Diabetes & Eye Health
Diabetes can affect your vision. Dr. Mary Price, UAMS Optometrist, discusses what diabetes does to eye health.
Featured Speaker:
Mary Price, OD
Dr. Price is an Arkansas native, originally from Russellville. She obtained her Bachelor of Science in Biomedical Engineering from the University of Arkansas at Fayetteville and received her Doctor of Optometry at Southern College of Optometry in Memphis, Tennessee completing clinical internships in Salem, VA and Lexington, KY. Dr. Price has been and continues to be very involved with medical outreach programs, volunteering with local community organizations as well as abroad in Costa Rica, Honduras and Belize (Remote Area Medical, Fellowship of Christian Optometrists Mission & Global Medical and Dental Brigade). Dr.Price is an optometric physician at UAMS, where she performs comprehensive eye exams and contact lens fittings. Transcription:
Diabetes & Eye Health
Alyne Ellis (Host): When you have diabetes, over time, high blood glucose levels can hurt your vision. To find out more, let’s talk to optometrist Dr. Mary Price. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Alyne Ellis. Dr. Price, thanks for joining me today. and how does diabetes affect the eyes?
Mary Price, OD (Guest): Diabetes can affect the eyes in many different ways. Most patients know that diabetes can cause kidney damage and nerve damage but not everyone knows that diabetes can actually cause vision loss and even blindness. Diabetic retinopathy is actually the leading cause of blindness in working age adults. And right now, about one in ten Americans are currently living with diabetes so, that is a huge part of our population.
So, patients should know that even if their vision is normal, there could be significant damage happening to the eye from diabetes.
Host: And what is diabetes retinopathy? Can you describe what’s happening in there?
Dr. Price: So, diabetic retinopathy is a disease that affects the back of the eye called the retina. So, the retina is a group of cells in the back of the eye that take light in and actually send an image signal to our brain. So, with diabetes, it can damage the small blood vessels inside the eye that provide the retina with oxygen and nutrients. This damage causes leaking of blood or even grows new fragile blood vessels in the retina. These new blood vessels can then scar and pull the retina away from the back of the eye resulting in even a retinal detachment.
Host: Is there something we can do about that? As blood glucose levels rise, I mean obviously keeping it low, but is there some treatment for this that can help as well?
Dr. Price: Good question. So, the most important thing for us as eye doctors is for every patient with diabetes to have a yearly dilated eye exam. So, the scary fact is patients can have significant damage to the inside of the eye without any symptoms. With a dilated eye exam, it opens up the pupil and let’s your doctor get a better look at the back of the eye including the retina which is what is affected with diabetic retinopathy. So, early detection is what is the most important and a dilated eye exam can help your eye doctor detect any problems early when they are still treatable.
Host: And once that is detected, do you take medication or what’s the treatment for this?
Dr. Price: So, with diabetic retinopathy, there are many different stages. So, in the early stages, your eye doctor will just monitor the damage and request that you keep your blood sugar under best control as you can as well as your blood pressure and cholesterol. If the retinopathy progresses more significantly, you will be referred or seen by a retina specialist where they can determine the treatment options that are needed. And there are multiple treatment options depending on the level of retinopathy and the damage that has been done. But most importantly, patients need to be dilated right when they are diagnosed so that we can detect any changes early.
Host: So, let’s move on to some of the other possible things that can happen including can diabetes cause double vision?
Dr. Price: Yes. That is something that a lot of patients don’t know that diabetes can cause double vision. So, diabetes can damage the nerves that send the signal from our brain to our eye muscles. If the signal is not received; the patient can have trouble moving their eye in a certain direction and can actually experience double vision. If the patient does experience double vision, this is a sign that the patient needs to be seen right away because there is nerve damage happening from the diabetes.
Host: What about wearing contact lenses if you are a diabetic? Is that something to be concerned about?
Dr. Price: Diabetes can actually affect the comfort of contact lenses. Diabetes can affect the nerves that control the tear production at the eye. When our eyes are not producing enough healthy tears; our eyes can become dry, red and irritated. If our eyes are more dry; contact lenses seem to become more uncomfortable especially towards the end of the day. So, if dryness is a problem, it could be a sign that diabetes is affecting the tear production of the eye.
Host: In that case, would you recommend drops or obviously an exam also, but would tear drops help?
Dr. Price: An exam is important. Based off the level of dryness, your eye doctor may prescribe some artificial tears, some lubricating eye drops to help with the discomfort. They may even recommend a different brand or material of contact lens or even coming out off the contact lens for a period of time until the dryness resolves.
Host: So, what about when blood sugar rises, can you tell right away? Is your vision affected in even a subtle way that a patient would be able to tell that something is going on?
Dr. Price: Yes. So, some patients notice that when their blood sugar rises, especially after eating, that their vision becomes more blurry. And this is actually because the natural lens inside our eye is very sensitive to changes in blood sugar. So, when the blood sugar elevates, the lens can swell and cause our eye to have a more difficult time focusing which results in blurry vision. Patients may notice right after they eat a big meal that their vision is blurry or that even taking off their glasses it seems more clear. And this is because your prescription can actually fluctuate as your blood sugar is uncontrolled. This is something that may take a few weeks or months to get back to normal if your blood sugar is very uncontrolled because that lens needs time to get back to normal and help your prescription resolve back to the way it was.
Host: And I guess the next thing I would think about is that all important lens and cataract surgery. So, what about cataract surgery and diabetes? Is it possible to take care of that?
Dr. Price: Yes. So, like I was saying earlier, that natural lens is very sensitive to changes in blood sugar. So, everyone gets cataracts as they get older but someone with diabetes may get cataracts at an earlier age. So, someone whose parents had cataracts at maybe age 70 or 80 may notice changes in their 40s or 50s if they have diabetes. And that’s because that natural lens inside the eye is affected more from the increase in blood sugar. Cataracts can be removed and taken out with surgery. What the surgeon does is they take the cataract out and put a clear lens implant inside the eye where that cataract was. So, the important thing for diabetic patients to know is that they can have an earlier onset of cataracts and that their cataract can progress quicker than someone without diabetes.
Some of the signs patients may notice from cataracts are more blurry vision, or glare halos around lights at night.
Host: So, the other one that I’ve experienced occasionally, I have a different eye problem; is little floaters and flashes and what does that mean for a diabetic?
Dr. Price: Yes. So, little floaters, flashes of light or even vision loss can all be signs of a retinal emergency. So, with diabetes, since it can cause damage to the little blood vessels inside the eye and cause leaking of blood or even growths of new fragile blood vessels; little floaters or flashes of light could be a sign of a retinal detachment or leaking of blood in the back of the eye. Any of these signs, can detect an emergency and you need to be seen by your eye doctor right away. Because this could be something that needs emergent surgery.
Host: If you look across the spectrum of diabetics, are there some that are at a higher risk for diabetes eye disease or not? In fact, who is in general at risk for diabetic eye disease?
Dr. Price: So, all diabetic patients need a yearly eye exam to detect if there has been any damage done to the eyes. But those patients with a higher risk for diabetic eye disease include those who have had diabetes for a longer duration of time. So, the longer you’ve had diabetes, the more chance you have of getting diabetic retinopathy or changes to the eyes. Also patients with a higher A1C level or a more poorly controlled blood sugar level, are at a higher risk for diabetic damage. And also those that have a higher blood pressure or even people who smoke have a higher risk of diabetic eye disease.
Host: And once again, you would recommend a full vision test at least once a year. But some might even have to have it more often than that or not?
Dr. Price: Yes, that is correct. So, if your eye doctor notices changes to the eye from diabetes at your exam; they may bring you back three or six months instead of the next year so that they can detect any changes that are being done.
Host: Well thank you Doctor, for joining us today. We really appreciate it. Dr. Mary Price is an optometrist at the University of Arkansas for Medical Sciences. For more information on diabetes and eye health visit www.uamshealth.com.
Diabetes & Eye Health
Alyne Ellis (Host): When you have diabetes, over time, high blood glucose levels can hurt your vision. To find out more, let’s talk to optometrist Dr. Mary Price. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Alyne Ellis. Dr. Price, thanks for joining me today. and how does diabetes affect the eyes?
Mary Price, OD (Guest): Diabetes can affect the eyes in many different ways. Most patients know that diabetes can cause kidney damage and nerve damage but not everyone knows that diabetes can actually cause vision loss and even blindness. Diabetic retinopathy is actually the leading cause of blindness in working age adults. And right now, about one in ten Americans are currently living with diabetes so, that is a huge part of our population.
So, patients should know that even if their vision is normal, there could be significant damage happening to the eye from diabetes.
Host: And what is diabetes retinopathy? Can you describe what’s happening in there?
Dr. Price: So, diabetic retinopathy is a disease that affects the back of the eye called the retina. So, the retina is a group of cells in the back of the eye that take light in and actually send an image signal to our brain. So, with diabetes, it can damage the small blood vessels inside the eye that provide the retina with oxygen and nutrients. This damage causes leaking of blood or even grows new fragile blood vessels in the retina. These new blood vessels can then scar and pull the retina away from the back of the eye resulting in even a retinal detachment.
Host: Is there something we can do about that? As blood glucose levels rise, I mean obviously keeping it low, but is there some treatment for this that can help as well?
Dr. Price: Good question. So, the most important thing for us as eye doctors is for every patient with diabetes to have a yearly dilated eye exam. So, the scary fact is patients can have significant damage to the inside of the eye without any symptoms. With a dilated eye exam, it opens up the pupil and let’s your doctor get a better look at the back of the eye including the retina which is what is affected with diabetic retinopathy. So, early detection is what is the most important and a dilated eye exam can help your eye doctor detect any problems early when they are still treatable.
Host: And once that is detected, do you take medication or what’s the treatment for this?
Dr. Price: So, with diabetic retinopathy, there are many different stages. So, in the early stages, your eye doctor will just monitor the damage and request that you keep your blood sugar under best control as you can as well as your blood pressure and cholesterol. If the retinopathy progresses more significantly, you will be referred or seen by a retina specialist where they can determine the treatment options that are needed. And there are multiple treatment options depending on the level of retinopathy and the damage that has been done. But most importantly, patients need to be dilated right when they are diagnosed so that we can detect any changes early.
Host: So, let’s move on to some of the other possible things that can happen including can diabetes cause double vision?
Dr. Price: Yes. That is something that a lot of patients don’t know that diabetes can cause double vision. So, diabetes can damage the nerves that send the signal from our brain to our eye muscles. If the signal is not received; the patient can have trouble moving their eye in a certain direction and can actually experience double vision. If the patient does experience double vision, this is a sign that the patient needs to be seen right away because there is nerve damage happening from the diabetes.
Host: What about wearing contact lenses if you are a diabetic? Is that something to be concerned about?
Dr. Price: Diabetes can actually affect the comfort of contact lenses. Diabetes can affect the nerves that control the tear production at the eye. When our eyes are not producing enough healthy tears; our eyes can become dry, red and irritated. If our eyes are more dry; contact lenses seem to become more uncomfortable especially towards the end of the day. So, if dryness is a problem, it could be a sign that diabetes is affecting the tear production of the eye.
Host: In that case, would you recommend drops or obviously an exam also, but would tear drops help?
Dr. Price: An exam is important. Based off the level of dryness, your eye doctor may prescribe some artificial tears, some lubricating eye drops to help with the discomfort. They may even recommend a different brand or material of contact lens or even coming out off the contact lens for a period of time until the dryness resolves.
Host: So, what about when blood sugar rises, can you tell right away? Is your vision affected in even a subtle way that a patient would be able to tell that something is going on?
Dr. Price: Yes. So, some patients notice that when their blood sugar rises, especially after eating, that their vision becomes more blurry. And this is actually because the natural lens inside our eye is very sensitive to changes in blood sugar. So, when the blood sugar elevates, the lens can swell and cause our eye to have a more difficult time focusing which results in blurry vision. Patients may notice right after they eat a big meal that their vision is blurry or that even taking off their glasses it seems more clear. And this is because your prescription can actually fluctuate as your blood sugar is uncontrolled. This is something that may take a few weeks or months to get back to normal if your blood sugar is very uncontrolled because that lens needs time to get back to normal and help your prescription resolve back to the way it was.
Host: And I guess the next thing I would think about is that all important lens and cataract surgery. So, what about cataract surgery and diabetes? Is it possible to take care of that?
Dr. Price: Yes. So, like I was saying earlier, that natural lens is very sensitive to changes in blood sugar. So, everyone gets cataracts as they get older but someone with diabetes may get cataracts at an earlier age. So, someone whose parents had cataracts at maybe age 70 or 80 may notice changes in their 40s or 50s if they have diabetes. And that’s because that natural lens inside the eye is affected more from the increase in blood sugar. Cataracts can be removed and taken out with surgery. What the surgeon does is they take the cataract out and put a clear lens implant inside the eye where that cataract was. So, the important thing for diabetic patients to know is that they can have an earlier onset of cataracts and that their cataract can progress quicker than someone without diabetes.
Some of the signs patients may notice from cataracts are more blurry vision, or glare halos around lights at night.
Host: So, the other one that I’ve experienced occasionally, I have a different eye problem; is little floaters and flashes and what does that mean for a diabetic?
Dr. Price: Yes. So, little floaters, flashes of light or even vision loss can all be signs of a retinal emergency. So, with diabetes, since it can cause damage to the little blood vessels inside the eye and cause leaking of blood or even growths of new fragile blood vessels; little floaters or flashes of light could be a sign of a retinal detachment or leaking of blood in the back of the eye. Any of these signs, can detect an emergency and you need to be seen by your eye doctor right away. Because this could be something that needs emergent surgery.
Host: If you look across the spectrum of diabetics, are there some that are at a higher risk for diabetes eye disease or not? In fact, who is in general at risk for diabetic eye disease?
Dr. Price: So, all diabetic patients need a yearly eye exam to detect if there has been any damage done to the eyes. But those patients with a higher risk for diabetic eye disease include those who have had diabetes for a longer duration of time. So, the longer you’ve had diabetes, the more chance you have of getting diabetic retinopathy or changes to the eyes. Also patients with a higher A1C level or a more poorly controlled blood sugar level, are at a higher risk for diabetic damage. And also those that have a higher blood pressure or even people who smoke have a higher risk of diabetic eye disease.
Host: And once again, you would recommend a full vision test at least once a year. But some might even have to have it more often than that or not?
Dr. Price: Yes, that is correct. So, if your eye doctor notices changes to the eye from diabetes at your exam; they may bring you back three or six months instead of the next year so that they can detect any changes that are being done.
Host: Well thank you Doctor, for joining us today. We really appreciate it. Dr. Mary Price is an optometrist at the University of Arkansas for Medical Sciences. For more information on diabetes and eye health visit www.uamshealth.com.