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Friday, January 17, 2020  Spokane, Washington  Est. May 19, 1883
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Left untreated, diabetic eye disease can rob vision

Dr. Alisa Hideg

About 10 years ago I met a young woman in her mid-20s who was blind due to retinopathy, damage to the retina at the back of her eyes caused by many years of uncontrolled diabetes. She had juvenile onset diabetes and had struggled with a lack of insurance and inability to get enough medication and care. Retinopathy is one result of uncontrolled diabetes. Retinopathy, cataracts and other eye complications from diabetes are not inevitable and do not have to result in blindness. Blood sugar control, proper preventive care and regular eye exams can reduce the risk and the damage of these complications.

When diabetic retinopathy begins, it causes small blood vessels at the back of the eye to swell and form pouches. The condition progresses from mild to severe as more blood vessels swell. If left untreated, people can eventually lose their vision.

If the capillary walls leak fluid into the macula (the part of the eye helps you focus), it swells and vision becomes distorted. An ophthalmologist can offer treatment to stop further vision distortion, and in some cases reverse vision loss.

Sometimes after several years of retinopathy, the capillaries are so damaged that they shut down. As a result, your body creates new blood vessels in your retina to provide circulation. The new blood vessels can leak and block your vision; they can also cause growth of scar tissue, which can distort the retina or cause it to detach as the scar tissue shrinks.

An ophthalmologist can treat diabetic retinopathy using medications injected into the eye, lasers or surgery. Results are best when treatment is done before there are symptoms and when your sight is still normal. This is why eye examinations every one to two years are recommended for people with diabetes.

Two other eye complications of diabetes are glaucoma and cataracts. People without diabetes can have these eye problems too, but with diabetes you are 40 percent more likely to have glaucoma and 60 percent more likely to get cataracts.

Glaucoma is an increase in pressure within your eye that slows down the normal drainage of the fluid in the eye. As the pressure from that fluid increases, the blood vessels supplying the retina and the nerve from the eye to the brain (called the optic nerve) are constricted and damaged. Vision worsens as damage increases over time. Glaucoma can be treated with medication and/or surgery to reduce the pressure. Medication is usually in the form of daily eye drops.

Cataracts cause the lenses in your eyes to become cloudy, which blocks light entering your eyes. If you have diabetes, you are more likely to get cataracts at a younger age than the general population, and it is more likely they will worsen quickly if your blood sugar is not well controlled. When cataracts are mild, people wear sunglasses when outside and have special glare-control lenses. When a cataract interferes too much with vision, the lens is removed and often replaced with an artificial lens or a donor lens. Complications of lens removal in people with diabetes can include worsening of retinopathy and development of glaucoma.

Preventing vision loss is one of the goals of diabetes care. Management of blood sugar levels, blood pressure control and regular eye examinations are needed for anyone with diabetes to keep your eyes and your body healthy.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.

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