For diabetes patients, prevention might help preserve their sight.
Some 3.7 million diabetics went blind over the last 10 years due to retina damage, according to recent studies funded by the National Eye Institute (NEI). Approximately 7.7 million Americans are now affected by diabetic retinopathy, and the rate is predicted to climb to 11 million by 2030. Early detection and annual eye exams are key prevention methods.
Diabetes damages blood vessels in the retina, the tissue layer that senses light. The vessels leak fluid and blood, which leads to blockage, rupture and new vessel growth on the retina.
“In our clinic, we definitely have increased numbers of patients with vision loss secondary to diabetes,” said Dr. Kara Crumbliss, the director of Low Vision Services at The Chicago Lighthouse, a social service agency that offers programs and support to individuals with vision loss. “It’s the leading cause of new acquired cases of blindness in Americans between 20 and 70 years old.”
Crumbliss attributed the rise of diabetic retinopathy to the increase in Type 2 diabetes, a disease linked to the nation’s climbing obesity rate. The earlier a patient’s diagnosis occurs, said Crumbliss, the greater the chance they’ll develop diabetic retinopathy later on in life.
Severe vision loss is preventable if diabetic retinopathy is diagnosed and treated in its early stages, Crumbliss said. But since the disease has no symptoms in its early stages, it is difficult to catch without annual eye exams.
“If diabetic retinopathy isn’t treated in a timely fashion, then usually the vision loss can be irreversible. That’s when the patient comes to see me – they are legally blind and learning to live with that level of vision for the rest of their life,” Crumbliss said.
Physicians often address diabetes management strategies with patients, including insulin regulation, diet and exercise. But scheduling an eye exam is often put on the backburner, said Dr. Jan Pauline Merrill, an assistant professor in the Department of Ophthamology at Rush University Medical Center and a partner at Illinois Retina Associates.
“There’s still disconnect between the endocrinologists, the primary care physicians, the ophthalmologists and the optometrists,” Merrill said. “When someone is diagnosed with diabetes, most doctors primarily talk to them about diabetic management – changing diet, lifestyle, checking blood sugar and taking medications. But eye exams, from my perspective, are still occasionally an afterthought.”
Both Crumbliss and Merrill stressed the importance of early – and regular – eye exams for patients. “Other than controlling their diabetes, it’s the next best thing they can do to reduce their risk of vision loss,” Crumbliss said.
But as eyesight wanes it is increasingly difficult for patients to treat their diabetes.
“Things we use as typical suggestions for diabetic control, like daily exercise, reading food labels and avoiding certain foods, and checking blood sugar regularly – all of those three tasks are very visual,” Crumbliss said.
She also noted that vision loss caused patients to become more cautious with their mobility, and less likely to engage in solitary physical activities like running or riding a bike.
Since the early stages of diabetic retinopathy are slowed through controlling blood sugar, blood pressure and blood cholesterol, already-poor vision deteriorates with the decline of self-treatment.
“It’s a vicious cycle and a perpetuating cycle,” Crumbliss said.
Merrill said that physician-directed campaigns such as American Diabetes Month are helpful ways to remind patients and physicians about the importance of initial eye exams and yearly follow-ups.
“But it would still be nice to see a certain point when diabetes is diagnosed and a patient is automatically referred to an eye exam,” Merrill said.