Throughout the month of November, eyecare organizations and vision care experts have been urging people to prioritize their eyecare during diabetes-related eye disease awareness month. Experts note that 95 percent of vision loss from diabetes is preventable, and with that in mind, many health care professionals recommend yearly eye exams as an essential tool not just for eye health, but also in the detection and treatment of diabetes and related conditions. In addition, they note that patient education should be top of mind, not just during exams but throughout the course of preventative and disease treatment, for any diabetes care team, as the risk of developing significant vision loss, blindness and other eye health risks increases the longer someone has diabetes.

“Many individuals with diabetes are aware of the potential harm to eye health through education received from their primary care physician and other health professionals on their care team,” said Premilla Banwait, OD, MPH, FAAO, vice president of clinical programs at UnitedHealthcare Vision.

Dr. Banwait continued, “However, many patients may not realize the full extent diabetes has on vision until they visit an eyecare provider. It can be challenging for patients to know when they have developed diabetic retinopathy since there are not many apparent signs in the early stages. The changes may be too subtle and could even be mistaken for natural signs of aging. A recent study showed that one in four diabetic patients have some form of diabetic retinopathy.”

Diabetes-Related Eye Disease

Two prevalent forms of diabetes-related eye disease include diabetic retinopathy, which is the leading cause of blindness in American adults, affecting more than one in four of those living with diabetes, and diabetic macular edema, which causes the retina to swell and can cause vision to become blurry, according to the eye health and safety nonprofit Prevent Blindness.



Sandra S. Block, OD.
 
  
“Unfortunately, there are many complications that people living with diabetes may experience,” said Jeff Todd, president and CEO of Prevent Blindness, which offers a number of educational resources related to diabetes-related eye diseases. “Loss of vision is often first among these due to the anatomy of the eye, and so ODs play a critical role in having important conversations with their patients and their care partners about the urgency of routine eyecare.”

“The challenge to controlling the complications from diabetes is that many individuals with diabetes are unaware of the diagnosis. If they do not know that they are diabetic then they will certainly do nothing to prevent its progression to major complications,” said Sandra S. Block, OD, DOS (h.c.), M ED, MPH, FAAO, Dipl AAO, FOVDR, FNAP, FARVO, FEAOO, president, World Council of Optometry, and an emeritus member of the Prevent Blindness board of directors. “Diabetes as a disease of the vasculature system affects many parts of the human body. Vision is one of the affected areas of the disease as it progresses. The primary concern in the development of diabetes is diabetic retinopathy, a complication of diabetes which is so devastating that it can lead to permanent vision loss.”

According to Rajeev S. Ramchandran, MD, associate professor of ophthalmology, University of Rochester Medical School Department of Ophthalmology, surveys and research have shown that most people with diabetes do not understand the risk and dangers of vision loss that having diabetes poses to their vision.

 
 Rajeev S. Ramchandran, MD.
“Diabetes, especially poorly controlled or managed diabetes with elevated blood sugars, high blood pressure, and low-density lipoprotein and triglyceride levels, or ‘bad cholesterol’ (cholesterol), leads to silent damage to the retinal blood vessels, retinal tissue and lens of the eye,” said Dr. Ramchandran. “Patients will not realize that they are having damage to their eyes as it is painless and does not immediately affect one’s vision. In fact, when vision is affected, the eye disease or diabetic retinopathy is advanced and reversing the damage from the disease may not always be possible.”

Eye Health Risks

Additional risks to eye health may also occur in people with diabetes. According to the National Eye Institute, those with diabetes are two to five times more likely to develop cataracts, and to get them at a younger age. Also, having diabetes nearly doubles the risk of developing a type of glaucoma called open-angle glaucoma, a chronic eye condition that causes a gradual increase in eye pressure, which can lead to optic nerve damage and vision loss, according to the National Institutes of Health.

“It is not unusual for an eye exam to be the first time an individual may be aware of the fact that they are diabetic—as some of the early signs are ocular changes, or more specifically, people become aware of visual symptoms which may lead them to go for an eye exam. Early stages of diabetic retinopathy are often missed or not diagnosed because the patient has experienced no obvious signs or symptoms or the signs are ignored,” said Dr. Block.

She continued, “The early signs are subtle such as small shifts in sight or blurry vision, an increase in floaters, poorer vision at night or even the feeling that part of their vision is missing. While we always think about diabetic retinopathy as the primary visual outcome of diabetes, other ocular problems do co-exist. They include diabetic macular edema, glaucoma and cataracts. Each of these diseases can have a detrimental outcome on vision.”

ODs on the Frontlines of the Battle

And of course, ODs are on the frontlines of the battle against diabetes-related eye diseases. They can and should be part of a health care team that takes on this challenge as a group effort, according to experts.


Premilla Banwait, OD.
 
“Eyecare providers play a key role in managing diabetes, as they might often be the ones to detect it before any other health care provider,” said Dr. Banwait. “During the visit, the eyecare provider gets a close-up look at the retina through a dilated eye exam. If a person has diabetes, an eyecare provider may be able to detect signs during the exam and get the ball rolling on monitoring and treating any diabetes-related eye condition. They also play an important role in a person’s care team. They can assist with communicating with other health care professionals about the state of a patient’s diabetes and help to initiate a care plan.”

“I personally feel that a health team approach for patients with diabetes is important,” added Dr. Block. “Support and education about prevention, healthy choices, early diagnosis and appropriate treatment is best served when all providers, including optometry and ophthalmology, are working to best serve our patients overall health. Universal health care is seen as a process that places the patient at the center of the care model. The choices for the team should include ensuring that all aspects of care are appropriate for the specific needs of the patient.”

“It is important for all patients with diabetes to select an eye doctor and see this eye doctor each year for a dilated eye exam to look for damage to the eye from diabetes,” said Dr. Ramchandran. “It is also important that patients with diabetes see their primary care provider, and when appropriate, their endocrinologist, as regularly scheduled to make sure that they are achieving their goals of blood sugar, blood pressure and cholesterol values.

He continued, “For those who have diabetic retinopathy that requires treatment from a retina specialist, treatments may be given frequently, sometimes monthly, and seeing the retina specialist for these vision preserving treatments is very important. Missing regular treatments and exams may result in advanced progression of diabetic retinopathy resulting in permanent vision loss.”

Providing patient-friendly education regarding diabetes and diabetes-related eye diseases is also a prime starter in the ongoing fight.

 
 Jeff Todd.
“Educating patients about the way their diabetes and its management affects their eye and their vision by the eye doctor is extremely important. Patients need to understand and act on the importance of these yearly eye exams,” said Dr. Ramchandran. “Ultimately, the key to avoid vision loss is to manage their diabetes well, especially achieving optimum blood sugar control, and this requires education of the patients by their primary care providers and patient educators on the management of diabetes. If patients understand and act on achieving optimum diabetes control, especially sugar control, they have a high chance of never developing vision threatening diabetic retinopathy.”

“Patient education is essential to patient centricity and must be encouraged,” said Prevent Blindness’s Todd. “Yet, we must also remember that people living with diabetes often face multiple health problems, which can lead to information overload for them and their care partners. Therefore, keeping educational resources complete, yet concise, is critical to patient friendly information.”