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Eyes on Diabetes

Helping to prevent eye complications

When my husband was diagnosed with type 1 diabetes over ten years ago, his doctor warned him that diabetes could damage his eyes. We didn’t really know what that meant, only that it was one of a long list of possible complications that could result from diabetes. But according to Dr. A. Paul Chous, an optometrist specializing in caring for people with diabetes, consultant to the American Optometric Association, diabetes educator, and author of the book Diabetic Eye Disease: Lessons From A Diabetic Eye Doctor, “It is estimated that 90% of severe vision loss caused by diabetes may be preventable with early diagnosis and proper treatment.” Ophthalmologist Anne Wishna agrees, saying, “The best way to avoid vision loss is with prevention.”

Before talking about preventing vision loss, though, it’s important to understand what ‘diabetic eye disease’ actually means. According to Dr. Chous, “‘Diabetic eye disease refers to eye conditions that are more common for those living with diabetes than people without diabetes. The eye problems may include cataract, glaucoma, dry eye syndrome, and, most importantly, diabetic retinopathy.”

Diabetic retinopathy is the leading cause of blindness in Americans of working age,” says Dr. Chous. “It causes about 12,000-24,000 new cases of blindness each year in the US.”

The American Academy of Ophthalmology explains that diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina change. “The retina,” says Dr. Wishna, “lines the inside of the eye and acts as the film of the eye if the eye were a camera. Sometimes the blood vessels in the retina swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.”

“It is absolutely critical for patients to understand that diabetic retinopathy often causes few or no symptoms until the retina is severely damaged, when the prognosis for maintaining good eyesight is much poorer,” says Chous.

How do you know if you might be at risk for developing diabetic retinopathy?

According to Dr. Chous, established risk factors include having poorly controlled diabetes and the duration of diabetes – the longer you’ve lived with diabetes, the greater the risk. Other factors that may be associated with diabetic retinopathy are:

  • High blood pressure
  • Obesity
  • Sleep apnea

To help prevent long-term diabetic complications that include diabetic eye disease, Dr. Chous recommends the following:

  • Schedule annual dilated eye examinations with an optometrist or ophthalmologist experienced with diabetic eye disease.
  • Keep average blood glucose and A1C levels as close to your goal as possible.
  • Maintain optimal blood pressure levels.
  • Eat a low-glycemic index diet with lots of colorful vegetables and some fruits with fish consumption twice per week. (Learn about the glycemic index here.)
  • Engage in physical activity regularly to keep excess weight off; Dr. Chous recommends a pedometer while walking to keep track of your steps each day.
  • Ask your doctor about checking your levels of vitamins D and B12.
  • Ask your doctor about whether you should get tested for sleep apnea if you have a large neck circumference, snore heavily, and/or are unusually tired during the day even after an adequate night’s sleep.
  • Keep your blood lipids well controlled.

Jessica Apple is the co-founder and editor-in-chief of the online diabetes lifestyle magazine A Sweet Life. Her writing has appeared in many publications, including The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, and Tablet Magazine. Apple is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor, and not of Sanofi US, its employees, agencies, or affiliates.

© 2013 The DX: The Diabetes Experience

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