November is National Diabetes Month and this gives me the opportunity to get up on my soapbox and shout through my megaphone about the importance of yearly eye exams. For patients who know they have diabetes, dilated eye exams are crucial in order to ensure that there is no diabetic retinopathy in the back part of the eye which if not treated can lead to blindness.
So what is diabetes and how does it affect your eyes? Diabetes is a disease which according to the CDC affects more than 100 million Americans and interferes with the body’s ability to store and utilize sugar. Very often patients who are unaware that they are diabetic will experience scary fluctuations in vision which will bring them into my office to see what’s going on. At this point I will refer them out for blood work and a visit with the primary doctor to check for diabetes. Changes in blood sugar can cause these wild changes in the prescription which will stabilize once the glucose (sugar) levels are under control. Once someone has had diabetes for many years and/or has poor control of their sugar levels, the risk of having diabetic retinopathy skyrockets. Diabetic retinopathy happens when the small blood vessels on the back surface of the eye weaken and leak blood and fluid into the retina. If this progresses further without blood vessels shutting off and the creation of new abnormal blood vessels creating scarring which can cause vision loss and/or blindness.
How do you prevent this? The key is keeping blood sugar levels under tight control. This is accomplished by paying attention to diet, exercising, keeping blood pressure and cholesterol under control and not smoking – in other words – maintaining a healthy lifestyle. One important number to be aware of when you come in for your eye exam is your HA1C (or glycosylated hemoglobin) which reflects the overall blood sugar levels over a three month period. Generally this number should be under 7.
All diabetic patients get a letter sent to their primary doctor after their eye exam with the results of the retinal evaluation. If there is retinopathy the primary doc may have to tinker with the meds in order to achieve better glucose control. Above all, be vigilant about any vision changes that are scary or unusual. As I always tell my patients, nothing is stupid or trivial and I’d rather check you and find nothing than have you ignore something serious.
The other day the cutest little girl came in for her first eye exam. She was starting third grade and was an excellent student reading above grade level. Her parents were sure she didn’t need glasses but thought it was time for her to start having routine eye exams. She was articulate and outspoken and wanted to be done with her visit so she could get on with her day. She read the eye chart in her right eye all the way down to the tiniest letter and was eager to do the same on the left eye. To everyone’s surprise she struggled, barely getting down to the second to last line, guessing and growing frustrated as she realized something wasn’t right. She also had some trouble seeing in 3D which indicated that her two eyes were not working together. At the end of the exam I told her parents that although her right eye was perfect she was hyperopic, or farsighted in her left eye and the large discrepancy between the two eyes had created amblyopia (lazy eye) in that left eye. She left with a new pair of glasses and a follow-up appointment in three months. 
This little girl and her family were lucky that she was doing so well in school despite her amblyopia and suboptimal visual system. Don’t wait until your child complains or you get a note sent home from the school nurse or your child’s teacher – book your childs yearly exam now before the school year gets underway. 
The study examined other foods that have flavonoids such as tea, apples and red wine (yes please) but for some reason oranges were the only food that aided in the prevention of AMD. The authors of the study acknowledge that more research has to be done before doctors can definitely prescribe an orange a day to keep AMD away.
As a dry eye patient myself I empathize with my fellow dry eye sufferers. For many of us, dry eye is a chronic condition that waxes and wanes for myriads of reasons. Dry eye sounds innocuous but anyone who has experienced it knows it can severely affect the ability to see both clearly and comfortably. Dry eye is a condition in which a person does not have enough “quality” tears to lubricate and nourish the eye. I give the example of driving with a dirty windshield – in order to see clearly to drive you need the wipers and the washer fluid in tandem to make the window clear and allow you to see well. So too if the tears and the eyelids are not working well together the vision will be impaired – like driving with a filthy windshield.
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