Eye disease is common for those with diabetes. Regular exams can … – Houston Chronicle

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The learning curve was steep when Ofelia Alvarez was first diagnosed with diabetes in her 30s. 
She had watched family members struggling with the condition. “But I really didn’t know exactly what I had to do, until I actually had it myself,” she said. “And it’s still a learning process.”
Early on, she learned the importance of regular eye exams.
Now 61, the Bay City resident goes to two eye doctors — an ophthalmologist and a retinologist — in Sugar Land two or three times a year. She also heads to their practices immediately if she notices a change in vision or pain in her eye.
“They take me in right away, because they know how serious it is,” she said. 
When Alvarez first started going to the ophthalmologist, she noticed her vision was blurry, and she saw floaters every once and a while. 
“But I didn’t think much of it,” she said. 
About six years ago, however, both of her retinas detached. She described her sight almost like double vision, seeing one angle and then another. 
For more information about diabetic eye disease, visit the American Society of Retina Specialists asrs.org. 
“I woke up, and it was like a camera trick,” she said. 
Alvarez underwent an operation for the two detached retinas — and, at first, normal vision returned to both eyes. Then, slowly, the right eye stopped working. 
“It was like a lens closing up on you,” Alvarez said. “I ended up losing sight.”
Now her right eye wanders, does not open all the way and is starting to turn white. Her vision loss prevents her from driving. 
“It’s the worst thing,” Alvarez said. “I really recommend that people take your eyes seriously. They don’t realize how much their lives will change when they don’t have eyesight anymore.” 
She hopes other diabetes patients will learn from her experience and understand the role of regular eye exams when it comes to preventing vision loss.
“Once you lose it, you can’t get it back,” she said. 
Diabetes is the No. 1 cause of blindness among working-age adults, according to the Centers for Disease Control and Prevention. 
Dr. Christina Weng, professor of ophthalmology at Baylor College of Medicine, explained that diabetic eye disease is unlike other retinal diseases because it often affects people in “the prime of their lives, when they’re still working and raising families.” 
“It’s a shame that there are still many people who aren’t aware of it, because the associated vision loss is largely preventable,” she said. “No one should go blind due to diabetes in this day and age.”
More than half of the individuals diagnosed will be affected by diabetic eye disease in their lifetime. 
There are different types of diabetic eye disease. For instance, diabetic macular edema is the result of damage from the blood vessels in the retina, caused by high blood sugar. 
“The vessels lose their integrity, and they start leaking,” Weng said. 
The leak affects the central part of the retina, or macula, she added, which results in blurry vision. 
“The retina is basically like the film of a camera,” Weng said. “If there is distortion of the tissues, patients will start noticing that they can’t see as well.” 
In the past two decades, she said, an effective treatment has been developed called anti‐vascular endothelial growth factor, or anti-VEGF.  “Anti-VEGF injections basically help seal vessels up,” Weng said. 
Other options include steroids and laser treatment.
An optical coherence tomography scan is used to diagnose diabetic macular edema. 
Another form of diabetic eye disease is proliferative diabetic retinopathy, which results when new blood vessels grow on the surface of the retina. 
The vessels are essentially in the wrong location — and are often weak and prone to bleeding when left untreated. The retina can be pulled off the wall of the eye, requiring surgery. 
“It is the most advanced diabetic eye disease,” Weng said. “And it’s something that does affect a lot of patients, especially if they have not had routine monitoring of their eyes.”
The condition starts as nonproliferative diabetic retinopathy, or a more mild or moderate form, before advancing to proliferative diabetic retinopathy. 
“That’s why we recommend at least an annual dilated eye examination for every single patient with diabetes,” Weng said. 
When detected early, nonproliferative diabetic retinopathy can be controlled or even reversed by controlling blood sugar, maintaining a healthy weight and not smoking. Weng said that patients who have NPDR often have no symptoms.
“But that can almost be a negative, because it can mislead the patient into thinking they are fine and skip screening exams,” she said. “They may have severe NPDR and not know it.”
Proliferative diabetic retinopathy can be addressed through anti-VEGF injections or laser treatment. Surgery is reserved for the most advanced forms of the disease, Weng explained. 
“The best treatment is prevention,” she said. “Routine screening is so, so important. Keep your eyes healthy and your good vision for life.”
In Alvarez’s case, diabetic retinopathy will continue to require close monitoring. Her endocrinologist, Dr. Shreya Parikh with Memorial Hermann in Sugar Land, said that vision loss is only one of the organ failures her patient faces. 
“Diabetes is kind of a silent illness up until it causes problems,” she said. “And diabetes isn’t like having a cold. It’s a chronic illness.”
That means a team of specialists is often required to manage and address health concerns. Kidney damage, vision loss, heart disease, nerve damage and problems with the feet can be common for diabetic patients. 
“You have to watch your diabetes and be proactive,” Parikh said. 
And each patient is different, she said. For instance, Type 2 diabetes patients often respond more to improved diet and exercise, while Alvarez has Type 1 diabetes, which can be more difficult to manage.
“Even though Ofelia is doing what she needs to, her sugars have a mind of their own,” Parikh said. 
The endocrinologist often tells patients, “Your diabetes will be predictably unpredictable. But we try to eliminate guesswork.” 
New technology, like insulin pumps with LED displays and touchscreens, have helped Alvarez. 
Parikh urges that patients maintain regular visits with specialists, like the eye doctor, podiatrist and kidney specialist. 
“We want to take control of your diabetes — and not let it take control of you,” Parikh said. “Know what’s happening with your diabetes, instead of reacting to it.”
Lindsay Peyton is a freelance writer.
 
 
Lindsay Peyton is ReNew Houston’s Transformation columnist.
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