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Diabetes Q&A With Dr. Stewart

person thinking about diabetes and diabetic eye disease in Greer, South Carolina

Eye Doctor in Greer, South Carolina, Answers 9 Commonly Asked Questions about Diabetic Eye Disease

What does the diagnosis of diabetes or diabetic retinopathy mean exactly? I’ve heard there are different types?

Dr. Stewart: The diagnosis of diabetes means that your body does not process glucose properly. Symptoms of diabetes include increased thirst, hunger, dry mouth, frequent urination or urine infections, unexplained weight loss, fatigue (weak tired feeling), blurred vision, and headaches. Diabetic retinopathy is a condition that may occur in people who have diabetes. Annual eye examinations can help diagnose and treat diabetic retinopathy before it causes blindness. At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Over time, diabetes damages the blood vessels in the retina. This occurs when the tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision, seeing spots or floaters, having a dark or empty spot in the center of your vision, and difficulty seeing well at night. This vision loss can’t fully be treated with eyeglasses or even specialty contact lenses. This condition usually affects both eyes. The longer the person has the diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness.

I understand that diabetes is common among those over 40 or with weight issues. What causes diabetes? Are there other groups that are at higher risk?

Dr. Stewart: The causes of diabetes can be from being overweight or obese, a family history, giving birth to big babies, high cholesterol, lack of exercise, autoimmune diseases (Graves disease, multiple sclerosis, and pernicious anemia), and age. Groups that are at higher risk are those who have a BMI greater than 23.

Please describe the typical progression for an individual with diabetes regarding their eyesight?

Dr. Stewart: When a person first becomes diabetic. Their elevated blood sugars cause the lenses in their eyes to swell, which changes their ability to see. Once their blood sugars return to normal with the help of oral or injected medicine, their vision returns to normal. As long as a person with diabetes maintains target blood sugar levels set by their MD, their eyesight will have a better chance of remaining normal. However, the longer the person is a diabetic, the chances of the person developing diabetic retinopathy increases, which is when blood vessels leak in the retina causing blurred or wavy vision, and color changes. Annual diabetic eye examinations help diagnose diabetic retinopathy.

What happens during a typical diabetic Eye Exam?

Dr. Stewart: Your eye doctor will evaluate the back of your eye called the retina to check for leaking blood vessels. diabetic retinopathy occurs when elevated blood sugars damage the walls of the blood vessels. The vessel walls may thicken, leak, develop clots, close off, or grow balloon-like defects called microaneurysms.

What treatment options and/or care is available for diabetic retinopathy?

Dr. Stewart: If your diabetic retinopathy has leaking vessels that threaten the seeing part of your eye called the macula. Your eye doctor may recommend anti-VEGF therapy as a stand-alone treatment or in combination with pan-retinal photocoagulation.

What are the risks and side effects associated with these treatments? What if you don’t proceed with the treatment?

Dr. Stewart: Possible side effects of these treatments include: eye irritation or discomfort, bleeding inside the eye, floaters or having something in your eye, watery or dry itchy eyes.

Will a change in a eiabetic’s diet, exercise routine, or medication help at all to prevent eiabetic retinopathy?

Dr. Stewart: Good blood sugar control levels, blood pressure, and cholesterol levels can reduce the risk of diabetic retinopathy in anyone with diabetes. This is done by making healthy lifestyle choices, although some diabetics will also need to take medication. Avoiding blindness can be a powerful motivator for people to change their lifestyle.

Regardless of the cost of coverage by my insurance, what are some alternative diabetic retinopathy treatments?

Dr. Stewart: If you have proliferative diabetic retinopathy or macular edema, you will need prompt surgical treatment. Depending on the specific problems with your retina, options may include Photocoagulation. This laser treatment, also known as focal laser treatment can stop or slow the leakage of blood and fluid in your eyes. Although the FDA has not yet approved the Lucentis for treating proliferative diabetic retinopathy. The drug is proving effective in treating proliferative diabetic retinopathy which is less expensive than photocoagulation treatment.

Can you recommend a vitamin/mineral program for me that might be helpful for diabetic retinopathy or are vitamin supplements specific to each patient?

Dr. Stewart: Only good control of blood sugar, blood pressure and blood cholesterol can help prevent vision loss from diabetes and diabetic retinopathy. Your MD can recommend a vitamin/mineral program along with diet and exercise, and diabetic medication.

Why does my Primary Care Physician want me to get a diabetic eye exam with a report?

Dr. Stewart: Diabetic retinopathy is the leading cause of preventable blindness for diabetics. Annual eye examinations are required to monitor and detect diabetic changes in the back of the eye which is called the retina. Type one and type two diabetics are both at risk of diabetic retinopathy which can cause permanent vision loss if it is not detected and properly treated.

Why is it important to have an eye exam when you have diabetes?

Dr. Stewart: Diabetes can harm your eyes. It can damage the small blood vessels in your retina, the back wall of your eyeball. This condition is called diabetic retinopathy. Diabetes also increases your risk of glaucoma and other eye problems. You may not know your eyes are harmed until the problem is very bad. Your doctor can catch problems early if you get regular eye exams. This is very important. The early stages of diabetic retinopathy don’t cause changes in vision and you won’t have symptoms. Only an eye exam can detect the problem, so that steps can be taken to prevent the retinopathy from getting worse.

What are the risk factors for diabetic retinopathy?

Dr. Stewart: The risk of developing diabetic retinopathy increases the longer you are diabetic. Your primary care physician will always want you to have a diabetic eye exam each and every year that you are diabetic. Your risk of having diabetic retinopathy greatly increases when your blood sugar is not controlled. That is why it is important to monitor your blood sugar daily and keep your appointments with your PCP. Having high blood pressure with diabetes is another risk factor for diabetic retinopathy. Uncontrolled blood pressure complicates the hemorrhages in the retina caused by diabetes.

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