Nov 13, 2014

Interviewer: If you have diabetes, you are at higher risk of eye disease than people without diabetes. We'll talk about that, and what you should know next, on The Scope.

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Dr. Bill Barlow is an ophthalmologist at the Moran Eye Centre. Diabetic eye disease, why is it so important for diabetics to make sure they get annual eye exams?

Dr. Barlow: Well the goal with that exam is to number one, identify diabetic changes at an early point in the disease, so that treatment can be instituted to try and prevent more severe damage that is vision threatening and cannot be reversed.
The other goal is of course, to encourage patients to take care of their diabetes. That's probably the biggest risk factor for developing diabetic problems is poor control of the diabetes. So again, it's just a way of reminding them of, "Hey, you're doing a great job. Keep it up." Or, "Hey, we need to be better," and these are the risks associated with not doing a better job of controlling their blood glucose, to controlling their diabetes, and the long-term ramifications not only to their eyes, but to other organs in the body, their hearts, their kidneys, etcetera.

Interviewer: Diabetes is just brutal, and the cause of so many different health issues. What type of eye diseases are most threatening to people with diabetes? Are there some that are more so than others?

Dr. Barlow: Diabetes can cause a number of different things, or different problems in the eye. Retinopathy, which is damage to the retina, that's the back part of the eye, it's the wallpaper if you will of the back part of the eye that's the initial light sensing organ of the eye. So, that light signal is taken by the retina and transmitted to the brain for interpretation.

Interviewer: It's pretty important.

Dr. Barlow: If it causes damage to that, our vision quality drops significantly. So, it can cause swelling in the retina, bleeding in the retina. It can cause abnormal blood vessels to grow inside the eye which can leak and bleed, and can cause scar tissue that can pull the retina off the back of the eye, and cause significant damage, and in some cases, permanent damage that can't be reversed. And so, that's why it's so important to take good care of the eyes, checking at least annually, or if there are diabetic changes, we will of course check it more frequently to monitor for treatment if it's needed, to try and prevent those particular problems from causing permanent vision loss.

Interviewer: Is that type of eye disease just for people that have diabetes, or do people without diabetes get that?

Dr. Barlow: There are some diseases that can cause things that look somewhat like it, but these changes are mostly diabetic-related.

Interviewer: Okay. What about other eye diseases that are common to regular people; people with diabetes, are they more susceptible to it?

Dr. Barlow: Diabetes does tend to cause cataract formation to occur at an earlier age. It can be associated with other eye health problems. It doesn't necessarily cause an increased risk of a lot of other issues. I mean, the main concern with diabetes is looking at the retina, protecting the retina from permanent damage from blood vessel damage from the diabetes.

Interviewer: If your diabetes diagnosis changes, does the threat of that eye disease change as well?

Dr. Barlow: So for example, somebody who has Type 2 diabetes, so they're diagnosed in adult age, they have a lot of weight loss that they're able to obtain through changing their diet and exercise patterns, in some cases their diabetes is "cured." They don't have diabetes any more. In that case, they can lower their risk substantially of developing diabetes-related problems. Again, the risk of developing diabetic changes is directly correlated with blood glucose control.
And so again, if somebody gets to the point where their blood glucose levels and all of the measures of that are within the normal range by changing diet and exercise patterns, just living a healthier lifestyle, in those cases yeah, they can return their risk down to the same level as somebody who doesn't have diabetes.
I think there's been a lot of public awareness campaigns and education about the importance of diabetes and eye exams, and taking care of that. And certainly, primary care physicians, family practice physicians, internists, endocrinologists, etcetera do a great job of educating their patients. They spend a lot of time hammering home these concepts, trying to help them understand that.

Interviewer: Is there anything else that somebody could do, other than annual eye exams if they have diabetes, to protect their eyes?

Dr. Barlow: The most important thing in terms of protecting their eyes, and this is a message I give to every patient I see that has diabetes, work with your doctor that's helping you manage that. Ask them, "How can we get the blood glucose control better than it is now?" Keep working to improve that. The tighter the blood glucose control, the better that control is, long term; the lower the risk of having problems long term.
So, I'm doing surveillance for problems, but if you keep that blood glucose control tightly controlled or really well controlled, every time I see you it's going to look beautifully healthy. We've never going to see any problems, and that's what I love to see. I just tell a patient, "You're doing a great job. Just keep doing what you're doing." And that's a patient that's going to do well, see well, and not have any problems, most likely.

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