A reality of diabetes, but one seldom associated with the chronic disease is vision loss — despite it usually being permanent and irreversible.
Many with diabetes seem more alarmed at the prospect of losing a foot or leg to amputation. However, eyesight problems are tell-tale signs the disease is already ravaging vital parts of the body, say Harris Health System experts from Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth).
Through a robust diabetic retinopathy screening program that in 2013 introduced photographic technology, Harris Health has a better than 90-percent annual screening rate for all patients with diabetes. The national benchmark is 63 percent. This is important because early detection and effective treatment can prevent or improve vision loss in more than 90 percent of cases.
More than 160,000 patients have been screened at Harris Health using Intelligent Retinal Imaging Systems (IRIS), an innovative tele-retina tool that looks for diabetic retinopathy — the leading cause of preventable blindness among working-age adults in the United States. The technology also has identified patients with other potential eye diseases in various stages such as cataracts, glaucoma, macular degeneration and retinal vessel occlusion.
“We’re taking a picture of the back of the eye, so we’re finding other eye conditions that need to be addressed,” says Dr. Yvonne Chu, chief, Ophthalmology, Ben Taub Hospital and Harris Health’s Ambulatory Care Services, and professor, Ophthalmology, Baylor College of Medicine. “These screenings are sort of like a canary in the mine shaft. If we identify problems with eyesight early on, we’re putting individuals on notice that, ‘Hey, you have to start taking better care of yourself or else you’re going to have some serious complications.’”
Diabetic retinopathy is caused by changes in the blood vessels of the retina. The longer someone has diabetes, the greater likelihood of getting retinopathy or other vision problems.
“A lot of eye problems tend to be associated with older people, but diabetes and its effects on the eyes is a young working person’s disease,” says Dr. Eric Crowell, chief, Ophthalmology, Lyndon B. Johnson Hospital and clinical assistant professor, Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at UTHealth. “Diabetes is creeping into younger populations. It’s taking people out of the workforce because they can’t see, and it’s taking family members out of the workforce who have to take care of their blind loved ones.”
Diabetic retinopathy can develop without symptoms in the early stages. It’s more successfully treated with early detection, but once retinal damage is in place, few viable treatments exist.
“People think ‘Oh well, the doctor will fix it’ and that’s not always true because vision loss from diabetic retinopathy may not be reversible,” Chu stresses. “Too many times, we’re not able to reverse the damage that’s done. We might be able to preserve the vision that they have, but for those with advanced disease, we sometimes can’t do anything to recover lost vision.”
Patients with diabetic macular edema — swelling in the retina — can face potential long-term treatments of eye injections administered once every 4-6 weeks to maintain vision and keep vision loss at bay.
“You either go blind or you die before we stop these treatments,” Chu has candidly told patients. “Some of them say they didn’t know diabetes could affect vision or lead to blindness.”
Crowell says the eye screenings also have given healthcare staff another opportunity to remind patients about the importance of controlling blood sugar levels and blood pressure, eating healthy and following the primary care physician and healthcare team’s recommendations.
Chu and Crowell say “time and control” drive the prevention of diabetic complications.
“The better you control diabetes, the longer it takes for you to have these (eye or other) complications,” Chu says. “The worse control you have of it, the shorter it takes to see complications. It’s just how quick and how fast you are burning off your candle wick.”
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