It’s been known since people started going to doctors to treat diabetes that loss of eyesight is a considerable risk. In fact, it’s the complication that most people, even those who don’t know much about diabetes, associate with having the disease.
This time last year, we published an article on the importance of regular visits to the eye doctor to check for signs of diabetic retinopathy, which can affect all people who have diabetes, regardless of the origin. The classical medical definition of retinopathy refers to development and worsening of tiny aneurysms in the blood vessels serving the retina, and to the accompanying deterioration of light- and image-sensing tissue of the eye.
What’s common to people who have T1D or T2D is the damage that elevated glucose can, over time, cause to the blood vessels serving the retina, and to nerve tissue. Before we went ahead in our July 2016 article with pointers for getting ready for an ophthalmic exam we described the two categories of retinal disease that people with diabetes can experience, especially as they age. While retinopathy is irreversible, its progress can be halted with proper attention to glycemic control.
About the ADA’s Standards of Care
The 2017 edition of the American Diabetes Association’s Standards of Care presents its eye disease prevention and treatment recommendations in the chapter on microvascular complications (Section 10, if you’ve seen our July 17 article on the Standards and gone to the ADA site to download the publication). The recommendations applicable to people with T2D include:
- An initial, comprehensive eye exam, including the dilated pupil exam, at time of diagnosis;
- If there’s no evidence of retinopathy for one or more annual exams and if glycemia is well-controlled [we’ve added this emphasis], then exams every two years may be considered;
- But, if any level of diabetic retinopathy turns up, dilated pupil exams need to be done annually, and;
- If the condition appears to be progressing or threatening eyesight, more frequently.
Glucose levels tend upward during pregnancy. So, for women who have diabetes and are pregnant, or may become pregnant, the Standards recommend that their OB-GYN or family doctor counsel them about the risk that retinopathy can develop or progress during pregnancy. According to ADA, eye exams for pregnant women with pre-existing diabetes should be done within the first trimester of pregnancy, and depending upon the degree of retinopathy, if it’s discovered, in each subsequent trimester, and once again during the postpartum year. Gestational diabetes can come on in women who have no history of diabetes or who’ve shown no signs of pre-diabetes, but that doesn’t mean that eye care becomes less important after pregnancy: women who develop gestational diabetes have an elevated risk of developing T2D, or even MODY (mature onset diabetes of youth) later on in life.
About Your Eye Exam
You already know that your chief defense against diabetic retinopathy, and your chief strategy for slowing its progression if it has come on, is controlling spikes in blood glucose and keeping your HBA1c at your target number. Because you’re diligent about protecting yourself against diabetic eye disease, you know that at your visit, your eye doctor, the technician, or the nurse will want to know how your blood sugar levels are doing, and will probably ask about the medications you’re taking. If you track your daily fasting glucose readings with your meter or CGM, you’ll have that record handy when you show up at the office, as well as your list of meds and dosages – and not just your diabetes meds – so you’ll be prepared to easily update your medical history form.
When I went to my appointment this year, we started off, just as last year, with a vision test. That resulted in a new eyeglass prescription, a tiny bit different from last year’s, which I hadn’t filled anyway because I thought I could still see well enough with my old specs. Then there were eye drops to ready me for a test for glaucoma — abnormal pressure within the eyeball — for which I rested my chin as the technician brought a blue bulb-like sensor to each eyeball. Then came the drops to dilate my pupils, and a wait for a few minutes as the drops worked, for photographs of the retinas to compare to the previous year’s, and this year a scan with a new piece of equipment.
This was a high-definition imaging machine that my eye doctor had put in since my last time in the office, so there would be one more chin rest after the digital pictures inside my eyes that I was used to having. For this new test, I looked into a machine at a tiny flashing red dot, with one eye and then the other, for what would become about a dozen images resembling weather radar screenshots when my doctor showed them to me. He explained that with the new gear, he’s able to pinpoint areas behind retina, inside the eyeball at various depths, and on the cornea where problems may be lurking. I got the impression that it worked a little like sonar without the pinging and a little like a MRI machine without all the noise and claustrophobia. The result was that I was showing subtle signs of a wrinkle in the retina, and a developing cataract, the results of age but not diabetes, and nothing to worry about for a year, probably.
I hadn’t been able to enlist anyone to come along to give me a lift home, and I was taking the day off because I had a late morning appointment, and so to burn up an hour or so as the dilating drops wore off I browsed through the selections at the frame shop in the office, then went for some lunch at the cafe down the hall. This year, though, I did not mistake the onion dip for the creamy potato salad. Instead I grabbed a blueberry yogurt smoothie and a banana, both easily in focus, and probably better for me.
It turned out to be a cloudy afternoon, and with my sunglass clip-ons I could easily make out the lettering on two road signs at the far end of the parking lot, so I headed safely home under my own steam a little over two and a half hours from when I’d gotten there. It was once again painless, and informative, and a good subject for T2N to boot. All in all a success, and peace of mind for another year.
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