Monday Medical: Diabetics can take control of eye-disease prevention

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November is Diabetes Awareness Month. For free educational materials about diabetes, stop by the Community Health Resource Center at Yampa Valley Medical Center. The YVMC Diabetes Education Program can be reached at 871-2352. The American Diabetes Association's Web site can be accessed at www.diabetes.org....

For many people, eye disease is one of the scariest complications of diabetes. There are several disorders affecting the eyes that are the result of high blood glucose over time.

However, just as I tell patients in YVMC's Diabetes Education Program, diabetes complications can be prevented or delayed by paying attention to diabetes management and routine monitoring.

Whether someone is nearsighted or farsighted, diabetes can cause changes and fluctuations in their eyeglasses prescription. It also can bring the early onset of presbyopia, or age-related farsightedness.

It is important for people with diabetes to remember not to get new glasses until their blood glucose levels have been stable (and as close to normal as possible) for at least three months. Fluctuating blood glucose levels can cause short-term vision changes.

Cataracts, involving a clouding of the lens of the eye, are common in the elderly population, but a person with diabetes can develop cataracts at a younger age and experience more rapid progression.

People with diabetes are two to four times more likely than people without diabetes to develop glaucoma. This disease involves a buildup of pressure within the eye because of poor drainage of fluids from the anterior chamber. This pressure can damage the optic nerve and/or the retina, eventually causing loss of vision if untreated. Pressure is measured at routine eye exams.

The most common form of diabetes-related eye disease is retinopathy. Retinopathy is caused by high blood glucose levels, which damage the blood vessels of the retina with time. In people with diabetes, there are two major forms of retinopathy.

- Non-proliferative (background) retinopathy, the most common type, starts when small blood vessels, or capillaries, in the back of the eye go through changes that impair circulation. Some become narrow and blocked; others balloon out and form pouches.

Macular edema is a condition in which fluid causes swelling in the macula. With macular edema, treatment is necessary and usually is successful at reversing vision loss.

- Proliferative retinopathy is more serious. When blood vessels become damaged to the point that they no longer function properly, new blood vessels form. These blood vessels are weak and prone to leakage, which can lead to a vitreous hemorrhage and blocked vision. Scar tissue can form, which can lead to retinal detachment.

High blood glucose increases the risk for eye disease and other diabetes complications. High levels of blood glucose and other cellular changes associated with diabetes eventually cause damage to the small blood vessels in the back of the eye. High blood pressure, another consequence of elevated blood glucose, often contributes to the development of retinopathy and glaucoma.

Treatment is most effective when eye disorders are detected early, and it may include laser therapy or medication. However, people with diabetes can prevent, delay, or slow the progression of eye problems by managing their blood glucose through healthy eating and exercise choices, maintaining blood pressure under 130/80, avoiding or quitting smoking and getting regular dilated eye examinations.

Many, if not most, of these eye conditions do not have warning signs. The only way to detect them is through regular eye exams by a specialist. The recommendation is to have yearly dilated-eye exams, starting five years after diagnosis for type 1 and immediately after diagnosis for type 2 diabetes.

It cannot be stressed enough that people with diabetes can prevent or delay long-term problems by taking good care of themselves, making healthy choices and having a positive attitude. People with diabetes are the best judges of their own health and the importance of knowing they are protected.

At YVMC, the Diabetes Education Program provides counseling for all aspects of diabetes management and resources for specific needs.

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