vision is more common in diabetics due to lack of blood flow to the nerves controlling the eye muscles.
- Glaucoma occurs 2x more frequently in diabetics.
- Carotid artery narrowing is more common in diabetics. This can lead to stroke.
- Diabetics are more susceptible to corneal ulcers, dry eye and eye pain.
The data is convincing, the longer one has had DM, the greater the chance of developing eye related complications.
Keys to avoiding eye problems in people with diabetes include:
- Regular eye examinations
- Hemoglobin A1C levels <7
- Controlled hypertension
- Appropriate cholesterol levels
- Avoidance of smoking
- Efforts to control obesity
Editor’s Note: This article was submitted by Alan Margolis, MD. Dr. Margolis is an ophthalmologist at Margolis Vision and may be reached at 303-797-1150