What is Diabetes?
Diabetes Mellitus is a chronic disorder characterized by lack of insulin secretion and/or increased cellular resistance to insulin in the body. Diabetes can result in complications involving the eyes, kidneys, cardiovascular system, and nervous system.
The Two Types of Diabetes
Also known as insulin dependent diabetes, accounts for 10% of all patients with diabetes in the United States. This type of diabetes results in the destruction of the islet cells in the pancreas, which is responsible for insulin production. This type of diabetes can occur at any age, but typically is more common in those under 30 years old. Symptoms of Type 1 Diabetes include: excessive hunger, excessive thirst, excessive urination, unexplained weight loss, dry mouth, leg cramps or pains, delayed healing of skin wounds, and recurrent infections of the skin, genitalia, or urinary tract.
Also known as non-insulin dependent diabetes, accounts for 90% of all diabetics in the US. Type 2 Diabetes is characterized by a resistance of body tissues to the action of insulin. It typically occurs in adults over the age of 40, but is also on the rise in children in the past few years. Most Type 2 diabetics have no symptoms, and therefore, frequently go undiagnosed for years. Risk factors for this type of diabetes include, cardiovascular disease, smoking, sedentary lifestyle, and obesity.
Diabetic Eye Disease – Diabetic Retinopathy
Diabetic Eye Disease is an end-organ response to a generalized medical condition. Diabetic Retinopathy is the most serious sight-threatening complication of diabetes, although, diabetes has been shown to cause an increased risk of cataracts, glaucoma, and refractive error changes (near-sightedness). Diabetic Retinopathy is characterized by blood vessel changes, swelling, leakage and/or hemorrhaging within the retina.
Diabetes is the leading cause of blindness in working age Americans today. At least 50,000 Americans are legally blind from this condition. Although Diabetic Retinopathy is not preventable or curable, many cases of blindness may be avoided due to advances in the management of Diabetic Retinopathy. Early diagnosis and long-term, consistent follow up evaluations are essential for effective treatment, and can significantly lower the risk of blindness.
Recommended Eye Examinations
All newly diagnosed diabetics should have a comprehensive, dilated eye examination immediately. In the absence of any diabetic eye disease, annual eye examinations are recommended. Depending on the level of retinopathy, you may need to be seen by your eye doctor more frequently, in order to monitor for progression of the disease.
The natural tears that your eyes produce are composed of three layers: the outer oily layer, the middle watery layer, and the inner mucus layer. Dry eye is the term used to describe eyes that do not produce enough tears or an eye without the proper chemical composition in the three layers of tears. Dry eye is most often a result of the eyes natural aging process. Most peoples’ eyes tend to become drier as they age, but the degree of dryness varies and some people have more problems than others. In addition to age, dry eye can result from:
- Problems with normal blinking
- Certain medications like antihistamines, oral contraceptives and antidepressants
- Environmental factors like a dry climate and exposure to wind
- General health problems like arthritis or Sjogren’s syndrome
- Chemical or thermal burns to the eye
Dry eye symptoms are often different in different people, but the following are commonly experienced by those whose tear production is inadequate:
- Redness of the eyes
- Irritated, scratchy, dry or uncomfortable eyes
- A burning sensation of the eyes
- A feeling of a foreign body in the eye
- Blurred vision
- Excessive watering as the eyes try to comfort an overly dry eye
- Eyes that seem to have lost the normal clear glassy luster
If untreated, dry eye can be more than just irritating or uncomfortable. Excessive dry eye can damage eye tissue and possibly scar the cornea, the transparent front covering of the eye, impairing vision. Contact lens wear may be more difficult due to the possibility of increased irritation and a greater chance of eye infection.
If you are experiencing the symptoms of dry eye, your optometrist can perform “dry eye” tests using diagnostic instruments to give a highly magnified view and special dyes to evaluate the quality, amount and distribution of tears. Your optometrist will also need to know about your every day activities, your general health, medications you are taking and about environmental factors that may be causing your symptoms.
Unfortunately, dry eye cannot be cured, but your eye’s sensitivity can be lessened and treatment prescribed so that your eyes remain healthy and your vision is not affected. There are several over the counter and prescription medications available to help treat dry eyes. Other dry eye treatments are:
- Changing environmental factors like avoiding wind and dust and increasing the level of humidity
- Frequent blinking to spread tears over the eye, especially when using a steady focus for an extended period
- Using artificial tear solutions
- Using moisturizing ointment, especially at bedtime
- Hot compresses or a heated mask (ask our doctors about the new Tranquileyes mask) to help tear gland function
- Taking a daily Omega-3 vitamin supplement (fish oil, and/or flax seed oil)
- Insertion of small plugs in the corner of the eyes to slow drainage and loss of tears
- In rare cases, surgery may be recommended
Whatever treatment is prescribed for you, it is very important that you follow your doctor’s instructions carefully. Dry eye does not go away, but by working together, you and your doctor can keep your eyes healthy and protect your good vision.
Eye infections cover a broad range, from an annoying irritation to serious sight threatening conditions. Bacterial infections will usually respond well to antibiotic eye drops. Viral infections are much more common than bacterial, can be much more difficult to treat and tend to last longer. Fungal eye infections, while rare, can create an extremely serious threat to vision.
As a general rule, a red, irritated eye that does not get better should be seen by a doctor within a couple of days. A contact lens should NOT be worn on a red, irritated eye. New eye drops, both prescription and non-prescription, are constantly being developed. They are giving us improved medical options as we treat our patients’ eye infections.
The sudden appearance of light flashes or floating spots can be a rather dramatic event occurring within the vitreous body of the eye. The vitreous is the jelly-like material which fills the large central cavity of the eye. It is 90% water with the remaining portion being fibrous proteins. These fibers are what give the vitreous a stiff consistency similar to gelatin. The vitreous has normal connections to the retina, the light sensitive layer lining the back of the eye.
As we age, there is shrinkage of the overall volume of the vitreous. With this comes a contraction of the fibrous elements away from the retina. This is called a POSTERIOR VITREOUS DETACHMENT. The resulting traction on the retina is responsible for the characteristic “flashes” which often accompany PVD’s. The “floaters” are typically fibrous clumps within the vitreous. However, in some cases, they are actually from some fragments of retina which may have been dragged into the vitreous cavity by this separation.
It is important that all eyes with recent onset of flashes and floaters be examined carefully by an eye doctor. Most of the time, nothing unusual is found and simple reassurance is all that is needed. The flashes eventually go away, and the floaters diminish and become less bothersome with time; however, in some eyes with a posterior vitreous separation, a tear in the retina may occur. If left untreated, these tears may lead to a retinal detachment. A retinal detachment is a very serious sight threatening condition requiring a major surgical procedure to repair. Even in the best of hands, the results can be very unpredictable.
If retinal tears are found, treatment is much easier and more effective. They can be sealed off to prevent a retinal detachment. This is done either by “spot welding” several circles of burns around the tear with a laser, or by sealing it with a freezing unit. Both accomplish the same purpose with good results and low complications rates. The procedure is done on an outpatient basis under local anesthetic.
When flashes and floaters appear, it is important to examine the eye within a few days of their onset. Changes can occur rapidly, and time can be of the essence if a retinal detachment is present. If all is normal in the first occurrence, one cannot assume that subsequent occurrences will be harmless also. Each event should be carefully examined and treated if necessary.
It is not uncommon for particles to get into an eye and adhere to the ocular surface: metal from a grinder, grass from a lawn mower, dirt from our Texas Panhandle winds, etc. Frequently these particles become embedded deeply enough on the eye that they cannot be rinsed out. Our doctors treat these occurrences on a daily basis. The goal is to remove these “foreign bodies” with as little disruption to the surface of the eye as possible. We take all necessary steps to minimize scarring and prevent any secondary infections. Bandages and eye patches are seldom needed anymore in the process of treatment. Proper removal of the foreign body, and the use of special “bandage contact lenses,” aid in a faster recovery and fewer long-term problems with the eye.
Glaucoma can most accurately be described as the silent thief of sight. Thousands of new cases of glaucoma are diagnosed each year by eye doctors. This disease can rob you of the vision you need to lead an active lifestyle. Glaucoma is a progressive disease that develops over months to years. It gradually causes loss of peripheral vision, and, if left untreated, can result in irreversible blindness. Your risk of developing glaucoma is higher if you have diabetes, high blood pressure or high cholesterol. Certain lifestyles such as smoking and obesity can also increase your risks. The most common factor, however, is genetic. If you have a blood relative with glaucoma, you should be checked by your eye doctor regularly.
Glaucoma treatments have drastically changed over the past decade. In the past, we had only a limited selection of eye drops to control pressure within the eye. Some of these medications caused unpleasant side effects, like headaches and blurred vision.
Today, we have a much wider range of choices. The specific glaucoma medicine you receive depends upon any pre-existing health problems, your lifestyle, and glaucoma history. If the eye drops do not adequately control the glaucoma, surgery can be done. Here, openings through the drainage system of the eye are artificially produced, often with a laser. This allows for healthier fluid circulation and a reduction in eye pressure. It’s good to know these treatments are available should you develop glaucoma, but early diagnosis is really the key to a lifetime of healthy vision.
Keratoconus is a non-inflammatory eye condition in which the normally round dome-shaped cornea progressively thins causing a cone-like bulge to develop. This results in significant visual impairment. The cornea is the clear window of the eye and is responsible for refracting (bending) most of the light coming into the eye. This distortion has been compared to viewing a street sign through your car windshield during a driving rainstorm. Therefore, abnormalities of the cornea severely affect the way we see the world making simple tasks like driving, watching TV, or reading a book difficult.
In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to glare and light. These symptoms usually first appear in the late teens and early twenties, and it has been estimated that the incidence of keratoconus is 1 in 2000. It is found in all parts of the United States and the rest of the world. It has no known significant geographic, cultural or social pattern. Keratoconus may progress for 10-20 years and then slow in its progression. Each eye may be affected differently.
Eyeglasses or soft contact lenses may be used to correct the mild nearsightedness and astigmatism that is caused in the early stages of keratoconus. As the disorder progresses and the cornea continues to thin and change shape, rigid gas permeable contact lenses can be prescribed to correct vision more adequately. The contact lenses must be carefully fitted, and frequent checkups and lens changes may be needed to achieve and maintain good vision.
In severe cases, a corneal transplant may be needed due to scarring, extreme thinning or contact lens intolerance. This is a surgical procedure that replaces the keratoconus cornea with healthy donor tissue.
For more information about keratoconus, visit the National Keratoconus Foundation’s website.
Macular Degeneration, sometimes called Age Related Macular Degeneration (ARMD), typically affects people 55 years old and older, but can be found in people much younger, as well. It is a degenerative condition affecting the macula – the portion of the retina that provides our fine, detailed, central vision. Activities such as threading a needle, reading, and recognizing vibrant colors or faces are just a few of the things the macula is responsible for.
Age-related Macular Degeneration is the leading cause of legal blindness in people older than 55 years in the United States, affecting more than 1.75 million individuals. Unfortunately, due to the rapid aging of the U.S. population, this number is expected to increase to almost 3 million by 2020. Smoking, obesity, and family history are among the leading causes of this debilitating disease process.
There are two types of Macular Degeneration, dry and wet. The most common type of Macular Degeneration is the dry form. In this form, progression tends to be slower, causing gradual vision loss over time. However, the dry form can convert to wet ARMD at any time when fluid starts to accumulate underneath the macula. Regular examinations by a doctor experienced with Macular Degeneration and monitoring your eyes daily with the use of an Amsler Grid, are vital. Vitamin therapy (an AREDS approved formula) can be effective in slowing down the advancement of this disease. Medical treatment, in the form of intraocular injections (injections directly into the eye), has been shown to greatly improve long-term vision related to wet ARMD.