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Diabetics: Watch your eyes

People with diabetes are more likely to develop eye problems, too

November 16, 2012|By MARIE GILBERT | marieg@herald-mail.com
  • Debra Crawford of Hagerstown was diagnosed with diabetes when she was in her 20s. She was more recently diagnosed with diabetic retinopathy, which is a form of eye disease that occurs when there is damage to the blood vessels in the retina. She is undergoing laser treatment to prevent further vision loss.
By Kevin G. Gilbert/Staff Photographer

When Debra Crawford was in her 20s, she received a life-changing diagnosis.

She had diabetes.

From that moment on, every day, every hour would require constant, unwavering attention to meals, lifestyle and medication.

The Hagerstown woman would learn the importance of willpower and self restraint and would walk a Goldilocks tightrope, making sure her sugar levels weren't too low or too high.

Food was no longer just food. It was a chart of carbohydrates, proteins, fats and serving sizes.

Crawford, 64, said her father and other relatives were diabetics, so her diagnosis didn't come as a complete surprise.

What did surprise her was the fact that diabetes put her at risk for a host of other health complications, including nerve damage and heart, kidney and liver problems.

Recently, she learned there's even more to diabetes than meets the eye when she developed diabetic vision problems.

Crawford said she had noticed during the past few years that her sight was getting worse.

"I love to paint and I love to do any kind of craft. I'm that type of person," she said. "But it seemed I was trying to do these things without seeing clearly."

Crawford didn't realize the seriousness of the situation until several weeks ago when she began to experience bleeding in her right eye.

"I couldn't see and didn't know what was happening," she said. "My eye became a brownish red color that kept getting darker."

Her doctor's office was closed at that hour, so she headed to the emergency room.  It was there that Crawford was evaluated by Dr. Sunil Thadani, a local eye doctor, who told her the bleeding was a result of diabetic retinopathy — a form of eye disease where there is damage to the blood vessels in the retina.

Crawford currently is undergoing laser treatment to prevent further vision loss, said Thadani, medical director of Maryland Vision Center in Frederick, Md.

Retinopathy is one of a group of diabetic eye problems. Other related eye disorders include cataracts, a clouding of the natural lens in the eye; and glaucoma, which is the result of increased eye pressure that can lead to optic nerve damage and loss of vision.

According to the American Diabetes Association, diabetics are 40 percent more likely to suffer from glaucoma than people without diabetes and 60 percent more likely to develop cataracts.

Most patients with diabetes will get some form of retinopathy, says the ADA. In extreme cases, uncontrolled diabetes can lead to blindness.

The reason?

"Diabetes weakens the blood vessels in the eye, causing them to break down, leak or become blocked," Thadani explained. "Abnormal new blood vessels can also grow on the surface of the retina. This can result in loss of vision."

During the early stages of the disease, Thadani said, "there are often no symptoms and vision may seem normal until the disease becomes severe."

It's also not unusual, he added, for eye doctors to discover that a patient might have diabetes.

"That's a good reason to have regular eye exams," he said.

For individuals who have been diagnosed with diabetes, Thadani recommends a regular annual eye assessment that includes a dilated examination to view the retina to monitor for diabetic retinopathy.

"Early diagnosis and treatment of diabetic eye disease can prevent vision loss," he noted. "For type 2 diabetics, an annual examination is recommended. For type 1 diabetics, an annual dilated examination is recommended five years after the diagnosis of diabetes. Pregnant women with diabetes should see their eye doctor during the first three months of pregnancy."

The ADA says there are two types of diabetic retinopathy. In nonproliferative retinopathy, the most common form, capillaries in the back of the eye balloon and form pouches. It can advance from mild to severe as more blood vessels become blocked.

In some patients, retinopathy progresses after several years to a more serious form called proliferative retinopathy. In this form, the blood vessels are so damaged they close off. In response, new blood vessels start growing in the retina. They are weak and can leak blood, blocking vision, which is a condition called vitreous hemorrhage.  The new blood vessels can also cause scar tissue to grow. After the scar tissue shrinks, it can distort the retina or pull it out of place — a condition called retinal detachment.

Huge strides have been made in the treatment of diabetic retinopathy, say both Thadani and the ADA, including scatter photocoagulation and focal photocoagulation.

In photocoagulation, the eye care professional makes tiny burns on the retina with a special laser. These burns seal the blood vessels and stop them from growing and leaking.

In scatter photocoagulation, the doctor makes hundreds of burns in a polka dot pattern on two or more occasions. This reduces the risk of blindness from vitreous hemorrhage or detachment of the retina; but it only works before bleeding or detachment has progressed very far. This treatment also is used for some types of glaucoma.

With focal photocoagulation, the eye doctor aims the laser precisely at leaking blood vessels in the macula.  This procedure does not cure blurry vision caused by macular edema. But it does keep it from getting worse.

With November designated as Diabetic Eye Disease Awareness Month, Thadani said it's the perfect time to have an eye exam.

He also made a decision to offer free diabetic eye screenings for the remainder of this year in an effort to raise awareness. The toll-free number is 800-778-7647.

As someone who has been dealing with diabetic vision problems, Crawford strongly encourages individuals to educate themselves about diabetes before the disease becomes too complicated.

"I probably had diabetes as a teenager, but I ignored the symptoms — excessive thirst and fatigue," she said. "I wish I would have done more. But you always wish after the fact.

"Today," she added, "I have a lot of health issues. I have so many things. I'm in a wheelchair and on oxygen all the time. I can't rejuvenate my body. But I have faith in God and a positive attitude.

"If you're diagnosed with diabetes, do everything you can to get it under control. Don't take a moment of your life for granted. And, most importantly," she noted, "follow what your doctor says. And then work at it each day of your life."




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