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Detecting diabetes through the eyes



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Diabetes is an epidemic. More than 18 million people in the United States, or 6.3 percent of the population, have diabetes, according to the American Diabetes Association. Unfortunately, one-third of them don't know it. While an estimated 13 million have been diagnosed with diabetes, 5.2 million people are unaware that they have the disease.

Diabetes was the sixth-leading cause of death listed on U.S. death certificates in 2000. The risk of death among people with diabetes is about double that of people without diabetes.

Heart disease and stroke, high blood pressure, kidney disease, nervous system disease, amputations, impotence, dental disease and pregnancy complications are all ill effects of diabetes.

Diabetes is also the leading cause of new cases of blindness among adults 20 to 74 years old. However, the majority of cases of blindness are preventable with proper treatment, and an eye exam can serve as the first line of detection and diagnosis for diabetes.

COMPREHENSIVE EYE EXAM

During a comprehensive eye exam, the outside and inside of the eye is examined, seeing blood vessels directly. The eye is the only place on the body where blood vessels can be seen without having to look through skin or tissue that interferes with the view.

RETINOPATHY

Diabetes damages the retina of the eye. This damage is called "retinopathy." Diabetic retinopathy causes between 12,000 and 24,000 cases of blindness each year. Diabetic retinopathy occurs as a consequence of abnormalities in the blood vessels of the retina - usually as a response to abnormal blood sugar levels.

There are two types of diabetic retinopathy: Non-proliferative and proliferative.

Nonproliferative diabetic retinopathy occurs when the retinal capillaries, the smallest blood vessels, become weak. This allows serum (the clear liquid portion of blood) to leak from within the capillary and into the retina. This results in swelling of the retina. The swelling affects the retina, and vision may decrease as a result. Patients may also notice distortion or difficulty reading when this occurs in the center of the retina, known as the macula.

Destruction of retinal capillaries may cause deterioration of vision due to lack of blood to the retina.

Proliferative diabetic retinopathy is the advanced form of diabetic retinopathy and occurs when new, abnormal blood vessels grow in the retina. These blood vessels are fragile and can cause scarring, which may lead to decreased vision or even blindness.

The growth of these new vessels, called neovascularization, can also allow bleeding within the eye. If the eye fills with blood, the patient may see floaters or experience a sudden loss of vision.

Advanced cases of proliferative diabetic retinopathy may allow scar tissue to form which can pull the retina from its normal position. The detachment that occurs can result in a devastating loss of vision.

DIAGNOSIS AND MANAGEMENT

Early detection is critical to the prevention of vision loss and diabetes treatment. People should have a yearly eye exam, regardless if they consider their vision to be good. Many patients who have retinopathy do not have symptomatic vision loss.

SOURCES:

- Herald archives

- American Diabetes Association

- American Optometric Association

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DIABETES FACT SHEET

- Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.

- The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

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MAJOR TYPES OF DIABETES

- TYPE 1 DIABETES: Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5 percent to 10 percent of Americans who are diagnosed with diabetes have type 1 diabetes.

- TYPE 2 DIABETES: Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.

- GESTATIONAL DIABETES: Gestational diabetes affects about 4 percent of all pregnant women - about 135,000 cases in the United States each year.

- PRE-DIABETES: Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 41 million Americans who have pre-diabetes, in addition to the 18.2 million with diabetes

SOURCE: American Diabetes Association

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EYE-RELATED WARNING SIGNS

- blurred vision

- trouble reading signs or books

- seeing double

- one of both eyes hurt

- eyes get red and stay that way

- pressure in the eyes

- seeing spots or floaters

- straight lines do not appear straight

- limited peripheral vision

SOURCE: American Optometric Association

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(c) 2004, Bradenton Herald (Bradenton, Fla.). Distributed by Knight Ridder/Tribune News Service.

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