DIABETES AND THE EYE
The fact is that adult onset or type II Diabetes is reversible most of the time by altering lifestyle factors. Most people are aware that they can eliminate medications for this type of diabetes with lifestyle choices. However, Type I Diabetes (usually childhood or early adult onset) requires insulin therapy. Either type of diabetes can be associated with eye damage if the blood sugar is allowed to remain elevated.
Sugar is damaging to the small blood vessels in the eye, kidney and peripheral nerves throughout the body. Over time the blood vessels develop microaneurysms that leak blood and fat, and eventually they “drop out” or die. This leaves the retina with poor circulation and new blood vessels grow to compensate for the lack of circulation, but these new blood vessels are harmful instead of helpful. If intervention either by better blood sugar control and or medical or surgical treatment is not done blindness can occur within 2 years.
Usually ocular damage secondary to diabetes takes 7-15 years to occur. Our recommendation is to keep the blood sugar between 70-120mg/dl prior to a meal and <180mg/dl after meals. Usually to accomplish this type of excellent control, multiple insulin injections per day or an insulin pump is required. One should work carefully with their physician to assure good blood sugar control.
The Hemoglobin A-1C (HbA1C) should be kept <7 to prevent retinopathy. The HbA1C is a measure of your blood sugar control over a 3 month period, therefore giving us more accurate depiction of your blood sugar control rather than just 1 reading prior to or after a meal.
Lifestyle changes reduce the risk of diabetic retinopathy. In the Early Treatment Diabetic Retinopathy Study (ETDRS) they found that lowering blood lipids (fats) decreased the risk of fat leakage into the retina, which leads to visual loss. Therefore our physicians recommend regular exercise and a constant awareness of fat and sugars in your diet. Diabetic patients should follow up with their physician/endocrinologist as directed, and have an eye exam (retinal evaluation) every 12 months. If diabetic retinopathy is noted in your eyes, our physicians will recommend more frequent visits depending on the severity of the condition.
Also patients with high blood cholesterol or elevated LDL had twice the amount of leakage into the retina compared to patients with normal blood levels.
Nine percent of retinopathy occurs in non-diabetics related to elevated blood pressure, elevated cholesterol and triglyceride levels, elevated body mass index, and elevated waist to hip ratio.