You’ve just been diagnosed with diabetes. Your head is still spinning with the news. Sensory information overload. Somewhere in between hearing those 3 words “you have diabetes,” you also heard that you should get your eyes checked. No problem. There are many optometrists out there in your community just like me. The first thing I usually do is to take a very detailed history of your overall health including various aspects of your diabetes management. Be prepared to answer questions regarding when you were first diagnosed with diabetes about what oral or injectable medications you are currently taking and what your blood sugar readings are. The history portion of the exam will also give me a chance to get to know you better and allow us to work together to set some important health care goals.
I tailor my diabetic eye work-ups for each patient that comes under my care, depending on if he/she is a newly diagnosed diabetic or have had some issues with diabetes in his/her eyes.
A complete diabetic examination may include but not limited to checking for prescription changes, lens clouding, and swelling or bleeding in the back of the eye.
With vigilant and periodic evaluations, you should reduce the chance of ever developing any of the following diabetic changes. Diabetes may cause your vision to “fluctuate” making your vision clear during parts of your day and blurry at other times. So, I will definitely check to see how different your prescription has changed from your previous exam. Diabetes may also cause you to prematurely develop cataracts or clouding of your lens. Most importantly, I will dilate your eyes to carefully inspect the retina for any bleeding, swelling, or new blood vessel growth. Again, I assure you that no one should lose their vision to diabetes these days with close monitoring. And if need be, I will refer you to a retinal specialist that I work in close partnership with for further evaluation.
Further testing or treatment by a retinal specialist may include:
- A dye test to evaluate the back of the eye (fluorescein angiography)
- Laser treatment (focal, grid, or pan retinal photocoagulation)
- Injection with steroid to reduce swelling (triamcinolone acetonide)
- Injection with anti-vegf medication that reduce swelling, stop the bleed, and stunt the growth of unwanted blood vessels (Avastin® or Lucentis®)
Now it’s your turn to do your part to prevent diabetes from developing in your eyes.
I always recommend four things to all my patients:
1) Eat sensibly – according to the American Diabetes Association, fresh veggies should fill half of your plate, a lean protein for a quarter, and a carb of your choice for the last quarter
2) Exercise for 30 minutes daily
3) Take your medication(s) as recommended by your primary care physician or endocrinologist
4) Know your level of blood sugar control. Ask your physician about your glycosylated hemoglobin or Hemoglobin A1C.
I look forward to seeing my patients back every year. Until then, stay happy and healthy.
~Judy Tong, OD, FAAO