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Diabetes and Eye Health: An Inside Look

Dr. Paolo Silva on eye health and diabetes

Laura Kolodjeski of Sanofi US DiabetesLaura Kolodjeski

One of the simple joys in my life is watching my daughter and husband interact with each other, and seeing her face light up as she laughs at one of his jokes. To help ensure I can continue to witness these precious life moments, I make it a point to have annual eye exams. For those living with diabetes, regular visits to an eye doctor are even more important, as people living with diabetes have a substantially higher risk of developing eye disorders like glaucoma and cataracts, according to the American Diabetes Association. To learn more about the importance of eye health and what to expect during an eye exam, I turned to Dr. Paolo Antonio S. Silva, staff ophthalmologist and assistant chief of the Center for Ocular Telehealth at Joslin Diabetes Center’s Beetham Eye Institute.

Dr. Paolo Silva
Dr. Paolo Silva

When Dr. Silva was growing up, his father had a rare eye condition and was legally blind for some time. Thanks to a corneal transplant, his father was able to see. This experience led Dr. Silva to become interested in medicine and ophthalmology specifically. He later went on to specialize in eye diseases related to diabetes. “My father developed type 2 diabetes during the latter part of his life, but fortunately due to good blood sugar control, he didn’t develop any eye complications,” Dr. Silva said. “With the number of people living with diabetes, I think many people have a connection to diabetes in one way or another. During our lifetime, it’s possible someone close to us will develop diabetes.

A large proportion of people with diabetes may develop eye complications. We need to try to help prevent patients from losing their vision.” Attention to eye health is important for those living with diabetes, according to Dr. Silva. “Diabetic retinopathy is one of the most frequently occurring microvascular complications associated with diabetes,” he said. “It affects the small blood vessels inside the eye, particularly in the sight-sensing part of the eye called the retina. Diabetes-related changes in the blood vessels in the retina include bleeding, changes in blood flow or abnormal blood vessel growth. The abnormal blood vessels can break or burst leading to significant bleeding. These abnormal vessels can pull on the retina to cause a retinal detachment. People with diabetes can also get diabetic macular edema, which is swelling of the center of the retina. Bleeding, retinal detachment and diabetic macular edema are the primary causes of vision loss in diabetes.” In addition to a primary care physician or endocrinologist, an eye doctor is a key member of one’s diabetes healthcare team.

“Only an eye doctor would be able to accurately determine whether retinopathy is present in your eyes,” Dr. Silva clarified. “You need to go to a doctor who’s experienced in eye disease and preferably diabetic eye disease in particular. In diabetic retinopathy, changes often happen in the eye without any early symptoms. Although treatment – which includes laser treatment, injections and surgery – may be effective, we try to prevent these changes from developing before any visual complications occur. I believe early appropriate intervention is most effective.” Establishing a relationship with an eye doctor is key. “A person living with diabetes should try to develop a lifelong relationship with an eye doctor experienced in managing and treating diabetic eye health,” he said. “Based on the American Academy of Ophthalmology and American Diabetes Association guidelines, it’s recommended that a comprehensive eye examination be performed at diagnosis for people living with type 2 and within three to five years of diagnosis for people living with type 1. Generally, an annual follow-up is recommended after that. If there are any changes in your eyes, then the frequency of your visits may be more often.” During a routine eye exam, the eye doctor will check vision and eye pressure, and then dilate the pupil.

“The essential portion of an eye exam is that your eyes need to be dilated,” Dr. Silva explained. “That gives your doctor a better view of your retina where the changes associated with diabetes may occur. I usually give eye drops to dilate the eye. Once the drops are administered, your vision may get a little blurry for several hours and you might experience some light sensitivity, but after that, your vision should return to the way it was. There are virtually no side effects for the examination if done appropriately.” According to Dr. Silva, many living with diabetes do not get the recommended annual eye exam. “The eye exam usually takes time out from work and you have to set aside time to get there, so there may be various geographic, physical and political barriers to getting the eye exam done,” he said. “There may be a barrier for people who lack health insurance. Patients are also largely unaware that they need an eye exam, so increasing patient awareness is essential.”

One way Joslin helps make getting eye exams more accessible is through their telemedicine program, the Joslin Vision Network™ (JVN). The JVN is a validated method to evaluate for the presence and extent of diabetic retinal changes using high resolution retinal cameras that do not require the pupils to be dilated and can be performed at the primary care or endocrinology office. The images acquired are securely transmitted to the Joslin Diabetes Center for evaluation by Joslin’s eye care team.

“Telemedicine makes the eye exam more flexible because it can be coupled with a routine endocrinology or primary care visit without the need for dilation,” Dr. Silva said. “This takes away the timing concern and the need to visit another healthcare provider.” The JVN evaluates about 4,000 patients each year in Boston. “In addition to the programs offered in Boston, the JVN has partnered with the Indian Health Service of the U.S. Department of Health and Human Services with nearly 90 telemedicine sites across the U.S.,” Dr. Silva said. “To date, the JVN program has captured over 2 million retinal images.” Diabetes management plays a role in eye health. “For people with diabetes, one of the best things they can do for themselves and for their eyes is to keep their blood sugar level under control,” he said. “By keeping your blood sugar under control, you may reduce the risk of developing eye complications. If eye complications are already present, keeping your blood glucose under control may help reduce the risk of these complications worsening. As part of their medical care, patients should be aware of their A1C level and work with their primary care physicians or endocrinologists to individualize a target.”

I was fascinated by the Joslin Vision Network’s telemedicine program; it’s impressive how they’re able to offer their expertise beyond the Boston area. I also appreciated Dr. Silva’s sentiment that many people have a connection to diabetes in one way or another – it truly is a connected community. My thanks to Dr. Silva for sharing his insight into eye health.

All the best, Laura K.

Disclosure: Dr. Paolo Silva received no compensation for this post. All opinions contained in this post reflect those of the interviewee, and not of Sanofi US, its employees, agencies or affiliates.

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