Diabetes is being diagnosed in unprecedented numbers across all ages and races. This increased incidence means a corresponding increase in health complications related to the disease, including sight-robbing “diabetic retinopathy”—now the leading cause of blindness in Americans. And, if you are black, you have a three times greater risk of losing vision to diabetes than a white person.
“Of the nearly 26 million Americans diagnosed with diabetes, up to 45% have some degree of diabetic retinopathy (damage to the sensitive retina in the back of the eye), which can lead to vision loss and blindness,” reports Dr. Norman Cohen, an eye surgeon who has treated thousands of diabetic patients since 1975. “For some people, when a routine vision check-up uncovers signs of retinopathy, it is their first clue that they even have diabetes.”
How diabetes affects vision With diabetes, high blood sugar levels can weaken blood vessels in the eye, causing them to leak. This causes the retina to swell and form deposits that can lead to vision loss. Blood sugar fluctuations can also promote the growth of new, fragile blood vessels on the retina, which can sometimes leak blood into the vitreous (the clear, jelly-like substance that fills the eyeball). This retinal blood vessel damage, or retinopathy, can blur vision and lead to permanent sight impairment.
Who is most at risk?
“Diabetic eye disease can appear as early as a year after the onset of diabetes. All diabetics—Type 1, Type 2, insulin-dependent or not—are at risk. And, risk increases with the number of years you have diabetes. For example, patients with diabetes for less than five years have about a 15% incidence of retinopathy. This skyrockets, however, to 80% in people who are diabetic for 15+ years” explains Dr. Robert Sucher, co-founder of Eye Care Specialists. He adds, “Because African-Americans have a higher incidence of diabetes, they are also at higher risk of blindness from diabetic eye disease.”
What are the symptoms?
Usually, none. In fact, many people don’t notice a problem until the retinopathy is so far advanced that lost vision can’t be restored. That’s why annual dilated eye exams are crucial. You should also call your doctor immediately if you notice vision changes in one or both eyes (not associated with fluctuations in blood sugar), numerous floating spots (like spider webs), or a veil over your vision.
How is retinopathy detected?
Eye care specialist Dr. Daniel Ferguson notes, “It is vital for people with diabetes to understand that significant retinopathy may be present and progressing even if their vision appears to be good. And, because fluctuations in blood sugar levels can temporarily affect vision, it’s sometimes hard to know if a serious eye problem is developing.” Diabetes-related eye damage can only be diagnosed through a comprehensive eye examination. Pupil dilation (enlargement with drops) is necessary to best check the back of the eye for early signs of retinopathy, such as microaneurysms (tiny blister-like outcroppings on retinal blood vessels that can bulge and leak), before noticeable vision loss occurs.
Prevention and Treatment
“Diabetes-related sight loss is often preventable with yearly exams and early intervention. But all of our expertise, lasers and treatments are of no use if patients don’t come in for regular eye check-ups,” comments Dr. David Scheidt, optometrist and 16-year member of the Wisconsin Diabetes Advisory Group. “Although not all diabetics can have or need it, laser treatment is extremely effective in reducing the incidence of severe vision loss—in some cases by at least 50%—especially if started early enough,” says Dr. Mark Freedman, a leading area eye surgeon and lecturer on diabetic eye disease.
“We have also been very pleased with the success of new medications that can be painlessly injected directly into the eye to stave off progression of the disease. We typically use Avastin because it is both cost-effective and works to inhibit the growth of the abnormal blood vessels related to diabetic retinopathy.” Dr. Brett Rhode, an ophthalmologist who has conducted continuing education programs for area diabetes coordinators, adds, “We have seen some amazing results with Avastin, including not only stabilization of vision, but in some cases, improvement in sight. However, we must evaluate each patient’s response individually to determine if and when (often every 6-12 weeks) they should receive injections.”
FREE Booklets & Information
Eye Care Specialists’ doctors are dedicated to the diagnosis and treatment of cataracts, glaucoma, diabetic eye disease, and macular degeneration. They frequently lecture to the public and fellow physicians and have written their own series of booklets on these conditions. Call 414- 321-7035 for FREE copies or to schedule an appointment for a thorough eye screening (usually covered by insurance or Medicare) at their offices on 7th & Wisconsin Avenue, Mayfair Road across from the mall, or 102nd & National. They also offer information at www.eyecarespecialists.net.
Tips for Protecting Against Diabetes-Related Vision Loss
- Have a blood sugar test every three years after age 45 to screen for diabetes
- Keep blood glucose levels close to normal through diet, medication and exercise
- Keep blood pressure under control
- Don’t smoke
- Keep cholesterol levels low
- Check hemoglobin A1c levels at least every four months and aim for less than 7.0
- Schedule dilated eye exams once a year, or as often as your Eye M.D. suggests
Diabetic patient “maintains” good vision & lifestyle
If you had to come up with a theme for David Kogelmann’s life so far it could be summed up in one word: “maintenance.” Kogelmann, 63, is a retired heavy duty maintenance mechanic who rebuilt printing presses for Quad Graphics for 20 years. He is also an auto show buff who meticulously maintains a 1967 Pontiac Firebird and an avid sharpshooter who maintains precision firearms. More recently, however, Kogelmann’s focus has broadened to maintaining something even more precious—his vision.
Diagnosed with diabetes in 1995, Kogelmann was diligent in sustaining proper blood sugars levels. His primary care doctor, however, reminded him of the importance of having his eyes checked for any diabetes-related changes to the retina that can go unnoticed at first. As an expert marksman and long-time member of the Schultz Rod & Gun Club on Big Muskego Lake, Kogel-mann knew the importance of finding an eye care specialist who shared his exacting attitude. His research led him to an appointment with Dr. Daniel Ferguson, a highly regarded ophthalmologist who also holds a degree and several patents in engineering.
“Because of Mr. Kogelmann’s vigilance in maintaining proper blood sugar levels, he was fortunate enough to still be enjoying good vision in both eyes when he first came to us,” notes Ferguson, a partner at Eye Care Specialists who sees patients at offices in Wauwatosa, West Allis, and downtown Milwaukee. “As happens, for most diabetics, however, the longer you have the disease, the more likely it is to take its toll, and by 2010, Mr. Kogelmann’s vision began to slip a little.” As a result, Ferguson recommended Avastin injection treatment to stave off further diabetes-related damage to Kogelmann’s retina.
“At first, I thought, ‘you’re going to stick a what in my eye’?” Kogelmann exclaims with a laugh. “But, the treatment really wasn’t bad at all. I’ve had cataract surgery too and that was so easy—no pain, just great!” In fact, with regular appointments and Avastin treatments, Kogelmann sports vision good enough to keep up with his hobbies. He proudly reports, “I’ve been doing more sharp-shooting than ever. When you go to the club, you always have to have two people on the range. I have people calling me all the time to shoot with them.” Kogelmann also enjoys spending time up north at his cabin and 120 acres of land in Ladysmith, WI. “I don’t hunt much anymore,” he states, “but I cook for my son and the guys up there. . . . They call me ‘Pot Banger’ because I do all the cooking, and I wake them up by banging my pots!”
Kogelmann also has a wake-up call for fellow diabetics to preserve their vision: “See an ophthalmologist regularly and keep your blood sugar under control!”