Question: I was a young boy when I saw my grandmother go blind from diabetes. How does it happen? Could she have prevented it? Medical science has advanced so much. Is there any treatment these days? — Chad, of Lima
How sad that your grandmother went blind from diabetes!
The complications of diabetes can be prevented by taking good care of diabetes. Good care includes achievement of near normal body weight, controlling blood pressure, controlling cholesterol, doing regular exercise and controlling the blood sugar. There is a world-famous clinic in Boston called Joslin clinic. They give gold medals to patients of diabetes who have no complications after 50 years of diabetes diagnosis. There are thousands of Americans who have Joslin Gold Medal. If your doctor writes to them certifying that you have no complications and have had diabetes for 50 years, they will send you a Gold Medal.
The effects of diabetes can be devastating to many organs in the body, including the eyes and vision. Fortunately, the diagnosis and treatment of diabetes and diabetic complications has made many advancements in the past few decades. Of course, the best way to combat diabetes is prevention. That subject was discussed in previous Ask the Doctor columns.
A major portion of the damage done to our bodies by diabetes is due to its effect on our circulation.
Uncontrolled diabetes can cause the tiny blood vessels throughout our body — the capillaries — to shrink and shrivel away. It’s these tiny capillaries that deliver the nutrients and oxygen and remove waste products from each cell in the body. This is needed for each cell and structure and organ to be healthy and function in the way it was meant. Specifically in the eye, when the capillaries shrivel, the delicate tissues of the eye are choked and become damaged.
One of the most common parts of the eye to become damaged is the nerve layer in the back of the eye — the retina. If the retina does not receive proper delivery of nutrients by the capillaries, it becomes weak and sick. The cells that make up the retina “starve” in a sense. As a result, the retina may not function well to deliver good vision.
Diabetes can also damage the bigger blood vessels in our body by weakening the walls of these vessels. This, too, can happen anywhere within the body. Specifically in the eye, this can lead to blood leaking out of the vessel wall as the blood circulates through the eye. This causes bruises and swollen spots inside the eye. Sometimes the leakage goes unnoticed … in other words, it may not cause any vision problems. Nonetheless, damage can be happening for years inside the eye of a diabetic person, and they would have no way of knowing about it unless they had an exam by their doctor or specialist called Retina Specialist. If the leakage does cause symptoms, it is typically in the form of gradual, but occasionally sudden, vision loss in one or both eyes.
The diagnosis of diabetes damage in the eye is done through direct examination by the doctor and also by sophisticated instruments and testing techniques. Such techniques involve various methods of photographing the blood vessels and surrounding nerve cells as blood circulates through the retina. Doing these tests can detect areas that are choked off or swollen, even identifying microscopic damage earlier than can be detected by direct examination by the doctor. There are techniques that help identify risk factors to help predict the risk of worsening damage. Other techniques are used to follow progression of the damage over time. Some centers use artificial intelligence to diagnose swelling inside the eyes. Still other techniques help direct which treatments might be of most help in stopping or reversing the damage already done.
Most often, the damage done by diabetes is found to be mild enough that no treatment is indicated — other than strict control of diet and nutrition, exercise and weight, blood pressure and blood sugar control.
When significant eye damage is found, or when progression to damage appears likely, there are two main forms of treatment used at this time, both done in the doctor’s office. The first type of treatment involves using a special type of laser to treat the retina. The second form of treatment involves injecting special medication into the eye. Both types of treatment are done under strict guidelines that have been laid out through years of fine-tuned testing. The purpose of both types of treatment is to prevent, reduce or even reverse the damage caused to the eye. On occasion, actual surgery in the hospital becomes necessary. These techniques are employed by medical doctors who are sub-specialists within the field of ophthalmology.
Even though detection and treatment of diabetic damage in eyes has greatly improved in the past several decades, vision loss from diabetes remains a real threat. Diabetes is one of the leading causes of blindness in the country. As the prevalence of diabetes continues to increase rapidly in the U.S. as well as worldwide, better detection and better treatments are needed. More than one in 10 Americans has diabetes. Hopefully, a time is coming when no one’s grandma goes blind from diabetes.
Michael Craig, M.D., Ophthalmologist, Advanced Vision Care, Inc., Lima.