Diabetes Health Talk

Each year thousands of Americans are diagnosed with diabetes.

Not only do they have to learn how to manage their disease, they also need to be concerned about vision.

German Martinez has a doctor check his eyes regularly, because he doesn’t want his vision to get any worse.

He’s already considered legally blind.

“I no longer drive, because I’m visually impaired and I can no longer pass the DMV eye test,” said Martinez.

Doctors say diabetes caused his vision problems.

“With diabetes, the disease process has to do with blood and the blood vessels start becoming leaky and can clog up also so what will happen in the eye is the blood vessels start leaking, they can leak fluid or blood or lipids and that can cause huge vision damage,” Optometrist Dr. Karin Meng said.

Martinez has diabetic retinopathy, abnormal blood vessel changes in the eye’s retina.

It can cause patients to see the world like this, experience blurriness, and in some cases blindness.

Hispanic Americans like Martinez are especially at risk for the condition because they’re at higher risk of developing diabetes.

Optometrist Dr. Karin Meng says the best thing diabetics can do for their eyes is to get regular checkups and effectively manage their disease.

“The best thing you can do is take care of your diabetes: follow your doctor’s instructions, exercise is a big component, the correct diet is a big component, take the medications,” said Dr. Meng.

The first signs of vision problems related to diabetes include fluctuating, blotchy or blurred vision.

Diabetics are also more likely to develop glaucoma, a disease that damages the optic nerve.

A laser treatment prevented Martinez from further vision loss.

He may not be able to drive any longer, but he’s the driving force behind encouraging other diabetics to get their eyes checked.

If you’re planning to retire to Florida or Arizona for health reasons, be sure to pack your sunglasses.

That’s the message from a new study that found that older people with low levels of certain antioxidants present in many fruits and vegetables, and who are exposed to short-wavelength blue light from the sun, are more likely to develop certain types of age-related macular degeneration (AMD). But the damage can start decades before you turn 65.

“We recommend that people use eye protection, including sunglasses and wide-brimmed hats, if going outside and especially in bright sunlight” and during the middle period of the day, said Astrid E. Fletcher, lead author of the study published in the October issue of the Archives of Ophthalmology.

“Our advice on nutrition,” she added, “is that people should ensure that they follow the five-a-day recommendations. In particular, they should see that their diet includes leafy green vegetables, citrus fruit, vegetable oils and nuts, as these are good sources of the antioxidant vitamins of relevance to the retina.”

Dr. Julie Belkin, an ophthalmologist with University Hospitals Case Medical Center in Cleveland, said, “Sunglasses are recommended anyway, and most people who have a normal, balanced diet will get adequate levels of those antioxidants. But there are vitamin supplements if you have other risk factors or other eye findings that put you at risk.”

While the authors of the new study found that the link between blue-light exposure and low antioxidant levels was stronger in middle age, compared to younger years, other experts said it’s unclear when the damage takes place.

“We don’t really know how many years it takes” for AMD to develop. “For some people, it could be a few years in the sun is bad, and for others, a few decades is bad,” said Dr. Robert Cykiert, an associate professor of ophthalmology at New York University Langone Medical Center in New York City.

Previous studies had suggested that blue light may damage the retina and set eyes on the path to developing AMD, a leading cause of vision loss in Americans aged 60 and older.

Studies have also shown that antioxidant enzymes such as vitamins C and E, the carotenoids (lutein and zeaxanthin), and zinc can protect against blue light. But no one had really looked at how blue light and antioxidants might interact to affect the risk for AMD.

Visual impairment appears to be more common in people with diabetes than in those without the disease, according to a report in the October issue of Archives of Ophthalmology.

Approximately 14.6 million Americans had diagnosed diabetes mellitus in 2005 and another 6.2 million had undiagnosed diabetes, according to background information in the article. It is estimated that the number of individuals with diagnosed diabetes will increase to 48.3 million by 2050. “Diabetic retinopathy [damage to the retina caused by diabetes], one of the most common microvascular complications of diabetes, is considered to be one of the major causes of blindness and low vision,” the authors write. Although studies suggest that controlling glucose and blood pressure have reduced the rate of retinal diseases, other ocular conditions suffered by diabetic patients, such as cataract and glaucoma, may increase the risk of visual impairment. Additionally, decreased vision caused by an abnormal shape of the cornea is also common among people with diabetes.

Xinzhi Zhang, M.D., Ph.D., and colleagues at the Centers for Disease Control and Prevention, Atlanta, used data from the National Health and Nutrition Examination Surveys from 1999 to 2004, which included 1,237 adults with diabetes (average age 59) and 11,767 adults without the disease (average age 45) and also measured their visual acuity before and after optical correction. Participants’ vision was tested while they were wearing any glasses or contacts they typically used, and their demographic information was also noted.

An estimated 11 percent of American adults with diabetes had some form of visual impairment (3.8 percent uncorrectable and 7.2 percent correctable), while only 5.9 percent of those without diabetes had some form of visual impairment (1.4 percent uncorrectable and 4.5 percent correctable). “People with diabetes were more likely to have uncorrectable vision impairment than those without diabetes, even after controlling for selected other factors,” the authors write. “Our findings also suggest a strong association between visual impairment (correctable and uncorrectable) and older age, member of racial/ethnic minorities, lower income and lack of health insurance, all independent of diabetes status.”