What does the diagnosis of Diabetes or Diabetic Retinapothy mean exactly? I’ve heard there are different types?
Diabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, causing elevated levels of glucose in the blood and urine. There are two main types of diabetes, Type 1 and Type2. Type 1 diabetes is when the pancreas lacks the cells which produce insulin. Type 2 is when the pancreas produces an insufficient amount of insulin because the cells of the body don’t use insulin the right way. Type 2 diabetes is more common and often develops later in life.
Diabetic retinopathy occurs typically later in the disease, or in patients who have uncontrolled blood sugar. The longer a person has uncontrolled and even controlled diabetes, the higher his or her chance of developing diabetic retinopathy. With Diabetes the patient’s blood vessels in the retina (the screen in the back of the eye that translates light information and sends it to the brain) can swell, leak fluid, or bleed which often leads to vision changes or blindness.
In what way(s) does a diabetic eye exam differ from a regular eye exam?
The only way to diagnose diabetic retinopathy is to have an eye examination with dilation and/or Optomap imaging, which is typically a part of your annual comprehensive eye examination. The Optomap technology in our office allows us to document more easily the extent of the retinopathy and enables us to follow the progression of the disease. However, once there is a diagnosis of diabetic retinopathy there is a secondary test that will be run called an OCT (optical coherence tomography) so the Dr’s can determine who can benefit from treatment, and identifies what treatment is indicated.
I understand that Diabetes are common among those over 40 or with weight issues. What causes it? Are there other groups that are at a higher risk?
Type 2 diabetes is typically the adult onset form in patients with obesity and lack of exercise, some patients are genetically at risk than others. Obesity (body mass index exceeding 30mg) is a common factor because fat affects the body’s cells ability to regulate and control blood sugar levels which leads to insulin resistance, a precursor of type 2 diabetes. The patient that is at high risk for developing Type 2 diabetes is obese, not physically active more than 3 days a week, is 45 years or older, have a parent or sibling with Type 2 diabetes, female who had gestational diabetes, African American, Hispanic/Latino American, and American Indian or Alaska native.Type 1 diabetes occur in patients with a family history of the disease and it typically develops earlier in life- but can occur at any age.
Please describe the typical progression for an individual with Diabetes regarding their eyesight?
Progression varies between patients with diabetes. Some patients do not develop the sight threatening pathologies, other patients will experience symptoms of progressive diabetic retinopathy such as gradual, progressive blurring of vision; sudden severe vision loss; floaters; or fluctuating vision.
What happens during a typical Diabetic Eye Exam at Our Brookfield Optometry Practice?
Diabetics should have their first comprehensive eye exam at your local Brookfield eye care clinic after being diagnosed within 2 years of the diagnoses. The earliest signs of diabetic retinopathy are not always symptomatic for the patient, however can be detected through a comprehensive eye exam. Early detection of diabetic retinopathy is very important. During the examination the Dr. will evaluate the different parts of the eye for problems that develop commonly in people with diabetes such as prescription changes, cataracts, glaucoma, and diabetic retinopathy. During the visit additional testing may be ordered and performed as needed. The Dr. will talk to you about possible life style changes that need to be made, like the importance of controlling blood sugars through diet and exercise.
What treatment options and/or care is available for this condition?
Communication between your general practitioner, endocrinologist and optometrist is very important. The most important preventative measure for diabetes is maintaining a low body mass index (BMI), and remaining active. Diabetes is treated with oral systemic medications and/or insulin to help to control the blood sugar levels which damage the walls of the blood vessels. Diabetic retinopathy has 2 stages, early and advanced. Early stages are monitored by your eye Dr. every few months. If the retinopathy progresses into the advanced form then treatment with a laser called panretinal photocoagulation might be used to help seal off leaking blood vessels. Laser surgery can also help shrink blood vessels and prevent them from growing again. Another treatment for advanced retinopathy is an injection in to the retina called anti-VEGF (vascular endothelial growth factor) to help reduce swelling in the area of central vision, slowing vision loss and perhaps improving vision.
What are the risks and side effects associated with these treatments? What if you don’t proceed with treatment?
There are always risks to medications and surgeries. You and your Brookfield eye doctor need to decide if the risks out-weigh the benefits. If you do not follow the Dr.’s instructions on controlling your blood sugar, and don’t get the proper treatment for the retinopathy you will go blind over time.
Will a change in a patient’s diet, exercise routine, or medication help at all?
A good Diet and exercise routine alone can prevent Diabetes. Diet, exercise and medication can treat and sometimes reverse diabetes.
Can you recommend a vitamin/mineral program for me that might be helpful or are vitamin supplements specific to each patient?
They are currently working on a supplement for diabetics to strengthen the walls of the blood vessels to prevent bleeding, and prevent new blood vessels from growing. At Brookfield Vision Care we recommend to our patients a whole food alternative called Juice plus. Juice plus provides the health benefits of the antioxidants, phytochemicals, food enzymes, vitamins and minerals from up to 30 different fruits and vegetables. Diabetics are typically reduced to 2-3 fruits a day due to the sugar in them. Juice plus capsules have no sugar, starch or salt. Go to: Schramm.juiceplus.com to learn more on how juice plus can benefit diabetics.