Fergus Falls Optometric Center
"Family Eyecare from the Eyecare Family."
Dr. Mark D. Olmsted and Dr. Christine A. Olmsted
117 E. Lincoln Ave.
Fergus Falls, MN 56537
Appointments: 218-736-7555

Diabetes and the Eye - 13 Feb 2005

Diabetes and the Eye
13 Feb 2005

Diabetes and the EyeDo you remember the scene in the Mel Brooks movie, History of the World Part I, where Moses holds three stone slabs and is about to present the "15" Commandments. He accidentally drops one slab and instead offers the 10 Commandments. I have it under good authority that the 11th Commandment was: "Diabetics Must Have Thine Eyes Examined Annually..." Those authorities include the American Optometric Association, the National Eye Institute, the American Medical Association, and the American Diabetes Association. Yet, according to numerous studies, only 50% of these at risk patients actually comply with this "divine" rule.

There are 16 million Americans with diabetes. These people are at risk for eye complications sometime during their lives. Since diabetic retinopathy is one of the leading causes of new vision loss in the U.S.A., an annual appointment with an eyecare professional, including a dilated internal exam of the retina (the thin nerve layer inside the eye) for this population, is a must.

If the retinal condition is at a stage where intervention via laser surgery is an option, blindness can be prevented. So, what are the different stages of the disease process of diabetic retinopathy? To keep this fairly concise let's break it down into three groups: background diabetic retinopathy (BDR), pre-proliferative diabetic retinopathy (PPDR), and proliferative diabetic retinopathy (PDR).

First, BDR is the earliest form of the disease. People who have been diabetic for 12 to 13 years are the most likely to have early signs. Of course, people with poor control of their blood sugar will be more prone to an earlier occurrence than the more vigilant. Also juvenile onset diabetics may develop this process sooner as well. BDR shows up as small pinpoint hemorrhages and eventually blood proteins (exudates) leak in the retina. Most eye care professionals will monitor this condition by more frequent followup visits, every 3 to 6 months depending its location in the retina.

Second, PPDR develops after the now oxygen starved areas of the retina, full of small hemorrhages and exudates, start to infarct or die. Next the PDR stage begins, where new, weak blood vessels (neovascularization) form, in the body's attempt to get more oxygen to the retina. Neovascular blood vessels tend to leak and scar. Because scars shrink, this process tends to "tear things up" inside the eye and can cause a detached retina and bleeding into the vitreous humor (the "jelly" in the eye).

Patients are referred to the appropriate eye specialist for intervention at both the pre-proliferative and the proliferative stage. When diabetics comply with an annual eye exam and more frequent followups when appropriate, a surgical referral is made before the person gets to the proliferative stage. If the vitreous get's involved, it is also surgically removed.

Diabetes also puts a person more at risk for glaucoma, a disease where the optic nerve is damaged most often from high internal eye pressure. Due to the fact that diabetes causes poorer blood circulation to the optic nerve, diabetics can develop glaucoma at lower internal eye pressures than non-diabetics. Also in PDR, neovascular blood vessels can interfere with the normal drainage of aqueous humor inside the eye, which causes the pressure to get high, leading to glaucoma.

So, what preventative measures should diabetics take to decrease their risk for vision loss? First, get a routine annual eye exam. Also, these patients must keep their blood sugar in the best overall long-term control as possible. They must keep seeing their physician regularly to ensure that they are doing well in that regard and if they are not, they need to follow their M.D.'s advise to get them back on course. Exercise and good nutrition not only help in the blood sugar control, but will also help by keeping better circulation throughout the body including the eye. Take care of yourself and if you have any idea what those other four mystery Commandments are, let me know.

Dr. Mark D. Olmsted