Diabetes and Diabetic Retinopathy Q & A

Questions were answered by Dr. Burt Dubow and Dr. Charles Slonim

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Q: How does diabetes affect your eyes? — L.L., Connecticut

A: Diabetes causes problems in the retina with what are collectively called microvascular abnormalities. The small blood vessels develop microaneurysms and leak blood. New blood vessel growth (neovascularization) occurs. Unfortunately, these blood vessels are weak and also leak. These leaks (hemorrhages) can cause irreversible damage to the retina, with subsequent vision loss.

Patients with controlled diabetes do better than those with uncontrolled diabetes. However, even the diabetic who is under perfect control can still develop diabetic retinopathy — hence, the need for yearly retinal exams. — Dr. Slonim

[Read more about diabetic retinopathy.]

Q: I've been having some cloudy vision and wonder if I should see the eye doctor first or physician first to check for possible diabetes. My maternal grandfather has Type II. I also have taken mestinon in the past for myasthenia gravis, but it seemed to be in remission, so I have not taken it regularly for a while. I think maybe computer use is a factor. — D.B., Ohio

A: Chances are that your medical doctor will eventually send you to the eye doctor. I would go there first, since it sounds like your only symptom right now is vision related. Problems with myasthenia tend to cause double vision or droopy lids (these are the most common symptoms). Your medical doctor can check for diabetes with a blood sugar determination. — Dr. Slonim

Q: How does diabetes affect my eyes? How often should I be checked to make sure that I am okay? — E.B., Pennsylvania

A: Diabetes is the number one cause of blindness in the United States. Although diabetics have a high sugar count in the blood along with insufficient insulin production, the real damage is done by lack of oxygen. Because the eyes have such tiny blood vessels and yet need a lot of blood (and therefore oxygen), diabetes can cause a great deal of damage. The veins in the eyes can leak, which can cause scarring and loss of vision.

It is extremely important for diabetic patients to see their eye doctor at least once a year to have their pupils dilated and a thorough retinal exam performed. If blood leaks are found, an eye surgeon can seal the leaking vessels with a laser. There is even a technique that uses a laser to destroy "unnecessary" retinal areas to provide more oxygen to the important areas.

Detecting early diabetes is a primary job for primary eyecare providers, such as optometrists. Most doctors of optometry recommend yearly exams, especially over the age of 40, to detect diseases such as diabetes. — Dr. Dubow

Q: How does age affect vision? I've noticed as I grow older my sight is getting worse. How often should a person get an eye exam? — C.D., Louisiana

A: Being 50, I can attest to the fact that the eyes do change with age! They actually change in a number of ways. The most obvious change usually happens between the ages of 40 and 50 when we lose our ability to focus on near things. This is called presbyopia, and it happens to all of us at some time. Progressive lenses certainly are a wonderful invention to those of us in this category!

There are other changes as well:

The liquid that fills the eyes (vitreous) changes in color and density, causing our vision to dim and colors to appear less bright.
Our tears change, causing many of us to have dry eye problems.
The skin around the eyes loosens, causing some droopiness.
The pupils get smaller and don't move as fast, making it more difficult to adjust to lighting changes.

Sounds grim, huh? Well, in truth, most people do just fine with these changes. The important thing is to have your eyes checked yearly to watch for diseases that can cause real problems with your vision (and your health), such as diabetes, high blood pressure, macular degeneration and glaucoma. — Dr. Dubow