The Quiet Epidemic: Why People With Diabetes Lose Their Sight

From mynewstouse.com

For the nearly 40 million Americans living with diabetes, the threat to their vision unfolds quietly, often without warning. Diabetic retinopathy, a complication that damages blood vessels in the retina, has become the leading cause of blindness among working-age adults in the United States. Yet what makes this epidemic particularly tragic is that it doesn’t have to be this way. 

“The vast majority of severe vision loss from diabetic retinopathy is preventable,” said Janice C. Law, MD, retina specialist in Tennessee. “Studies show that regular eye examinations and timely interventions can reduce the risk of severe vision loss by 90 percent.” 

Still, many Americans are falling through the cracks. Only about 60 percent of people with diabetes receive the annual dilated eye examinations recommended by the American Academy of Ophthalmology, a shortfall driven by lack of access, awareness, and time. 

Expanding Access to Care 

If you or someone you care about has diabetes, schedule a dilated eye exam today. Uninsured or underinsured? See if you qualify for a no out-of-pocket cost medical eye exam through EyeCare America®. This public service program matches volunteer ophthalmologists, physicians who specialize in medical and surgical eye care, with eligible patients aged 18 and older who need eye care. Visit www.aao.org/eyecare-america to learn more. 

                                   People with diabetes are particularly at risk for vision problems and should see an eye doctor regularly

When to See a Doctor 

In its early stages, diabetic retinopathy often presents no symptoms at all—a fact that underscores the importance of preventive screening rather than waiting for problems to emerge. 

“Even if your vision seems fine, a yearly dilated eye exam is important,” said Dr. Law. “By the time patients notice flashing lights, blurred vision, floating spots, or other warning signs, the disease may have already progressed significantly.” 

When should a person with diabetes have an eye exam? 

If you have type 1 diabetes, you should have eye examinations at least yearly beginning 5 years after being diagnosed with diabetes. Your ophthalmologist may recommend more frequent examinations. 

If you have type 2 diabetes, you should see an ophthalmologist at least yearly as soon you are diagnosed, regardless of your age. Follow your eye doctor’s recommendation about how often you should be rechecked, as this varies for every individual. You may need to have your eyes checked more often than once a year. 

But diabetes isn’t the only reason to see an ophthalmologist. All healthy adults should have a comprehensive eye exam by age 40 when early signs of cataract, glaucoma, and age-related macular degeneration?may begin to emerge. 

“Forty is typically when subtle signs of eye disease begin to emerge,” Laura C. Fine, MD, chair of EyeCare America, explained. “Many times, people don’t even notice any changes to their vision during these early phases of disease. However, vision-saving treatments are most effective when the disease is caught early.” 

The Treatment Gap 

Ophthalmologists have more tools than ever before for diagnosing and treating eye diseases. But these innovations cannot help patients whose disease goes undiagnosed or who remain unaware of their condition’s severity. 

The message is clear: The technology to save sight exists. What’s needed now is making sure that everyone who needs it can access it in time. 

https://www.mynewstouse.com/stories/untitiled,37792 

Managing your diabetes can help prevent associated vision loss

From michiganmedicine.org/health-lab

Although there is no cure, diabetic retinal disease treatment has improved over the past two decades 

Diabetes affects more than 1 in 10 adults worldwide and has been accompanied by an increase in vision-threatening diabetic retinal disease (DRD).

Concerningly, DRD is the leading cause of preventable blindness for those aged 20-74 years.

Multiple studies have shown that DRD screening remains challenging because patients often do not have any symptoms in the early stages and, therefore, misunderstand the importance of regular screenings.

In a recent publication in Diabetes Technology & Therapeutics, Thomas Gardner, M.D., M.S., professor of ophthalmology and visual sciences and a member of Caswell Diabetes Institute, discusses current screening recommendations and treatment options for DRD.

Diabetes can damage multiple parts of the body, including kidneys, nerves and eyes. DRD affects the blood vessels and nerve cells in the retina, resulting in haemorrhages, abnormal blood vessel growth and loss of critical nerve cells.

“People usually are not motivated to take action until their vision is threatened, by which time they might develop late-stage DRD,” Gardner said.

The American Diabetes Association therefore recommends that adults with type 2 diabetes have their first eye exam when they are diagnosed and those with type 1 diabetes have their first eye exam within five years of diagnosis.

“The guidelines for type 1 and type 2 diabetes are different because adults who have the latter can develop vision complications before they become aware of their condition,” Gardner said. 

“Importantly, adolescents and young adults are at a higher risk, largely because it is very difficult for them to control their diabetes.”

                                                                      Retinal damage caused by diabetic retinal disease. Getty Images

Diabetes requires constant monitoring of blood sugar and diet.

“Sometimes patients can take the same amount of medication, eat the same food and get the same amount of exercise only to find that their blood sugar levels fluctuate. This makes it hard to manage,” Gardner said.

The biggest challenge for patients is lowering their blood sugar levels without becoming hypoglycemic, which is characterized by shakiness, uneven heartbeat, sweating and dizziness.

Although improvements in insulin pumps and continuous glucose monitors have made it easier to control blood sugar levels, Gardner emphasizes treating the other aspects of diabetes.

“People with diabetes need to have regular health checkups to ensure that their blood pressure is normal and all their organs are functioning correctly. Establishing good control on every facet of diabetes is essential,” he said.

Although the effect of diabetes on the retina is not completely understood, researchers have found several drugs that are promising.

In particular, those that help control blood pressure and lipid levels, including SGLT inhibitors, GLP-1 receptor activators and fenofibrate, can help slow the progression of DRD. However, these are generally prescribed by physicians and not ophthalmologists. 

“Although these drugs were developed to treat other disorders, including kidney disease, heart disease and high cholesterol, ongoing studies have shown they can reduce the risk of vision loss in patients with diabetes,” Gardner said.

As a part of Caswell Diabetes Institute's Mary Tyler Moore Vision Initiative, Gardner and his colleagues are hoping to develop screening techniques that can catch DRD in its early stages and therapies that preserve and restore vision in people with diabetes.

“The prognosis for vision in people with diabetes is better now than it's ever been in the past. There's every reason to be optimistic that vision loss can be avoided with regular screenings and treatment,” Gardner said.

https://www.michiganmedicine.org/health-lab/managing-your-diabetes-can-help-prevent-associated-vision-loss

How to care for your eyes when you have diabetes

From parkview.com

The post was written by Susan Bruick, RN, MSN, CDCES, Parkview Diabetic Care Services. 

Did you know that having diabetes puts you at an increased risk of vision changes and problems? That’s because poorly controlled diabetes can cause microaneurysms (MAs) in your retinas, a part of your eye that is responsible for the images you see. This can lead to an eye disease called diabetic retinopathy. Knowing how to care for your eyes if you have diabetes and understanding the treatment options for diabetic retinopathy is an important step to maintaining or improving your eye health.

In this post, we’ll take a closer look at the complications that come with diabetic retinopathy, and how Parkview Diabetic Care Services is utilizing artificial intelligence (AI) to screen for the disease.

 

What is diabetic retinopathy?

Diabetic retinopathy is a complication of diabetes that occurs when the tissues in the back of the eye are damaged due to poorly controlled blood sugars. This damage can cause blood vessels to leak blood into the retinas, creating changes in vision and possible vision loss. Early symptoms of diabetic retinopathy include floaters, blurriness, dark areas of vision and difficulty perceiving colours.
 

How can I prevent diabetic retinopathy if I have diabetes?

If you have diabetes, it’s critical that you have yearly eye exams by a trained optometrist or ophthalmologist. It’s also important that you take steps to decrease your chance of developing diabetic retinopathy including:

• Managing your glucose levels
• Managing your blood pressure values
• Following standards of care for your diabetes 

How is diabetic retinopathy diagnosed?

Eye doctors can check for diabetic retinopathy as part of your dilated eye exam. Here at Parkview, we can also provide a convenient screening during your routine doctor’s visit that utilizes AI technology. This quick screening takes less than five minutes and is completely non-invasive.

If the result of the screening is negative, the care team will document the results and no additional screening is necessary unless you are experiencing blurred vision, in which case you should followed up with your eye doctor. If you have a positive result from the screening, a referral will be placed to an optometrist or ophthalmologist for additional diagnostics.
 

What are the treatment options?

Treatments for diabetic retinopathy depends on the length of time you’ve had retinopathy, the severity of the condition, as well as the cause of retinopathy. Some options that can be discussed with your eye doctor include:

• Injections to block the growth of abnormal blood vessels and reduce potential fluid in the retina.
• Laser surgery to treat retinopathy to cauterize microaneurysms in the eye and prevent further damage.
• Vitrectomy, which is a kind of eye surgery that can treat problems with the retina.

You should also make lifestyle modifications, including lowering glucose values, reducing blood pressure vales and reducing cholesterol levels. Some anti-glycaemic agents have been associated with worsening of retinopathy, which is an important discussion to have with your healthcare provider.

https://www.parkview.com/blog/how-to-care-for-your-eyes-when-you-have-diabetes 

Diabetic retinopathy: Understanding diabetes-related eye disease and vision loss

From health.harvard.edu/blog

By Leo Kim, MD, PhD

Over 30 million people in the United States live with diabetes, and approximately 7.7 million people have diabetic retinopathy, making it the most common cause of vision loss in working-aged adults. The prevalence of diabetic retinopathy has increased significantly over the past 20 years, due to the rise in the number of people diagnosed with diabetes.

How does diabetes affect the retina?

The retina is the light-sensing component located in the back of the eye. It is composed of blood vessels, nerve cells (neurons), and specialized cells called photoreceptors that are involved in directly sensing light. The ability of the retina to sense light requires energy, which is dependent on the oxygen supplied by blood circulating through blood vessels.

In diabetes, elevated blood sugar levels damage the blood vessels of the retina. These damaged blood vessels leak fluid, bleed, and do not provide adequate oxygen to the retina, leading to retinal ischemia. As a result, retinal cells begin to die and the retina is unable to function properly. In addition, diabetes also damages the neurons of the retina directly. Together, these effects cause diabetic retinopathy.

Vision loss associated with diabetic retinopathy may initially affect central vision due to a condition called diabetic macular edema. This swelling of the macula, a portion of the retina responsible for sharp, central vision, can lead to blurry vision and distortion of images.

Advanced diabetic retinopathy is characterized by the formation of irregular blood vessels that can bleed inside the eye, causing a rapid loss of vision. This results in a sudden, curtain-like vision loss as blood fills up the inside of the eye. Further worsening of advanced diabetic retinopathy can lead to retinal detachment, which requires urgent surgical intervention and can result in permanent, irreversible vision loss if not promptly treated.

What can I do to prevent diabetic retinopathy?

The American Diabetes Association recommends that most people with diabetes keep their A1c level (a measure of average blood sugar levels over the previous two to three months) below 7% to prevent the risk of complications. As blood glucose directly damages retinal blood vessels, there is strong epidemiological evidence that blood sugar control translates to decreased incidence and severity of diabetic retinopathy.

In order to reduce the cardiovascular and microvascular complications of diabetes, which include retinopathy, nephropathy (kidney disease), and neuropathy (nerve damage), it is recommended that people achieve and maintain a normal blood pressure. Blood pressure reduction can delay the onset of diabetic retinopathy, but it is unclear if controlling blood pressure can alter the course of established diabetic retinopathy. Similarly, managing cholesterol is advocated for overall diabetes management, but it is not clear whether doing so reduces the risk of diabetic retinopathy.

How can I find out if I have diabetic retinopathy?

An ophthalmologist can diagnose and begin to treat diabetic retinopathy before sight is affected. In general, people with type 1 diabetes should see an ophthalmologist once a year, beginning five years after the onset of their disease. People with type 2 diabetes should see an ophthalmologist for a retinal examination soon after their diagnosis, and then schedule annual exams after that. You may need to see an ophthalmologist more frequently if you are pregnant or have more advanced diabetic retinopathy.

What can I do to prevent or slow down vision loss if I have diabetic retinopathy?

As mentioned above, damage to the blood vessels deprives the retina of oxygen. Insufficient oxygen leads to production of a signal protein called vascular endothelial growth factor (VEGF). VEGF and its role in eye disease were first discovered at Harvard Medical School.

Currently, there are medications that can bind VEGF and subsequently improve the symptoms of diabetic retinopathy. These “anti-VEGF” agents are injected directly into the eye and can improve diabetic macular edema, and can even improve the severity of diabetic retinopathy. In some people, steroids injected directly into the eye may also improve diabetic macular edema. In some advanced cases of proliferative diabetic retinopathy (the most advanced form of diabetic retinopathy), patients may require retinal laser therapy or retinal surgery to stop or slow bleeding and leakage, to shrink damaged blood vessels, or to remove blood and scar tissue.

https://www.health.harvard.edu/blog/diabetic-retinopathy-understanding-diabetes-related-eye-disease-and-vision-loss-2020011618394