Diabetes : Diabetes and Eye Health

Katie Crowe, The Frederick News-Post, Md.

Debra Crawford struggles daily with various medical problems, including Type 2 diabetes, chronic obstructive pulmonary disease (COPD) and heart problems, including angina.

Due to these health issues, the activities she can take part in have been limited over time. One thing Crawford really enjoys, however, is crafting. She calls it a relief, or something that helps her get her mind off other stressors. But in order to complete her beloved crafts, it is essential for Crawford to have healthy eyes.

"My vision is my life now that so many other things have been cut off," she said in a recent phone interview.

A little more than a month ago, however, Crawford, 64, could have completely lost her vision had she not been proactive about her ocular health.

In late October, Crawford and her husband were running errands when she began to feel a little funny and she didn't know why, she explained.

"When I left a store and got to my vehicle, I said, 'Something is wrong -- I'm seeing red and brown in front of my eye,'" said Crawford, who lives in Hagerstown. She was seeing dark lines and splatters in her right eye, she said, and noted that although she was not experiencing pain, it was a "horrible feeling." Despite wearing glasses and having cataracts on both eyes, Crawford said she could see normally the day before.

"It was one of those things that comes on and you really don't know what's happening or why," she explained. "The only peace I could get was from closing my eyes," she said.

After going home and feeling no relief, Crawford went to the emergency room, she said.

"I couldn't focus on anything -- I could hardly tell what was in front of me, and I was straining with the other eye to see things," Crawford said. "It was just scaring me to death because it wasn't getting any better."

Doctors told Crawford she had experienced hemorrhaging in her right eye and possibly had a torn retina as well. They called ophthalmologist Dr. Sunil Thadani, who agreed to examine Crawford the next day.

Thadani confirmed the doctors' diagnosis, and noted it was hard to even get a good visual of the back of Crawford's eye due to the amount of blood and fluid leakage, Crawford said. In addition to his treatment, Thadani referred her to a retina specialist.

Although Crawford has been treating her diabetes for more than 40 years and she currently takes two types of insulin, the hemorrhaging was a result of diabetic retinopathy, or diabetic eye disease. She underwent surgery for minor bleeding in her eyes about seven years ago, she said.

So far, she has had two laser surgeries in both eyes to reduce swelling and has four upcoming laser surgeries scheduled throughout the next few months to seal, or cauterize, the blood vessels that were leaking. (When she was examined, doctors said Crawford's left eye was on the verge of hemorrhaging as well, she added.)

A leading cause of blindness

Crawford's case is just one example of a common danger that can result from Type 1, Type 2 and gestational diabetes, Thadani said in a recent interview at his new Frederick practice, Maryland Vision Center. Diabetic retinopathy is defined as damage to the blood vessels in the retina, at the back of the eye, and is a leading cause of blindness among American adults, according to the National Institute of Health's National Eye Institute. Diabetics are also more at risk for developing cataracts, or a clouding of the eye's lens; and glaucoma, an increase in fluid pressure inside the eye that leads to optic nerve damage and vision loss. Macular edema, or a swelling of the center of the macula (the part of the eye where sharp, straight-ahead vision occurs), can result from uncontrolled diabetes as well, Thadani said.

Because it is so important to get regular eye examinations -- especially for diabetics -- Thadani is offering free services for diabetic eye exams for the remainder of the year, he said. In order to be screened for diabetic eye disease, patients must have a complete retinal eye exam in which the pupils are dilated and the back of the eye and retina are examined with a microscope to get a close look at the blood vessel architecture, making sure there is no evidence of leakage or hemorrhage in the small vessels in the back of the eye, Thadani said.

Based on the patient's specific diagnosis or severity of diabetic retinopathy, Thadani or a retina specialist will do further testing or move forward with laser treatments. For those with subtle retinopathy, Thadani will work with the patient's primary care doctor to get his or her diabetes under control and continue observation, he said.

"We don't want to just fix this -- we also want to address the cause of the problem," he said. "If the patient can get the diabetes under control, it can delay the progression of the eye disease." Although diabetic eye disease cannot be reversed, he said, it can be halted if the patient is getting treatment for diabetes and maintains control of his or her blood sugar levels.

It is very important -- especially for those who have diabetes or who are at risk for the disease -- to get regular eye exams every year or more frequently for those who have evidence of eye disease related to diabetes, Thadani added.

"In the case of those with diabetes, chances are if there is blood vessel damage in the eyes, there is damage elsewhere," he added. "Just going to get new glasses is not enough."

Thadani and Crawford, after having gone through this experience, want to raise awareness about the importance of regular eye exams.

"I want patients to take that initiative and think, if they want to see well into their 70s and 80s, this is what they have to do," he said.

Crawford added that as opposed to when she was diagnosed with diabetes, patients now have many more affordable options to maintain and improve their physical health.

"If you are diagnosed ... really work at it and don't ignore it," she said. "I know it's my diabetes that has led to most of the problems in my body.

"Take (a diabetes diagnosis) very seriously. Control your diet and exercise ... and make it a priority."

©2012 The Frederick News-Post (Frederick, Md.)

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