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.