Eye problems a sign of diabetes

By Janice Gibbs

Damage to the diabetic’s eye starts slowly and without symptoms.

Diabetics have an issue with not producing enough insulin to regulate their blood sugar. The elevated blood sugar will cause damage to blood vessels in the body, with capillaries being the first to be injured, Scott & White optometrist William White said.

White recently spoke to the Diabetes Support Group at Scott & White about reducing risk of diabetic eye disease.

The blood vessels carry the blood, which includes oxygen, to the tissue, White said. If the vessel is damaged and oxygen doesn’t reach the tissue it can’t survive.

Organs damaged early on as a result of blood vessel damage are the eyes, kidneys, heart and the extremities.

“Most doctors will tell diabetics to have their eyes and feet checked once a year,” White said.

Early in the disease process there might be swelling of the eye’s lens, which can change vision, he said. Some patients say they know their blood sugar is high when their vision gets blurry.

As the disease goes on microaneurysms, balloon-like swellings, will show up in the retina’s blood vessels. As it progresses the swellings might break open and there’s bleeding.

“The retina is like the film in a camera; it absorbs the light and allows you to see,” he said.

If the blood flow to the retina is restricted the body tries to fix it by making new blood vessels, which usually leak and block the light.

“If it’s a large leak you can’t see through the blood,” White said.

Diabetic retinopathy is the most common type of diabetic eye trouble and is caused by damage to blood vessels in the retina.

“There’s no need for surgery; your body does a wonderful job of absorbing the blood,” he said. “If I see that I’m not overly concerned, we just have to control your blood sugar.”
It’s all about optimal blood flow.

Macular edema is the leading cause of blindness for people age 45 and older. Diabetic macular edema is caused by fluid leaking from damaged blood vessels into the macula. The macula is the center of the retina and provides sharp detailed focus.

The macula can swell and gaps form in the layers and cells won’t work together, White said. It can be reversed pretty easily with diet and exercise, he said.

Once you have new blood vessels forming you’re in another category of diabetic retinopathy, proliferative diabetic retinopathy, and you need to see a retina specialist, he said. It will require treatments with laser or injections.

When black spots appear and hamper vision, it’s likely that the blood leaking is coming from the newly formed blood vessels. Sometimes the body can reabsorb the blood, but it takes time.

 In an effort to save central vision, peripheral vision may be sacrificed during treatments that reduce oxygen demand within the eye.

“It can be a trade-off when trying to save vision,” White said.

Injections can be used to stop the signals for more blood vessels to form.

The worst stage of disease is neovascular glaucoma, blood vessel developing in the iris.

“The eye is painful and it’s going blind because of damage to the nerve and retina,” he said.

How long a person has been diabetic is the major risk factor.

In the first 11 to 13 years, about 23 percent of patients will develop retinopathy.

About 60 percent of people who have been diabetic for 16 years will have diabetic changes in their eye.
“Those who have tight control of their blood sugar can reduce risk of developing retinopathy by 76 percent,” White said. “Those who have bleeding in their eyes can reduce their risk by half by getting sugar under control.”

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