Diabetes: Don’t lose sight of danger to your eyes

Diabetes wrecks many parts of the body, including the eyes, thereby causing poor vision and blindness. In this report by SADE OGUNTOLA, experts warn that with good blood sugar management and regular eye examinations, damage to the eyes could be prevented or treated.

D IABETES can wreak havoc on many parts of the body, including the eyes, but people with diabetes are not doomed to have problems with their vision. With good blood sugar management and regular eye examination, many eye conditions can be prevented or treated, experts say.

Mrs. Sherifat Haruna, a retired school teacher, wished she had known more about preventing eye problems related to diabetes before it was too late. She was diagnosed with type 2 diabetes at 50 and lost one of her eyes to it when she was in her 60s.

“I was always scared of eye complications and blindness from diabetes,” Mrs. Haruna said. Her uncle and her mother both had diabetes and had problems walking. But Mrs. Haruna was diagnosed in the 1990s after she kept having problems seeing and at the hospital, she was told it had been due to poor blood sugar control.

“Looking back, it started with a fluctuating blurry vision and difficulty seeing little dots. Afterwards, there were spots or dark strings floating in my vision. Then one day I saw flashes in my left eye,” she said.

Diabetes occurs when glucose (sugar) in the blood is not converted into energy, so its level becomes too high. Blood sugar levels rise due to a dysfunction in the way insulin, a hormone that regulates high blood sugar is released. If the pancreas does not produce enough insulin or the body’s cells do not react to insulin, blood sugar levels have free reign.

Dr Gboyega Ajayi, a consultant ophthalmologist, Ojulowo  Eye Clinic, Mokola, Ibadan says “The longer an individual has diabetes, the more the chances of the person having eye challenges. These challenges worsen if there is no proper blood sugar control as diabetes effect will show more on the eyes 10 or more years down the line.”

Diabetes-related eye disease can occur when there is damage to the blood vessels on the retina, a thin layer at the back of the eye. This damage, medically termed diabetic retinopathy, is related to the abnormally high blood sugar levels which limit oxygen and other nutrients reaching the eye. The retina is the part of the eye that senses light and sends visual messages to the brain.

Symptoms of diabetes-related eye disease might include blurry vision, seeing spots or floaters, dark or empty spots in the centre or peripheral vision or poor contrast or colour vision.

Many cases of diabetes-related eye diseases are detected late because, at its early stages, there might be no symptoms. It goes unnoticed as it may not cause significant visual problems.

According to Dr Ajayi, many cases are diagnosed after a sudden impairment of vision or sudden change of glasses. “When diabetes-related eye disease becomes more advanced, it can cause blurred or distorted vision and blindness. So, there is the need for a comprehensive yearly eye examination to find the damage and treat early before they have irreversible damage to the eyes. Abnormally high blood sugar causes the lens in the eye to swell preventing the ability to see. Usually, the blurry vision disappears within a few days of the blood sugar becoming normal. However, if the blurry vision persists after the fasting blood sugar has become normal, it may be due to more serious causes.

“Also, anyone can get cataract, a condition when the natural lens inside the eye gets cloudy, and this prevents light to pass through. But people with diabetes tend to get it earlier, and it worsens. Similarly, diabetic patients are more likely to have glaucoma which can come in several forms and types. Pressure builds up inside the eye because its fluid cannot drain as it should. This leads to damage to the nerves and blood vessels and can cause changes in vision.

“In addition, diabetes can affect the macula, the area of the retina that provides the best vision necessary for reading, driving and other similar activities. The fluid makes the macula swell, blurring vision.”

Importantly, a known diabetic must keep their blood sugar under control with the necessary medication and diet. Frequent measurement of random fasting and postprandial blood sugars, as well as Hba1C level, is advised.

Associated conditions such as hypertension and high cholesterol levels should also be kept under control as these can either aggravate the diabetic effects on the eye or by themselves affect the eye. Smoking should be avoided, and physical activity is encouraged.

In case of detection of diabetic retinopathy, the treatment varies depending on the stage of the condition. Milder stages of the disease only require stricter control of blood sugar levels. More severe stages will require some form of laser, injections or in some cases, surgery. Depending upon the severity of the condition, the management and follow-up examinations will vary from person to person.

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