Your Eyes and Diabetes - National Diabetes Month

Wow, it is November already!  For me that means my oldest son turns 15, I need to mow the yard one last time and rake some leaves, and it might be a good idea to put the Christmas lights on the roof soon before the cold weather gets here and makes that task miserable.  It also means it is National Adoption Month, National Diabetes Month, and Diabetic Eye Disease Month.  All are important observations to me.

Diabetes is becoming an epidemic here in the United States.  My grandfather had diabetes and after observing him deal with this disease I have made it a goal of mine to do what I can to prevent it from happening to me.  I have lost friends to diabetes too.  It is a nasty disease and I hate it, just as much as I hate cancer and heart disease.  It is estimated that 29.1 million Americans, 9.3% of the population, has diabetes.  Of those 29.1 million 1-in-4 of them don't even know they have diabetes.  86 million more American adults, 1 out of every 3, have pre-diabetes.  It is all around us.

Diabetes is a disease of the vascular system.  Diabetes, in a nut shell, damages the capillary walls and thus causes damage to the surrounding tissue.  This tissue gets necrotic and will eventually die off, creating an even bigger mess.  Nerves can be damaged leading to neuralgia.  Diabetes can affect a number of organs and systems, taking a toll on nearly every organ in your body including the heart, kidney, nervous system and eyes.

There is a saying that the eyes are the window to the soul.  While that isn't really true, the eyes can indeed tell us many things, especially as it relates to diabetes.  The eyes become a very important part of evaluating the effect of diabetes on a person.  Since the blood vessels in the eye can be directly observed, they can give us an insight to how well diabetes is being controlled.  Periodic examination of the retina via dilation is essential in evaluating diabetes.  When we examine a diabetic patient's eyes, we can observe stability in many instances, but often we might find prescription shifts, hemorrhages, retinal deposits, and swelling, among other things.  The retinal changes as the result of diabetes are referred to as diabetic retinopathy.

The amount of retinopathy that is seen correlates most of the time with the extent of diabetic damage in other places in the body.  In this way, the eye is really a window of sorts to see more of what is going on internally.  If a person has had diabetes for several years, even decades, and there is no retinopathy present at all, that person is most of the time doing a very good job of maintaining a good level of health relative to their diabetes.  However, if in observation of the retina, we see widespread hemorrhaging with exudates, drusen, macular edema, and neovascularization, that will send up a red-flag that the diabetes is likely not being managed well and is causing extensive problems elsewhere. 

Neovascularization is the growth of new blood vessels by the retina of the eye to help supply blood to damaged areas of tissue.  While that seems to be a valiant effort by the body to repair itself, the new blood vessels are more leaky than the old ones and even further damage is done.  In these instances a laser surgery is often needed to basically kill off large areas of the retina to prevent this from snowballing into an even bigger problem.  In order to prevent these types of things from occurring it is imperative that the patient with diabetes do whatever is necessary in order to stabilize their diabetes via medication, eating properly, and exercise.  The old adage is right, an ounce of prevention is worth a pound of cure.  It is far better to do the right things in the first place to prevent retinopathy than to have to deal with the consequences otherwise.

Some of the most rewarding experiences to me in practice are the times when I can evaluate the ocular health of a patient and determine that there are serious health issues that must be addressed, such as diabetes.  It is not uncommon for diabetes to be initially detected during the process of an eye exam.  While I wish I didn't have to see health problems in my patients, it is wonderful when the problem can be detected in one of its earliest stages and taken care of before it becomes problematic.  Annual eye exams are ultimately very beneficial and sometimes critical in determining the ongoing overall health of the patient.  Check yearly and see clearly isn't just about making sure the prescription is right, but also is about the eyes and the body maintaining a good level of health, especially when diabetes is involved.

National Cholesterol Education Month

September is National Cholesterol Education Month and you may be wondering what in the world does cholesterol education and Hook Eye Care have in common and why is he letting us know about this?  Well, truth is that it can be possible to see signs of elevated cholesterol just by looking at someone's eyes with the microscope.

Arcus Senilis...two Greek words that have a relationship with cholesterol.  "Arcus" is the Greek word from which we get the word "arc" or something circular in appearance.  "Senilis" is the Greek word from which we get the word "senile" or since most of us don't like the implication of that word let's just say "age-related".  Arcus senilis is simply a circular age-related change we see on the cornea.  It consists of lipid deposits around the outer edge of the cornea (the clear, front, vaulted part of the eye).  These grayish colored rings form in the cornea as we get older and pose no problem whatsoever with one's vision, just a benign age-related change...most of the time.

However, if we see such deposits in someone younger, say 40 years old or younger, then it can possibly not be so benign.  These deposits are somewhat premature and that could mean that the younger person having such deposits could have elevated cholesterol levels.  That isn't always the case, but it is just a red flag of sorts that is waving at us saying that we should probably investigate such a possibility a little more closely.  There is a chance that the cholesterol levels are fine, but there is that chance that they might be elevated.  It could be that the "good" cholesterol levels are high and that is what is being deposited, but on the flip side it could involve high levels of the "bad" cholesterol.  Either way, I just want to make sure each patient is aware of what their cholesterol level is so that we can make sure all is OK, and if not, we can take necessary steps to improve our health in this regard.

I had this "ah-ha" moment several years ago when I was performing a routine exam on a patient in his middle-to-late 40's.  As I was looking at his eyes with the microscope he asked me if I could still see the cholesterol in his cornea, which basically told me that I must have already had the arcus senilis discussion with him at his last visit or how would he have known.  I told him "yes, they are there, they will always be there and won't ever go away, but don't worry because they will never affect your vision."  He responded that he wasn't worried about that, he was just happy to be alive.  ???  I was curious as to what that meant.

He told me that I had informed him of this finding two years ago and had recommended he get his cholesterol levels checked out since it had been well over a decade since he had last had routine blood work done.  So he did.  The results were alarming.  His cholesterol levels were sky high, so high I didn't know they could measure that high.  He had 98%, 96%, and 95% blockage of three coronary arteries!  He was immediately admitted to the hospital and had stents put in to open the blocked arteries, and when he had stabilized and was doing well his cardiologist told him it would have been a matter of a couple of weeks and he would have killed over of a heart attack and there would have been no way to revive him, it was a good thing they caught this high cholesterol situation when they did.

I was shocked.  I am so glad that I suggested a check-up.  I could have easily thought to myself, "he is over 40, there is just a little bit of a deposit, he's probably OK", and if I had thought that he would be dead right now.  I made it a rule for myself that day, I don't care how healthy they look, how good their diet might be, or how close to 50 years old they might be, if I see some arcus in someone under the age of 50, I am telling them to get it checked!

The scary thing about cholesterol is that it is so quiet, so often you just never really know.  I'm always struck by how many people I know who appear to be the epitome of good health and then I find out they are having to have heart surgery because their cholesterol is about to do them in.  It's sneaky that way.  I love the Lipitor commercial that shows the older gentleman walking by the pool in just his swim trunks, he looks like he is straight out of a health and fitness magazine and all the ladies 30 years younger than him are taking notice and checking him out.  He proceeds to dive into the pool and you would have expected a beautifully graceful dive but instead there is an ugly belly buster and in mid-air his total cholesterol of 258 is exposed on a portion of the screen.  Just goes to show you that looks can be deceiving.  I also like the old Vytorin commercial that shows the different foods and relatives who resemble those foods (or do the foods resemble the people?)  There is Grandpa Frank with his fabulously bald forehead separating two gray patches of temporal hair, and on the split screen is the hot dog that looks just like Grandpa Frank.  The commercial is a great reminder that someone's high cholesterol could come from the foods they eat, or from genetics, or from both...from frankfurters or from Grandpa Frank.

Cholesterol education, that's all it is.  I don't want any of my patients being surprised by this silent killer.  I will look for the signs at each and every exam and if I see something suspicious I will let you know.  They say the eyes are the window to the soul, that is probably quite a stretch but the eyes can certainly tell us some things we may not have already been aware of in regards to our internal health, that's for sure.

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