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Do You Have Diabetes? Take Good Care of Your Eyes

Featured Speaker

Shalini Johnson, MD

Shalini Johnson, MD

About this Podcast

About This Podcast

Diabetes can harm your eyes.

It can damage the small blood vessels in your retina, which is the back part of your eye. This condition is called diabetic retinopathy.

Diabetes also increases your risk of having glaucoma, cataracts, and other eye problems.

You may not know there is any damage to your eyes until the problem is very bad.

Your doctor can catch problems early if you get regular eye exams.

If your doctor finds eye problems early, medicines and other treatments may help prevent them from getting worse.

Shalini Johnson, MD is here to discuss Diabetic eye care.



Melanie Cole (Host):  If you have diabetes, there are steps that you can take to avoid eye problems. My guest today is Dr. Chalene Johnson. She’s an ophthalmologist specializing in comprehensive eye care for all ages at Aspirus Eye Clinic. Welcome to the show, Dr. Johnson. Tell us a little bit about some of the risks for diabetics that they might possibly develop eye problems.

Dr. Chalene Johnson (Guest):   So, in general, diabetes is a systemic disease. Just as diabetes affects other parts of your body, diabetes can also affect your eyes. Specifically, high blood sugars can cause damage to your blood vessels and your nerves. In your eyes, you have a lot of very fine blood vessels that supply blood to your retina, to your macula, to different parts of your eyes, so as high sugars or advanced stages of diabetes can cause damage to blood vessels in other parts of your body, it can also do the same to those blood vessels in your eyes.

Melanie:  What are some of the conditions that could come about if your eyes are not taken care of when you have diabetes?

Dr. Johnson:  Specifically, diabetic retinopathy. Diabetic retinopathy is when those blood vessels are damaged in your retina and the retina no longer has the proper blood flow to the retina and this causes changes in the retina where the blood vessels leak and causes the retina to swell up and causes edema, which is basically swelling in those tissues. The other thing that can happen is when there’s not proper blood flow to the retina, abnormal blood vessels can grow and those blood vessels can bleed. So, you can have bleeding in the eye, you can gave edema or swelling in the eye and all these things can cause changes in your vison that can eventually lead to permanent blindness.

Melanie:  Our eyes are so precious. What do you want people to do first and foremost to protect their eyes, if they have diabetes?  Then, we’ll talk about getting those exams and what they can expect.

Dr. Johnson:  The most important things for avoiding complications from diabetes is really preventing the blood sugars from being uncontrolled. So, following up with your primary care doctor to have those blood sugars well controlled, optimized is crucial in avoiding these other complications that can happen in your eyes. It’s also very important to get an annual eye exam to detect if those changes are occurring because these changes actually happen very, very slowly over time and it is very difficult, if not impossible, for patients to know when those changes are happening early on. So, having those regular checks or eye exams will be able to identify those changes early and to do intervention early to prevent further complications.

Melanie:  You said that it was impossible for them to know. Are there any symptoms--things that might crop up that would say, “Whoa, I have to get myself to an ophthalmologist very quickly”?

Dr. Johnson:  Yes. Once the changes in the eye get to a certain point, once the diabetic retinopathy is more advanced, then there are changes. So, some of the symptoms that patients may notice are blurred vision. They may notice floaters which may look like little shadows that are just moving around in their vision. They also may notice parts of their vision missing, so they may notice a big blind spot if they look out in their vision part of it, it may just be missing.

Melanie:  What can they expect from the eye exam if they start to get any of these symptoms, if they start to get blurry vision or even pain in their eyes and they come to see you, what can they expect?

Dr. Johnson:  In terms of the eye exam, we would do a comprehensive eye exam where we would check the vision, we would check the eye pressure to make sure that’s normal and then we would do a very detailed exam of the eye itself with what we call a slit lamp. It just basically gives us a very high magnified view of the eye structures. Then, we would put some drops in the eye to dilate the pupil so that the ophthalmologist would be able to look at the retina to detect if there are any changes within the retina itself. If there are changes, then we could do further imaging studies. There’s an imaging study called the OCT where we would actually image the layers of the retina to see if there’s any fluid or swelling in the retina.

Melanie:  If they have had some of these symptoms and changes, is there anything you can do to reverse it? It’s extra important if you can’t, that they come and see you regularly.

Dr. Johnson:  Yes. If we can actually detect these changes early on, it responds to interventions a lot quicker and a lot better. If there is any type of fluid build-up in the eye, the longer that fluid build-up or that bleeding has been there, it’s less responsive to any type of treatment. So, treatment including laser treatments or injections of the medicine that we can put in the eye to dry up that fluid or dry up that swelling in the eye. The longer that changes in the eye, the less responsive it is to those treatment options we have.

Melanie:  Does diabetes, Dr. Johnson, put you at risk for other eye problems besides diabetic retinopathy?  Because we hear about eye problems like glaucoma and cataracts, are you at higher risk for any of these?

Dr. Johnson:  Yes. Diabetes can affect the retina but high sugars can also cause the clouding of the lens to occur more quickly. So, it can cause quicker progression of your cataracts. In addition, in more advanced stages of diabetes when there’s not proper blood flow to the eye, the eye will try to compensate for that lack of blood flow by causing abnormal blood vessels to grow in the eye. Sometimes these abnormal blood vessels grow in the angle of the eye and that can cause high pressures to build up in the eye. This is called “neovascular glaucoma”. So, that’s a type of glaucoma that can result from diabetes itself and this can lead to symptoms such as pain, sudden decrease in your vision, you can see halos around lights, sometimes you can have nausea and vomiting and it’s a very acute, uncomfortable situation to be in.

Melanie:  In just the last few minutes, give us your best advice for people suffering with diabetes and taking good care of their eyes and your best lifestyle and behavior modification advice to protect those precious eyes.

Dr. Johnson:  The best thing to do is to optimize the blood sugars, to keep the blood sugars under as good control as possible and to also get an annual eye check so that we can detect if there any of those changes occurring early on. If we catch those changes early on, we can intervene more effectively.

Melanie:  That’s great advice. Thank you so much, Dr. Johnson. You’re listening to Aspirus Health Talk and for more information, you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.