The American Diabetes Association and the American Academy of Ophthalmology have advised that for individuals who have been diagnosed with diabetes between the ages of up to 30 years of age, the recommended time of the first eye exam is five years after the onset of the disease, and routine minimum follow-up should be continued annually.
If an individual is 31 years of age or older, the recommended time of the first eye exam is at the time of the diagnosis and then annually thereafter for routine minimum follow-up. When planning pregnancy, women with preexisting diabetes, should be counseled on the risk for development or progression of diabetic retinopathy or both (see Dr. Garrett’s article that follows). Women with diabetes who become pregnant should have a comprehensive eye exam in the first trimester and follow-up visits at three month intervals thereafter until it is decided they are stable.
Numerous studies reveal that a large portion of people with diabetes do not obtain necessary eye care. Patients may be asymptomatic despite the presence of high risk proliferative diabetic retinopathy. Because of this and the fact that early diagnosis and treatment are the most important factors in preventing permanent loss of vision due to diabetic retinopathy, a diabetic should follow their ophthalmologist’s advice is obtaining a dilated eye exam by a qualified eye doctor.
Charles Walter Garrett, III, M.D.
Dr. Garrett has been practicing ophthalmology with specialization in vitreoretinal disease in Tulsa since 1990. Dr. Garrett is Board Certified in Ophthalmology and completed a residency in Houston, Texas, where he subsequently extended this training with a two year Vitreoretinal Fellowship with one of the premiere diabetic retinopathy specialists in the country. Dr. Garrett is a Fellow of the American Academy of Ophthalmology and numerous medical organizations.
Diabetes and Your Eyes
by Charles W. Garrett, III, M.D.
Health surveys repeatedly reveal that Americans treasure their eyesight second only to life itself. Diabetic retinopathy, a complication of diabetes in which the blood vessels supplying oxygen and nutriments to the retina become damaged, is the leading cause of new cases of legal blindness among working age Americans. It is estimated that of the over 16 million people with diabetes in America, at least 300,000 of them are presently at risk of blindness, and as many as 24,000 Americans lose their vision each year to diabetes.
The risk of developing diabetic retinopathy increases with the duration of the disease. The longer a person has been diabetic, the more likely they are to develop diabetic retinopathy. After 15 or more years of having been diagnosed with diabetes, approximately 80% of noninsulin dependent diabetics and 97% of insulin dependent will have developed diabetic retinopathy.
Diabetic retinopathy is particularly likely to occur in insulin dependent diabetics who were diagnosed with this condition during their childhood or teen years. People with untreated diabetes are said to be 25 times more prone to blindness than the general population. African American, Native American, and Hispanic populations are at even higher risk of developing diabetic retinopathy.
However, with improved methods of diagnosis and treatment, only a small percentage of those who develop diabetic retinopathy experience serious problems with vision. Currently recommended treatments are 90% effective in preventing blindness in patients with the most severe type of diabetic retinopathy: proliferative retinopathy.
The causes of diabetic retinopathy are probably multiple, but this is not completely understood. It is known that diabetes damages small blood vessels in various areas of the body, and when the blood vessels supplying nutrition and oxygen to the retina are damaged, then the ability of the retina to sense light and transmit visual images to the brain is impaired. Other health factors, including pregnancy, high blood pressure, and high cholesterol levels may aggravate diabetic retinopathy.
It is important to note that one may not have any symptoms at all with significant degrees of diabetic retinopathy, although gradual blurring of vision may occur if macular edema is present. Sight is usually unaffected by background diabetic retinopathy and changes in the eyes can go unnoticed unless detected by a medical eye examination.
When bleeding occurs if proliferative diabetic retinopathy is present, the sight may become hazy, spotty, or even disappear altogether. While there is usually no pain associated with diabetic retinopathy or hemorrhaging in the eye, this more severe form of diabetic retinopathy, proliferative retinopathy, requires immediate medical attention.
A complete medical eye examination and appropriate treatment by an ophthalmologist is the best prevention against eye damage from diabetic retinopathy. Severe retinopathy can be present without symptoms and be improved with treatment. Therefore, people with diabetes should be aware of risks of developing visual problems and should have their eyes examined regularly.
It has been shown that timely laser surgery can reduce the risk of visual loss from proliferative diabetic retinopathy and from diabetic macular edema by at least 50%. Vitrectomy surgery can restore useful vision in some diabetic patients whose retinopathy is too advanced for laser surgery.