Q: I have been diabetic for many years and take my medications faithfully. My new eye doctor wants to see me every three months now, but that seems like too much to me. Why would he advise eye check ups so often?
A: In West Virginia, about 1 in 5 people have diabetes, so yours is a common issue for many folks. As you may know, diabetes is what we call a “vascular disease”, causing many problems with blood vessels throughout your body. Our eyes give a unique opportunity to actually see and examine blood vessels in their natural state. By looking inside your eyes, we can evaluate blood vessels in your eyes, and logically assume that any changes there may be happening in other organs in your body.
In fact, for many people the first indications of diabetes are found during a “regular” eye examination! Unfortunately, like many eye problems, diabetic effects often give little or no symptoms. For many patients, a change in vision is the first or only sign of a problem developing. And for many patients, even though your vision seems ok, trouble in the back of the eyes can be developing.
Fortunately, we have very good tools to examine for these changes. Diabetic eye exams may include pupil dilation. This means we instill eye drops to enlarge, or open up, the pupils….giving us a bigger better view inside your eyes. Sometimes, we can get the exam view we need using a special eye camera called Optos to give the view we need without dilation eye drops. The frequency we recommend for this evaluation depends on what we see.
Early changes of concern can be subtle blood vessel changes in the retina or the iris of your eyes. Sometimes we will discover tiny areas of blood vessel leakage in the eye. This could leakage of serum or actual blood in retina. And of greater concern, we may find new, but abnormal, blood vessels growing inside the eye. This is called “neovascularization” and requires more aggressive exams and treatment.
In general, keeping your A1C level as low as possible is the main goal to preventing diabetic eye disease, called diabetic retinopathy. Be sure you are getting your A1C check in blood tests, and know your number. Because diabetic retinopathy is a actually a systemic disease, and not really caused inside your eyes, treatments involve general health treatments, not eye medicines alone. Eye treatments may be required, often by a retina specialist your eye doctor would refer you to see. They may use laser treatments or more commonly eye medication injections to slow or stop the diabetic progression.
Because diabetic damage can be permanent and irreversible, you are better to follow your eye doctor’s guidelines for exams regardless of how your vision seems. Prevention and early detection/treatment are essential to preserving your clear eyesight for your whole life.