Transcription:

Prakash Chandran (Host): High blood sugar and diabetes can lead to problems like blurry vision, cataracts, glaucoma and retinopathy. In fact, diabetes is the primary cause of blindness in adults ages 20 to 74. I’m Prakash Chandran and in this episode of Magnolia Matters Healthcast Series we’re going to talk about diabetes and vision complications. Here with us to discuss is Dr. Jennifer Garrett, an ophthalmologist at Garrett Eye Clinic and on staff with Magnolia Regional Health Center. So, I want to get started by learning a little bit more about how having diabetes can lead to vision problems.

Jennifer Garrett, MD (Guest): Elevated blood sugars cause lots of damage inside the body. And one of the places that it causes damage is inside the eyes. Some of the changes that we have from diabetes inside our eyes is related to number one, too much sugar in the body cannot be processed and it is stored inside the lens of the eye which is what becomes the cataracts later. And that change inside the lens can actually make people’s vision blurry by causing them to become more nearsighted.

In addition to that, more chronic and debilitating damage occurs when the diabetes weakens the blood vessels which causes them to leak resulting in little tiny microaneurysms or little blood spots inside of the eye that could eventually get larger causing swelling within the retina or bleeding actually inside of the eye.

In addition to this, additional blood vessels sometimes try to grow in the eye to help it heal, but they can cause problems like scar tissue inside of the eye or glaucoma in some cases when the diabetes is severe.

Host: Okay, so diabetes can actually lead to quit e bit of problems like you mentioned there. So, I’m curious, as someone that wears glasses and probably eats more sugar than I should; how can I tell if the vision problems that I’m having are actually related to diabetes?

Dr. Garrett: That’s a great question. So, if you are diabetic or sometimes, I have people that don’t even know they are diabetic, and they’ll come in and say I cannot see far away anymore. Their distance vision tends to get really, really blurry. And that’s because the lens shifts them into nearsightedness or let’s say these people have worn glasses and all of the sudden, they say I don’t need them to see far away anymore. It may be because the diabetes has changed how their eyes are focusing. And so one of the major ways that I determine if somebody has diabetes and they have never been diagnosed before is if they come in and they say I just can’t see with my glasses anymore. This has been a rapid change over the last month and then we start to check them and see that they’ve become very nearsighted. That’s my clue that they may be diabetic.

Host: I see. Okay. Well it sounds like you are speaking directly to me in this case. So, if a person like myself, is experiencing this issue; should they automatically be tested for diabetes? What would you recommend?

Dr. Garrett: Well first I would recommend if they are coming in to see me as a patient; then we do a full eye exam and we see if maybe okay maybe it is related to the diabetes or is this just some mild change that you are starting to notice more. If I do see that there’s a significant change and I look inside of your eyes and if I see any bleeding inside of the eye or even if I don’t see any bleeding and I have no other way to explain the change then I will set up an appointment with a primary care physician to get them checked for diabetes.

Host: Got it. So, we always like to talk about prevention on this podcast. And I’d love to learn a little bit about steps people can take to prevent the onset of vision problems caused by diabetes.

Dr. Garrett: Absolutely. Well some of the best things that we can do are actually to screen for diabetes. By the time a person who is an adult is diagnosed with type 2 diabetes which is the type that does not require insulin; at least it does not initially; those people sometimes 40-45% of those people may already have diabetic bleeding in their eyes. When I was younger, I had an uncle who went blind from diabetes before he even knew he had it. And that’s sort of what spurred me into thinking more and being very proactive about this. Because if you are screened routinely and we find these small minute changes we can actually work with your primary care doctor, let them know that you are having these problems and they can make adjustments to your medicines so that you decrease the risk the you will go on to develop blindness.

And so, it’s very important that if you are a type 2 or an adult onset diabetic patient who started off not using insulin or you mostly taking the pills that you get screened initially when you are diagnosed and usually, I screen them every year. It could be every two years if it’s very, very mild, but at least once a year is what I typically do to check my patients for diabetic retinopathy.

And if you are a type 1 patient who is diagnosed as an adult; then you can be screened anywhere three to five years after your initial diagnosis and then yearly. That is the best chance that we have for detecting bleeding inside of the eye that could cause vision loss.

Host: Yeah, what I’m hearing from you is it’s very important to get screened and tested early and often especially if you fall into the category of type 1, type 2 diabetes as you were mentioning. You did say that if you catch it early; they can work with their primary care doctor to work with some medication to help I guess treat this. So, maybe talk about some of the different treatment options that will be available to these patients.

Dr. Garrett: Okay so with their primary care doctor of course, they are going to talk about different oral medications they can take or different injectables they can to get better control of their blood sugars. Many diabetic patients I find tend to just think that diabetes is one of those things that you just take a pill for every day. The need to be more proactive in checking their own blood sugar at home at different times of the day to see if their blood sugar is fluctuating.

So, they can work with their primary care to figure out when they are having issues of elevated blood sugar so that they can better treat it with the appropriate oral medication or an injectable medication. And if that isn’t controlling it, at that point they need to consider insulin to supplement to their oral medication as well.

If we find diabetes inside the eye, then that’s a whole different pathway down on how we treat that and what we do to decrease the risk of vision loss.

Host: Okay, so maybe expand on that a little bit. I know it’s a worse case scenario, but for the people listening to this; that might kind of be in that demographic; just kind of talk to them through the process.

Dr. Garrett: So, I always tell people that the longer you have diabetes, the greater the chance that you are going to have some type of bleeding in your eyes. Just because the excessive blood sugars just break down those blood vessels and those little tiny cells and they allow blood to leak out. And I always think that they never completely go away. They heal themselves, but there is always that potential. So, when I look in someone’s eyes, if they have what’s called mild diabetic retinopathy; they have a few little pinpoint blood spots in the retina that are not near the center of the vision and those people we just say, look you’ve got some signs of diabetes. You’ve had diabetes for X number of years, it’s likely that – it’s not unexpected that we find this.

But if I look in their eyes and I see bleeding or little hard spots that are close to the very center of the vision; then I will have a test in my office done called an OCT that looks at the layers of the retina. So, the retina is the part, the film of the camera that helps you see. It is what transmits the image to the brain. And so we take a scan of the retina and it can show me all the layers of the retina and exactly where the bleeding is and if it’s causing swelling in the center part of the vision. So, it’s very easy to detect. It’s painless. And if we see that; then we refer them to a retina specialist.

Once they are at a retina specialist then they will talk with them about options of doing either laser treatment inside the eye or injecting a medicine actually into the eye to shrink the blood vessels and decrease the bleeding inside of the eye. So, there are several options for diabetic retinopathy and when it gets to the point where there’s actually swelling in the central vision; then usually that’s when we refer and the retina specialist at that point more than likely is going to do an injection inside of the eye.

And these injections are done in the office and they are done under local pain medicines. Sometimes they do an injection around the eyeball, but actually sometimes they can go straight into the eye with very minimal pain and inject a medicine called Avastin. That’s just one of the medicines. There are other things called Lucentis, Eylea. All these medicines are just simply medicines that tell the body to stop blood vessel growth. So, by shrinking these blood vessels; then we also allow the body to absorb the fluid that’s formed there and improve vision.

Host: Okay, well it is good to know that there are those treatment options in case well, worse case scenario happens like that and there’s medications like you said to tell the body to stop creating those blood vessels. I did have a question before it gets that bad, are any of these issues reversable or preventable by potentially improving your health or getting your diabetes under control?

Dr. Garrett: Absolutely. Just like with your kidneys. And I always tell people your eyes and your kidneys are very similar. Because the blood vessels are very, very tiny in those areas. And they are critical for supply that tissue. So, if you catch these things early and you see that you have diabetes in your eyes, or you see that it’s worsening; then that is really a wakeup call and I always send a letter to the referring physician or to their primary care to let them know. Because if you can obtain tight control of your diabetes and much control either through adding insulin or insulin pump or just adjusting what medications that they are on and more than that; making the patient aware of their responsibility for their own healthcare. That it’s not just a pill that you take, and you can eat what you want. Meeting with a dietician, going to some counseling; all those things are very important to let the patient take control of their healthcare and realize that they are the ones in control and they can make the difference if they can make some dietary modifications and get better control over their blood sugar; in the long run, they’ll have – they can actually some of these things can improve and even go away.

Host: I really appreciate that Dr. Garrett. It’s such good advice and all of us listening, we need to take control of our lifestyles as prevention measure for any of these diseases and symptoms that do appear. So, Dr. Garrett thank you so much for educating us today on diabetes and vision complications. Is there anything else you want to share with our audience before we sign off?

Dr. Garrett: No, just make sure that if you are diabetic that you try to get your eyes checked at least once a year, check you blood sugars at home and maintain those regular visits with your primary care physician so that they can better control your diabetes.

Host: Fantastic. So, for more information please visit www.mrhc.org. My guest today has been Dr. Jennifer Garrett. I’m Prakash Chandran. Thank you so much for listening.