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Diabetes and Your Eyes

Diabetes is becoming much more prevalent around the globe. According to the International Diabetes Federation, approximately 425 million adults were living with diabetes in the year 2017 and 352 million more people were at risk of developing type 2 diabetes. By 2045 the number of people diagnosed is expected to rise to 629 million. 

Diabetes is a leading cause of blindness as well as heart attacks, stroke, kidney failure, neuropathy (nerve damage) and lower limb amputation. In fact, in 2017, diabetes was implicated in 4 million deaths worldwide. Nevertheless preventing these complications from diabetes is possible with proper treatment, medication and regular medical screenings as well as improving your diet, physical activity and adopting a healthy lifestyle.

What is Diabetes?

Diabetes is a chronic disease in which the hormone insulin is either underproduced or ineffective in its ability to regulate blood sugar. Uncontrolled diabetes leads to hyperglycemia, or high blood sugar, which damages many systems in the body such as the blood vessels and the nervous system.  

How Does Diabetes Affect The Eyes?

Diabetic eye disease is a group of conditions which are caused, or worsened, by diabetes; including: diabetic retinopathy, diabetic macular edema, glaucoma and cataracts. Diabetes increases the risk of cataracts by four times, and can increase dryness and reduce cornea sensation.

In diabetic retinopathy, over time, the tiny blood vessels within the eyes become damaged, causing leakage, poor oxygen circulation, then scarring of the sensitive tissue within the retina, which can result in further cell damage and scarring. 

The longer you have diabetes, and the longer your blood sugar levels remain uncontrolled, the higher the chances of developing diabetic eye disease. Unlike many other vision-threatening conditions which are more prevalent in older individuals, diabetic eye disease is one of the main causes of vision loss in the younger, working-age population. Unfortunately, these eye conditions can lead to blindness if not caught early and treated. In fact, 2.6% of blindness worldwide is due to diabetes. 

Diabetic Retinopathy

As mentioned above, diabetes can result in cumulative damage to the blood vessels in the retina, the light-sensitive tissue located at the back of the eye. This is called diabetic retinopathy. 

The retina is responsible for converting the light it receives into visual signals to the optic nerve in the brain. High blood sugar levels can cause the blood vessels in the retina to leak or hemorrhage, causing bleeding and distorting vision. In advanced stages, new blood vessels may begin to grow on the retinal surface causing scarring and further damaging cells in the retina. Diabetic retinopathy can eventually lead to blindness. 

Signs and Symptoms of Diabetic Retinopathy

The early stages of diabetic retinopathy often have no symptoms, which is why it’s vitally important to have frequent diabetic eye exams. As it progresses you may start to notice the following symptoms:

  • Blurred or fluctuating vision or vision loss
  • Floaters (dark spots or strings that appear to float in your visual field)
  • Blind spots
  • Color vision loss

There is no pain associated with diabetic retinopathy to signal any issues. If not controlled, as retinopathy continues it can cause retinal detachment and macular edema, two other serious conditions that threaten vision. Again, there are often NO signs or symptoms until more advanced stages. 

A person with diabetes can do their part to control their blood sugar level. Following the physician’s medication plan, as well as diet and exercise recommendations can help slow the progression of diabetic retinopathy. 

Retinal Detachment

Scar tissues caused by the breaking and forming of blood vessels in advanced retinopathy can lead to a retinal detachment in which the retina pulls away from the underlying tissue. This condition is a medical emergency and must be treated immediately as it can lead to permanent vision loss. Signs of a retinal detachment include a sudden onset of floaters or flashes in the vision. 

Diabetic Macular Edema (DME)

Diabetic macular edema occurs when the macula, a part of the retina responsible for clear central vision, becomes full of fluid (edema). It is a complication of diabetic retinopathy that occurs in about half of patients, and causes vision loss. 

Treatment for Diabetic Retinopathy and Diabetic Macular Edema

While vision loss from diabetic retinopathy and DME often can’t be restored, with early detection there are some preventative treatments available. Proliferative diabetic retinopathy (when the blood vessels begin to grow abnormally) can be treated by laser surgery, injections or a procedure called vitrectomy in which the vitreous gel in the center of the eye is removed and replaced. This will treat bleeding caused by ruptured blood vessels. DME can be treated with injection therapy, laser surgery or corticosteroids. 

Prevent Vision Loss from Diabetes

The best way to prevent vision loss from diabetic eye disease is early detection and treatment. Since there may be no symptoms in the early stages, regular diabetic eye exams are critical for early diagnosis. In fact diabetics are now sometimes monitored by their health insurance to see if they are getting regular eye exams and premium rates can be affected by how regularly the patients get their eyes checked. Keeping diabetes under control through exercise, diet, medication and regular screenings will help to reduce the chances of vision loss and blindness from diabetes. 

 

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Dear Patients,

As of Tuesday evening, March 17th, the CDC has recommended that all routine eye care be deferred until further notice, in order to slow the transmission of COVID-19 through our community.

Please be assured that we are still available to triage all urgent and emergent calls during this challenging time.

We are officially closing our offices effective at 3:00pm today, March 20 th and tentatively plan to reopen on April 1 st . We are rescheduling all routine visits and are available by phone to triage ocular emergencies.

Our phone lines will be open:

Monday the 23 rd and 30 th : 10:00am to 5:00pm

Tuesday-Friday (24 th -27 th and the 31 st ): 9:00am to 3:00pm

What does this mean?

1) If you are scheduled for an annual eye examination we will tentatively reschedule you starting April 1 st

2) If you are running out of a medication please contact us and we can transmit a refill electronically to your pharmacy.

3) If you have an issue which cannot wait for an office visit, contact us and we will schedule a Telephone appointment with one of our doctors. Medicare has temporarily relaxed its telehealth rules to allow this type of communication during the pandemic crisis. Other insurers may follow suit and allow for reimbursement of virtual care costs. The consultation must be initiated at your request.

4) If you have an ocular emergency we are, as always, available to help you at any time. Call 1-850-455-0120 andwait for instructions at the end of the message.

Dr. Leonard or Dr. Charbonneau will discuss your condition by phone and make the best treatment decision for you on a one on one basis.

5) Please remember that 80% of COVID-19 cases are mild and resolve within a week. However, if you feel your symptoms are worsening, call ahead before visiting your doctor’s office or emergency department and tell them you have or may have COVID-19. This will help the office protect themselves and other patients.

The CDC has many wonderful resources. Arming yourself and your family with clear information will help you avoid undue stress.

https://bit.ly/2WxWYIe and https://bit.ly/33FBlXZ

Together we will weather this storm.

With sincerest wishes for your continued good health we remain at your service,

Dr. Clare L Leonard

Dr. Mary Charbonneau