Houston Chronicle

People with diabetes often face elevated risk of eye disease

Doctors say regular exams, personal awareness of changes in vision are critical to early diagnosis

- By Lindsay Peyton CORRESPOND­ENT Lindsay Peyton is a freelance writer.

The learning curve was steep when Ofelia Alvarez was first diagnosed with diabetes in her 30s.

She had watched family members struggling with the condition. “But I really didn’t know exactly what I had to do, until I actually had it myself,” she said. “And it’s still a learning process.”

Early on, she learned the importance of regular eye exams.

Now 61, the Bay City resident goes to two eye doctors — an ophthalmol­ogist and a retinologi­st — in Sugar Land two or three times a year. She also heads to their practices immediatel­y if she notices a change in vision or pain in her eye.

“They take me in right away, because they know how serious it is,” she said.

When Alvarez first started going to the ophthalmol­ogist, she noticed her vision was blurry, and she saw floaters every once and a while.

“But I didn’t think much of it,” she said.

About six years ago, however, both of her retinas detached. She described her sight almost like double vision, seeing one angle and then another.

“I woke up, and it was like a camera trick,” she said.

Alvarez underwent an operation for the two detached retinas — and, at first, normal vision returned to both eyes. Then, slowly, the right eye stopped working.

“It was like a lens closing up on you,” Alvarez said. “I ended up losing sight.”

Now her right eye wanders, does not open all the way and is starting to turn white. Her vision loss prevents her from driving.

“It’s the worst thing,” Alvarez said. “I really recommend that people take your eyes seriously. They don’t realize how much their lives will change when they don’t have eyesight anymore.”

She hopes other diabetes patients will learn from her experience and understand the role of regular eye exams when it comes to preventing vision loss.

“Once you lose it, you can’t get it back,” she said.

Diabetic eye disease

Diabetes is the No. 1 cause of blindness among working-age adults, according to the Centers for Disease Control and Prevention.

Dr. Christina Weng, professor of ophthalmol­ogy at Baylor College of Medicine, explained that diabetic eye disease is unlike other retinal diseases because it often affects people in “the prime of their lives, when they’re still working and raising families.”

“It’s a shame that there are still many people who aren’t aware of it, because the associated vision loss is largely preventabl­e,” she said. “No one should go blind due to diabetes in this day and age.”

More than half of the individual­s diagnosed will be affected by diabetic eye disease in their lifetime.

There are different types of diabetic eye disease. For instance, diabetic macular edema is the result of damage from the blood vessels in the retina, caused by high blood sugar.

“The vessels lose their integrity, and they start leaking,” Weng said.

The leak affects the central part of the retina, or macula, she added, which results in blurry vision.

“The retina is basically like the film of a camera,” Weng said. “If there is distortion of the tissues, patients will start noticing that they can’t see as well.”

In the past two decades, she said, an effective treatment has been developed called anti-vascular endothelia­l growth factor, or anti-VEGF. “Anti-VEGF injections basically help seal vessels up,” Weng said.

Other options include steroids and laser treatment.

An optical coherence tomography scan is used to diagnose diabetic macular edema.

Another form of diabetic eye disease is proliferat­ive diabetic retinopath­y, which results when new blood vessels grow on the surface of the retina.

The vessels are essentiall­y in the wrong location — and are often weak and prone to bleeding when left untreated. The retina can be pulled off the wall of the eye, requiring surgery.

“It is the most advanced diabetic eye disease,” Weng said. “And it’s something that does affect a lot of patients, especially if they have not had routine monitoring of their eyes.”

The condition starts as nonprolife­rative diabetic retinopath­y, or a more mild or moderate form, before advancing to proliferat­ive diabetic retinopath­y.

“That’s why we recommend at least an annual dilated eye examinatio­n for every single patient with diabetes,” Weng said.

When detected early, nonprolife­rative diabetic retinopath­y can be controlled or even reversed by controllin­g blood sugar, maintainin­g a healthy weight and not smoking. Weng said that patients who have NPDR often have no symptoms.

“But that can almost be a negative, because it can mislead the patient into thinking they are fine and skip screening exams,” she said. “They may have severe NPDR and not know it.”

Proliferat­ive diabetic retinopath­y can be addressed through antiVEGF injections or laser treatment. Surgery is reserved for the most advanced forms of the disease, Weng explained.

“The best treatment is prevention,” she said. “Routine screening is so, so important. Keep your eyes healthy and your good vision for life.”

A collaborat­ive team for diabetic treatment

In Alvarez’s case, diabetic retinopath­y will continue to require close monitoring. Her endocrinol­ogist, Dr. Shreya Parikh with Memorial Hermann in Sugar Land, said that vision loss is only one of the organ failures her patient faces.

“Diabetes is kind of a silent illness up until it causes problems,” she said. “And diabetes isn’t like having a cold. It’s a chronic illness.”

That means a team of specialist­s is often required to manage and address health concerns. Kidney damage, vision loss, heart disease, nerve damage and problems with the feet can be common for diabetic patients.

“You have to watch your diabetes and be proactive,” Parikh said.

And each patient is different, she said. For instance, Type 2 diabetes patients often respond more to improved diet and exercise, while Alvarez has Type 1 diabetes, which can be more difficult to manage.

“Even though Ofelia is doing what she needs to, her sugars have a mind of their own,” Parikh said.

The endocrinol­ogist often tells patients, “Your diabetes will be predictabl­y unpredicta­ble. But we try to eliminate guesswork.”

New technology, like insulin pumps with LED displays and touchscree­ns, have helped Alvarez.

Parikh urges that patients maintain regular visits with specialist­s, like the eye doctor, podiatrist and kidney specialist.

“We want to take control of your diabetes — and not let it take control of you,” Parikh said. “Know what’s happening with your diabetes, instead of reacting to it.”

 ?? Photos by Meridith Kohut/Contributo­r ?? Dr. Shreya Parikh, an endocrinol­ogist with Memorial Hermann in Sugar Land, examines the eyes of Ofelia Alvarez, who is diabetic.
Photos by Meridith Kohut/Contributo­r Dr. Shreya Parikh, an endocrinol­ogist with Memorial Hermann in Sugar Land, examines the eyes of Ofelia Alvarez, who is diabetic.
 ?? ?? Alvarez, whose diabetes has affected her eyesight, closely monitors her vision to help prevent future loses.
Alvarez, whose diabetes has affected her eyesight, closely monitors her vision to help prevent future loses.
 ?? ?? Alvarez adjusts her insulin pump before her doctor’s appointmen­t. She was diagnosed with diabetes in her 30s.
Alvarez adjusts her insulin pump before her doctor’s appointmen­t. She was diagnosed with diabetes in her 30s.

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