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What is Diabetes?
Diabetes can affect nearly every system in the body and the eyes are no exception. Annual dilated eye exams are a key component of comprehensive multi-disciplinary diabetic care.
Blood sugar fluctuations can cause an influx of fluid into the crystalline lens of the eye. When this occurs, often the eye becomes more myopic, or nearsighted. This can manifest as a transient shift in the prescription found on exam. These changes usually self-resolve over the course of days or weeks once blood sugar levels return to normal but should be recognized as a warning that blood sugar levels are in flux, and generally high.
Diabetic retinopathy is used to describe a variety of retinal findings that result from either the leaking of blood or fluid from vessels damaged by elevated blood sugar levels, or ischemia from the same. This can manifest in the form of small hemorrhages, different forms of edema, or in more severe cases, new blood vessel growth. In addition to the risks to vision associated with these findings, diabetic retinopathy can be an indication that other organ systems are under increased stress from diabetes. The eye is the only place in the body that blood vessels and nerves are visible by noninvasive examination. The eye is also considered a diabetic “end organ.” Damage in the retina could signal concerns in the heart and kidneys, among other organ systems and may be the first sign of a need for improved control of blood sugar and blood pressure. This information is helpful for primary care providers in the management of systemic health and medications.
Diabetic macular edema is the leaking of fluid from blood vessels that occurs in the macula and can have significant effects on vision. This complication can occur with or without other retinopathy. Typically this does not result from leaking from new blood vessels but weakened vessels. When new blood vessels do grow, they can fibrose or scar and result in a tractional retinal detachment.
Generally, annual eye exams are used to monitor for changes related to diabetes. However, if concerns arise follow up can be done more frequently. In cases of severe diabetic retinopathy, especially with macular edema or new blood vessel growth, a referral is made to a retina specialist who will evaluate and potentially treat with injectable medications, similar to wet macular degeneration management.
Blood sugar levels and stability are a major contributing factor to the presence of diabetic retinopathy. In addition, the duration of disease plays a large role in the odds of seeing these complications. Good control over blood sugar and blood pressure can limit the lifetime risk of losing vision from diabetic complications. Maintaining regular care with the physician treating diabetes, as well as annual dilated eye exams can help identify and mitigate the risks for vision and health complications resulting from uncontrolled or poorly controlled diabetes.
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