Diabetes and Vision: Understanding the Link

As part of the presidential election this year, Americans were allowed to gather information about what is happening in their communities and across the nation. It's called "Diabetes in America" and includes statistics like these:

· 54 million people live with diabetes in the USA

· Diabetes is responsible for 9.2 million hospitalizations every year, 6 percent of all hospital admissions; 90 percent over age 65

· Life expectancy has decreased due to diabetes complications since 1980 by three years on average

In addition, an American is more likely to die from a stroke caused by macrovascular disease than from cancer or heart disease.

World Health Organization (WHO) predicts that the number of people diagnosed with diabetes will grow from 171 million in 2000 to 285 million by 2030. WHO reports that approximately 21 million people die each year as a result of complications related to high blood glucose.

Baylor College of Medicine recently sent out an appeal for the development of new treatment options for diabetes, stating, "The discovery and development of effective treatments for diabetes have lagged far behind our understanding and ability to treat cardiovascular disease." As a result, the school is asking its alumni to support funding for research into new drugs, devices, vaccines, and other medical advances that are necessary to achieve this goal.

Diabetic Retinopathy

Two factors that seem to be linked to the onset of retinopathy are increased blood pressure and changes to the eye's fluid handling mechanism.

Retinal lesions often follow the development of diabetes in several different ways. Usually, for many years, there is no change.

Then very slowly over time, spots appear in the retina. These spots grow, then merge into spider-like or chain-like growths that crisscross the retina. These lesions are called retinal proliferation (also called "Rods").

A rod can be recognized by its appearance on funduscopy - it has a spot about an inch in diameter over one of the foveal areas (the part of the retina where sharp images are produced). As in all proliferations, they tend to be identical in appearance in both eyes.

They appear in the macula and over the ora Serrata (the edge of the retina where there are no photoreceptors). There may be extra blood vessels extending from the swirls.

Diabetic retinopathy can cause a significant loss of vision when blood vessels grow on the retina and begin to leak. These blood vessels, called neovascularization, are visible on the funduscopic exam. It can cause rapid changes over weeks, months, or years causing significant loss of vision. Sometimes the new vessels will stick to other tissues on or inside the eye causing scarring called "exudative retinopathy.

Recovery

If caught early, diabetic retinopathy can be treated to prevent permanent vision loss. Those treated before the disease developed into retinal changes had 15/16 vision, versus 5/16 for those without treatment.

The goal of treatment is to slow down the progression of the disease. Current treatments include laser procedures, cryotherapy (freezing), photocoagulation (burning), injection sclerotherapy (which depresses the formation of new vessels), and vitrectomy surgery (removal of part of the vitreous body). The type required will depend on the stage of the disease and general health status.

Diabetic retinopathy can lead to loss of vision because the disease damages the tiny blood vessels in the retina and they leak. This can be halted by clearing out abnormal vessels while preserving healthy ones.

Frequently Asked Questions on Diabetes and Vision

What is the difference between diabetes and pre-diabetes?

Diabetes is a disease in which the body either doesn't make or cannot respond to insulin, a hormone that regulates the amount of sugar in the blood. People with diabetes have too much sugar in their blood, which can lead to serious complications.

Pre-diabetes is a condition that may put you on the path to developing type 2 diabetes. It means you have higher than normal blood sugar, but not high enough for a diagnosis of diabetes. Pre-diabetes increases your risk of developing cardiovascular disease and it also increases your risk for type 2 diabetes.

Why is it important to control blood sugar levels?

People with diabetes have high blood sugar, which can lead to serious complications. One of the most common complications is heart disease, which can lead to heart attack or stroke.

Low blood sugar may also cause nerve damage that may affect your legs, arms, and/or face. Untreated high cholesterol can also lead to heart disease.

Research shows diabetes is the leading cause of kidney failure in men and women, and excess weight increases your risk for cancer of all types. Living with diabetes or pre-diabetes increases your risk for other problems such as infertility and sexual dysfunction.