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Tag: diabetic retinopathy

  • Protect Your Eyesight

    Protect Your Eyesight

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    By Sunir Garg, MD, as told to Hallie Levine

    Diabetic retinopathy, a type of diabetic eye disease, is one of the leading causes of blindness in the United States. Despite this, almost 40% of people with diabetes don’t get an annual eye exam. But these screening tests are key, since they can prevent vision loss by catching diabetic retinopathy in the early, more treatable stages of disease.

    Diabetic retinopathy can cause permanent vision loss.

    Many people are surprised to learn that diabetic retinopathy is the most common cause of vision loss for people with diabetes. Here’s a quick primer.

    Diabetes is a disease that affects the small blood vessels throughout the body, including the delicate blood vessels in the back of your eye. These blood vessels are just like pipes: When they become damaged, they weaken and start to leak. Over time, these tiny blood vessels drip blood and plasma onto your retina. This causes retinal tissue to swell, which leads to cloudy or blurred vision. This also causes damage that results in less oxygen and other nutrients getting to your retina.

    Sometimes, your body tries to correct the problem by making new blood vessels. But these blood vessels are fragile and can burst and bleed, or form scar tissue that pulls your retina off of your eye wall. All of these scenarios may ultimately lead to blindness.

    You can have diabetic retinopathy and not know it.

    The condition often has no symptoms in its early stages, which is why an annual eye exam is so important. As it worsens, you may notice symptoms like:

    • Blurry vision
    • Vision that changes from blurry to clear
    • Blank or dark areas in your field of vision
    • Floaters, or dark spots in your vision
    • Poor night vision
    • Colors appear faded

    Unfortunately, patients often don’t see an eye specialist until they experience symptoms such as floaters or blurry vision, and by then damage has been done.

    There’s a lot you can do to treat diabetic retinopathy.

    When we notice signs of diabetic retinopathy during a patient’s routine eye exam, they’re often very frightened. They worry that they will lose their vision. But most of the time, their disease is mild. We explain that the best way to stop vision loss is to make sure their blood sugar and blood pressure are both under good control. They need to watch their diet carefully and take all their medications as prescribed. Oftentimes, we show patients a picture of their eyeball so they can see the damage their diabetes has done. That’s usually enough to help them understand why blood sugar and blood pressure control are so critical to help their overall well-being.

    But if your disease is more advanced, don’t panic. The first step is a class of drugs known as anti-VEGFs. These medications help reduce eye swelling, which can slow down vision loss and even improve vision. It’s given as a shot, injected into your eye at your eye specialist’s office. Laser surgery can also help seal off leaking blood vessels, shrink abnormal blood vessels, and reduce retinal swelling. If you have a very advanced case, you may need a type of eye surgery known as a vitrectomy. An eye surgeon will remove blood and plasma from your eye and remove scar tissue from your retina. This will also help you to see more clearly again.

    Regular eye exams are key.

    People with diabetes need to have a routine eye exam every year by an eye doctor (either an ophthalmologist or an optometrist). This is true even if you otherwise have 20/20 vision. Your doctor will give you some eye drops to dilate, or widen, your pupils so that they can look inside your eyes to check them for diabetic retinopathy and other eye problems.

    If you’ve just been diagnosed with diabetes, you need an eye exam right away to make sure your eyes are OK. After that, you should have an eye exam every year — more frequently if you have diabetes-related eye problems such as diabetic retinopathy.

    There are also other times in your life when you may need a full eye exam. Women with diabetes who are pregnant, for example, need an eye exam during every trimester, since changes in blood pressure and fluid retention may cause their diabetes to worsen.

    Interestingly enough, you also need to get your eyes checked once you get your diabetes under good control. For some reason, that shift can cause some worsening of diabetic eye disease in certain patients. We don’t know why, other than your body has gotten used to things being a hot mess and your eyes don’t know how to cope with this sudden change.

    The good news is that most patients with diabetes who get regular eye exams who do go on to develop diabetic retinopathy end up doing very well. When we monitor them appropriately and treat problems when they creep up, we can keep the vast majority of patients seeing quite well for years, sometimes even an entire lifetime. But both the doctor and the patient must work together to make that happen.

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  • Facing Vision Problems Head-On

    Facing Vision Problems Head-On

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    By Chelcie Rice, as told to Hallie Levine

    I learned I had diabetic retinopathy in 2004. Unfortunately, my diagnosis came a little too late, and I lost most of the vision in my right eye. Today, when I do advocacy work, I stress how important it is to stay up to date on your eye exams. It could save your sight, literally. Here’s what I want others with diabetic retinopathy to know.

    Don’t blame yourself.

    When I was diagnosed, I had a lot of self-loathing. I’d noticed symptoms months earlier, when I bent over to pick something up and noticed black jellyfish-like streaks that drizzled down my left eye. I went to a local eyeglass shop for an eye exam from an optometrist, who told me I needed to see a retina specialist.

    Unfortunately, I didn’t have health insurance at the time, so I put it off. Eventually, my symptoms got so bad that I had no choice. I needed a vitrectomy, which is a surgical procedure where the surgeon makes a tiny incision in your eye to drain blood from the middle of the eye and remove scar tissue that tugs on the retina. A year later, I had to have the same procedure done on my right eye, but it was too late. My retina completely detached, and I lost most of my vision.

    I blamed myself, which seems ridiculous now. It wasn’t my fault that I couldn’t afford to pay for my medical care. But for those first few years after my eye surgeries, I lived in the fear of it happening again. If I lost the vision in my left eye, I’d be pretty much left blind. That stress is almost impossible to carry. You can’t live your life on pins and needles. I had to learn to push forward. One of the ways I did that was to begin taking my diabetes more seriously than I had in years past. I knew that if I got my blood sugars under better control, I would have less risk of other health complications, including loss of vision. 

    You can still live your life.

    Thankfully, I can continue to do most day-to-day activities, with some modifications. While I can no longer read with my right eye, my vision is still good enough that I can drive and go to my day job at a credit union. My left eye is 20/20, but my right eye only has about 10% of its vision. That means when I look at something on my right, it’s very blurry, so much so that it’s like looking through a distorted mirror. There are also large patches of dark spots. I try not to put myself in positions where I have to drive at night, and when I do, I practice the route over and over during daylight hours so I know exactly where I’m going.

    It took me a while to wrap my head around the fact that I have a disability and as such, am entitled to certain work-related accommodations through the Americans with Disabilities Act. I’ve been up-front with employers about my vision, and my current job has provided a great deal of modifications — for example, a large monitor for my computer so I can magnify my work.

    A few months ago, I had a corneal erosion on my left eye. This is when the layer of cells on the surface of your cornea loosens. It’s very painful and can make your vision very blurry. My symptoms were always worse in the morning, so I couldn’t work for a few hours. But since it was related to my diabetes, I just filled out certain forms for my employer and it wasn’t counted against me. Don’t be afraid to ask for these accommodations. It’s your legal right to have them.

    It helps to be open.

    I’m a comedian, and for a long time I grappled with how much to tell my audience about both my diabetes and my diabetic retinopathy.  But a few years ago, I watched another comedian who lives with cancer open up about his disease on stage. He told me later that it was my responsibility to talk about my diabetes and my vision because you never know whom you’ll reach. He’s right. After my shows, people will come up to me and tell me their personal stories as well.

    It helps smooth over some awkward moments too. Like the time in the middle of my act I walked too close to the edge of the stage and almost fell off.  It was only about an 8-inch drop, but when you’re almost blind in one eye, that’s really scary! I also always try to work some sort of diabetes joke into my act. I’ve even joked about my retina surgeries. It’s a way to educate people about diabetic retinopathy without them even realizing it.

    Get that annual eye exam!

    When you have diabetes, you have got to stay on top of all your medical care. You see your endocrinologist every 3 months, your dentist at least twice a year, and foot and eye specialists at least once a year. Otherwise, little problems can become big ones, fast.

    You also need to pay close attention to what’s going on with your eyes. People with diabetic retinopathy often see dark spots, or floaters, in their field of vision. I know all of my floaters well. But if I see something new, I pay close attention. If it doesn’t leave after a couple of days, I see my eye doctor. After two surgery scares, I’m not going to take any more chances.  

    And remember, if you ever feel the need to beat yourself up about your vision, remind yourself: you didn’t do this, diabetes did. Every morning, I wake up, get out of bed, give myself time for my vision to clear, and take on another day. That’s all we as people with diabetes can do. We need to meet all our challenges head-on and commit to staying heathy.

    Stay aware of your body — including changes with your vision — and then go out and live your best life. I’m still tossing around the idea of riding a motorcycle, for example. I’ve seen people with eye patches ride them, so why not? I might not be able to ride across the country on a Harley, but I can at least take a spin around town. Anything’s possible. Don’t let your diabetic retinopathy hold you back.

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