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Preventing Vision Loss

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The outlook is good for people with diabetes who worry about vision problems. According to Dr. Robert Ramsay, staff doctor at Phillips Eye Institute, early detection, frequent monitoring and new treatments have made blindness rare and other vision problems much easier to control. “We can almost always prevent diabetic blindness now,” Dr. Ramsay says. “Our biggest concern is managing and preventing visual impairment caused by diabetic retinopathy.”

Dr. Ramsay describes this kind of careful monitoring as one of

  • Surveillance
  • Early detection
  • Correct classification of the condition
  • Early treatment
  • Continued lifestyle management

“Hyperglycemia (high blood sugar) can damage the capillaries,” Dr. Ramsay explains. “About 90 percent of people with insulin dependent diabetes will develop diabetic retinopathy. About 40 percent of those who don’t take insulin will develop the condition. Eventually, the more serious form, called proliferative diabetic retinopathy, will develop in some people. That’s usually when treatment becomes necessary. It’s extremely important to monitor people’s vision and to initiate treatment as soon as it’s appropriate.”

Highly effective treatments available
The National Institutes of Health (NIH) has conducted comprehensive research showing that intervention with laser treatment can stop the progression of diabetic retinopathy. “The latest research has given us not just good information about doing the surgery itself, but also good guidelines on when the best time is to do the surgery. All of this has contributed to the great decrease in diabetic blindness,” says Ramsay.

“People with type II diabetes should have a dilated retinal exam as soon as they’re diagnosed,” Dr. Ramsay continues. “They’ve been mildly hyperglycemic for a while already, so they need to have their eyes evaluated right away. Retinopathy rarely happens in people with type I before puberty. Pregnant women with diabetes can experience rapid vision changes, so they should have their eye evaluated during the pregnancy.”

When diabetic retinopathy is detected…
As soon as diabetic retinopathy is detected, the ophthalmologist “stages” it. This is a way to classify it and determine the course of treatment. “For mild, non-proliferative retinopathy, the ophthalmologist is likely to decide that either annual or six-month exams are most appropriate,” says Dr. Ramsay. “When the retinopathy becomes proliferative, that indicates it’s time to do laser surgery to prevent further damage. It’s usually a series of treatments that take place over the course of a year or two.

“The laser surgery usually is successful at stopping the damage to capillaries. But if there’s still damage (bleeding) going on, we can do what’s called a vitrectomy procedure, where we can remove scar tissue and other problems that the damage can cause. That usually halts the progression of the retinopathy. But if it doesn’t, we can do microsurgery. This is a relatively easy procedure for the patient, although it does require short hospitalization. And for some people, visual recovery may take months.

“Before, we didn’t have any options for people who continued to experience bleeding after laser surgery. These were the people who were at serious risk of diabetic blindness. But that’s all changed now that we have these new surgical techniques.”

Another common problem for people with diabetes is blurred vision. The most common cause is macular edema. The macula is a small part of the retina. It’s what allows you to read and see details. “We can stabilize macular edema early by performing focal laser treatments,” says Ramsay.

Good blood sugar control: essential
Dr. Ramsay stresses, “One thing we also do as soon as we detect retinopathy is re-emphasize the importance of good blood sugar control. The Diabetes Control and Complications Trial shows that good control of diabetes reduces the risk of vision problems—and other common diabetes complications as well. It’s extremely important for people to know their A1C measurement and get it to where it needs to be.

“So we also talk to them about getting hypertension (high blood pressure) under control, getting blood fats, like cholesterol and triglycerides, into the healthy range, quitting smoking, etc. We encourage people to talk with their healthcare team to find out whether the insulin pump might be a good idea for them. Low-dose aspirin therapy is another good preventive measure for most people. And it’s a good idea to work with your dietician as well.”

A positive outlook for the future
There’s research going on all the time that’s likely to help people with diabetes improve their blood sugar control and decrease their risk of vision problems even further. “The beta cell islet transplant studies are promising,” Dr. Ramsay says, “and there are new oral medications in research as well. And we’ve been learning more about preventing type II through diet and exercise.”

If you’ve been diagnosed with diabetes, be sure to have your eyes evaluated right away. Most healthcare providers would agree that it’s a good idea to see a retinal specialist as soon as there’s any sign of eye disease.

Source:
Dr. Robert Ramsay, MD, Retinal Specialist; staff physician, Phillips Eye Institute



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