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Article by Dr. Sheri Colberg, Phd, FACSM

 

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TYPE 2 DIABETES AND DECLINING VISION AND BLINDNESS


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One of the distressing complications that can develop from type 2 diabetes is declining vision, which, if neglected, can lead to blindness.

Type 2 diabetes needs to be managed with optimum efficiency to maximize insulin sensitivity by reversing Insulin Resistance, otherwise, this condition may lead eventually to blindness.

Diabetic eye disease can include:

Diabetic Retinopathy – damage to the blood vessels in the retina.

Cataract – clouding of the eye's lens.

Glaucoma – increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.

There are an estimated 20 million people with full-blown diabetes in America. Around 95% of them have the Type 2 variety and the National Eye Institute reports that about half of the total number of persons with diabetes in the U.S have at least the early stages of Diabetic Retinopathy.

Roughly 50% of those have more serious retinal disease. Each year, about 65,000 Americans progress to Proliferative Retinopathy, the most sight-threatening stage of the disease.

As many as 25,000 people go blind from this condition in the U.S. every year.

Woman experiencing a vision screening exam.Compared with the general population, people with diabetes are 25-30 times more likely to lose their sight from Retinopathy, Cataracts or Glaucoma. Because of the high risk for eye disease, persons with diabetes aged 30 and older should have a dilated eye exam every year.

For persons with diabetes younger than 30, an annual dilated eye exam is recommended after they have had diabetes for 5 years.

DIABETIC RETINOPATHY

The leading cause of blindness in American adults, this Diabetic eye disease weakens blood vessels of the retina, causing them to break down, leak or become blocked. All these processes can affect and impair vision over time.

In some people with Diabetic Retinopathy, damage to the eye can occur when abnormal new blood vessels grow on the surface of the retina.

Early detection of Retinopathy and close watch by an eye doctor are essential. Persons with diabetes need to know that dangerous changes in the retina often happen before they notice changes in their sight.

All people with diabetes should have a professional eye exam at least once a year. The eye doctor can decide if you need more frequent examinations.

Risk Factors

Woman looking forward with her hands providing shading to her eyes.Anyone with diabetes, young or old, is at risk for Diabetic Retinopathy. Some of the most severe cases occur in people who were diagnosed with having diabetes at a young age after having developed the disease, unknowingly, years earlier.

The longer a person has diabetes, the greater the chance of Retinopathy. Virtually everyone diagnosed with diabetes before the age of 30 risks developing Diabetic Retinopathy within 15 years of their diagnosis. About three quarters of those who are diagnosed after the age 30 risk developing Diabetic Retinopathy within 15 years of diagnosis.

High Blood Pressure (Hypertension)

High blood pressure increases the risk of eye disease, as well as heart disease, stroke and kidney disease. Switching to a balanced, nutritious diet and getting regular exercise to reduce weight can help to keep blood pressure under control.

Pregnancy

Scientists are still unsure why pregnancy seems to increase a woman's risk of developing, or accelerating, Diabetic Retinopathy. But pregnant women with diabetes should consult their eye doctor during their pregnancy.

Diagnosis and Testing

Often, there are no symptoms in the early stages of Diabetic Retinopathy. Vision may seem unchanged until the disease becomes severe. Eventually, vision may become blurred or blocked entirely.

But even in more advanced cases, the disease may progress without symptoms for a long time. That is why regular eye exams are so important for people with diabetes.

Eye Test: Fluorescein Angiography

Woman looking forward.The blood vessels in the eyes cannot be distinguished from the surrounding structure of the eye in conventional imaging techniques. However, doctors can document potential damage caused by Diabetic Retinopathy by injecting a substance that "lights up" the veins. This simple procedure provides a clear picture of the retinal blood vessels for diagnosis.

Stages of Diabetic Retinopathy

The early stage of this disease is called Nonproliferative Diabetic Retinopathy. At this point, blood vessels swell and sometimes bulge or balloon (aneurysm). The vessels may leak fluid that can build up in the retina and cause swelling. This condition is called Macular Edema and it changes vision. The blurriness is sometimes compared to trying to look through water.

The fluid deposits that build up in the retina may clear up on their own. But fatty deposits sometimes remain that can affect vision. Later, vessels may begin to bleed inside the retina.

In many cases, when the small blood vessels close down, there will be growth of new, unhealthy blood vessels grow. But these blood vessels are not able to feed the retina. This stage of the disease is known as Proliferative Diabetic Retinopathy.

The unhealthy blood vessels can grow on the back of the vitreous, the clear jelly-like fluid that fills most of the eyeball. Vessels may also bleed into the vitreous. This bleeding can cause dark spots, also called floaters or strands, that look like cobwebs and result in clouded vision.

As vessels heal, scar tissue may also grow. The scar tissue sometimes pulls the retina away from the back of the eye. As a result, the retina can tear or come completely loose from the eye. A detached or torn retina may result in serious loss of sight or even blindness.

CATARACT

Woman resting with her eyes closed.Persons with diabetes, even young ones, often suffer from a cataract, which forms when the lens of the eye becomes cloudy – probably because of changes in the proteins of the lens.

Cataracts are extremely common; more than half of Americans age 65 and older have a cataract.

There are several types of cataract. The most common is called a nuclear cataract because it affects the inside of the lens. Another common form is a cortical cataract, which forms in the lens cortex and extends its spokes from the outside of the lens to the center, causing the outside to become cloudy.

The main symptoms of a cataract are blurred, dulled vision in the affected eye, which cannot be corrected by wearing stronger glasses or contact lenses. A brighter light may be needed for reading, while increased sensitivity to glare may also be a problem.

GLAUCOMA

Persons with diabetes are more likely to develop this condition, which is caused by an increase in fluid pressure within the eye that damages the optic nerve. Glaucoma may result in partial or complete loss of vision. But annual eye exams often detect this disorder, which can be treated with eye medication or surgery.

TAKE CONTROL OF YOUR BLOOD SUGAR - INCREASE YOUR INSULIN SENSITIVITY, STOP SMOKING AND WEAR SUNGLASSES

A pair of eye glasses resting upon an eye chart.Poor blood sugar control is one of the main causes of Diabetic Retinopathy and Diabetic cataracts.

Efficient management of type 2 diabetes is the key. A balanced diet and regular exercise to lose weight, combined with careful monitoring and control of blood sugar levels to maximize insulin sensitivity, can slow the onset and progression of Retinopathy.

When it comes to Diabetic cataracts, quitting smoking can be crucial because lighting up is a common cause of a nuclear cataract.

Poor blood sugar management is another cause. Keeping blood sugar levels under tight control can slow the formation of Diabetic cataracts.

Sunlight exposure may have a borderline effect on hastening the formation of a cortical cataract. So persons with diabetes are advised to wear sunglasses and brimmed hats to shield their eyes in bright sunshine.

Antioxidants (especially vitamin C) and carotenoids in the diet may slow down the progression of some types of cataract, though the evidence is conflicting. However, the prudent thing to do is to eat several portions a day of fruits and vegetables to boost Vitamin C levels in the body.

 

 

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