It probably sounds kind of scary to patients when they know all of the things that can go wrong with the diabetic eye. But the vast majority of patients do really well. If the blood sugar level is nicely controlled, the blood pressure is well controlled, patients are watching their diet, have some type of regular exercise regimen, and follow up with their primary care doctors – the expectations are that they’ll maintain really good vision and be able to avoid many of the diabetic eye problems.
Being aware of all of the different types of diabetic eye problems can sound kind of scary to patients. But the vast majority of people who come in to get examined are okay. They’re fine – they will stay fine. Even for those patients who are doing great with their blood sugar control, blood pressure, their diet’s good, exercise regimen is good – it’s still really important to go in once a year and get their eyes checked. As with almost anything – we do much better if we diagnose things and treat them early.
One of the risk factors for developing diabetic eye disease is simply the length of time that an individual has had diabetes. That’s not really something you can control because you got diagnose when you got diagnosed – it’s in the past. But there’s still a lot you can do: the blood sugar level being nicely controlled will afford you a much better prognosis. Also, there’s a correlation with regards to blood pressure: people with diabetes who might also have blood pressure issues will do much better if not just their blood sugar is controlled but also their blood pressure. A nice diet and exercise regimen and following up with some diligence with your primary care doctor will help people with diabetes try to avoid diabetic eye disease.
One of the common things that happens is that the patient comes in carrying a bag full of glasses, complaining that none of them work. They’ve seen three different eye doctors and they’re really struggling. One of the things on the list of potential problems is that the patient might have diabetes. What happens in the diabetics is that when their sugar is not well controlled, the lens of their eye kind of swells and then gets a little thinner so that their prescription is just changing all over the place. It’s really important for these patients to get their sugar under nice control and then it makes it a lot more reliable to prescribe a pair of glasses.
One of the biggest roadblocks to patients getting treated for their diabetes is that they’re scared. Sometimes people just don’t want to find out the answer and they’re concerned that they won’t be able to handle the news or something. First of all – there may not be anything wrong at all. The vast majority of people with diabetes don’t even have problems. Certainly, you don’t know if you’re the one that does but if you treat it early, you should be able to do something to really help you. Patients that are well controlled tend to do very well. Patients that have very limited access to health care or haven’t been taking care of themselves for whatever reason (maybe they’re just really busy) – those are the people that we’re more concerned about and tend to see more widespread diabetic eye disease.
Diabetics (particularly those in whom the blood sugar levels are not really well controlled) can develop earlier cataracts than is normal. Cataracts happen when the lens of the eye gets cloudy. Diabetics can get a particularly aggressive type of cataract that comes on rather quickly called a Posterior Subcapsular Cataract. With that type of cataract, it’s almost like looking through ground glass. So they’ll get a lot of glare like a dirty windshield or something – a ton of glare. They’ll also start having problems with their reading vision.
Lifestyle choices that people can make to really help their prognosis with regards to developing diabetic eye disease revolve around the same things that people try to do to allow them to live healthier in general with diabetes. These include a healthy diet, low carbohydrate diet, a nice regular exercise regimen, keeping your blood sugar under control, keeping your blood pressure under control, and importantly: following up with your primary care doctor.
Diabetes can affect one’s eyes in many different ways. Some people just come in for a diabetic eye exam and they don’t really have any symptoms at all – everything’s fine. But they should get checked once a year to make sure they’re not developing a problem. Some patients come in because they’ve had a big change in their glasses prescription and they need that adjusted. It’s not unusual for people with diabetes (particularly ones that have sugar that’s pretty poorly controlled) to have rather dramatic swings in their prescriptions.
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