Protecting Your Vision From Diabetes

The primary cause of legal blindness in the working population of the United States today is diabetes mellitus.  Fourteen million Americans have this disease, 90% of whom have non-insulin dependent (Type II) diabetes, and 10% who have insulin-dependent (Type I) diabetes.  Insulin-dependent  diabetes typically occurs in people younger than 30, and requires regular insulin injections to live.  Non-insulin dependent diabetes is most often observed in severely overweight adults and usually does not require insulin treatment.

Both types of diabetes can affect a person's vision on many different levels, the most common complication being retinopathy.  The earliest signs of diabetic retinopathy are observed when structural changes take place in the capillaries, thereby impeding the flow of nutrients to the retina.  The lack of nutrients and oxygen to the tissue result in damage to the retina.  Many diabetics have few, if any, visual symptoms in the early stages of diabetic retinopathy, which is why it's so critical to have regular, dilated eye exams every year.

Diabetes can also alter the clear tissue covering the front of the eye.  Decreased corneal sensation has been noted and swelling of the corneal tissue can reduce vision, sometimes dramatically in people with this disease.

Overall, the risk of cataract is two to four times greater in diabetics as compared to those without the disease.  In those with insulin-dependent (Type I) diabetes, the risk may be 15 to 25 times greater.  Results of cataract surgery are quite good for patients who have no retinopathy; however, there seems to be a slightly higher risk of macular edema (swelling of the retinal tissue) after surgery in diabetics versus non-diabetics.

Temporary muscle paralysis of isolated muscles around the eye may occur in diabetes, and is frequently the initial clue to a latent diabetic condition.  A person with this condition will often complain of "seeing double", and as aggravating as that may be, a temporary solution (such as a patch) is sought since this condition usually resolves on its own in one to three months.

The first key in protecting your vision from the potential ravages of diabetes, is in close monitoring of your blood sugar.  The Diabetes Control and Complications Trial (DCCT) determined that control of a patient's blood sugar is critical in reducing the rate as well as progression of retinopathy.   Diet and exercise are also essential components in maintaining tight control of your blood sugar.  Your endocrinologist or internist should be able to help you design a regiment that works the best for you.

The second element in safeguarding your vision is to get annual dilated eye exams with your eye doctor.  As mentioned previously, early diabetic changes may not cause you any visual symptoms initially, but they still need to be closely monitored.  Your optometrist is skilled in detecting any early diabetic changes in the eye, monitoring these changes, and referring you to a retinal specialist when necessary.