Eye Doctor Q And A - Diabetes And Its Effect On The Eyes
Q: How does diabetes affect your eyes? L.L., Connecticut A: Diabetes causes problems in the retina with what are collectively called microvascular abnormalities. The small blood vessels develop microaneurysms and leak blood. New blood vessel growth ( neovascularization ) occurs. Unfortunately, these blood vessels are weak and also leak. These leaks (hemorrhages) can cause irreversible damage to the retina and permanent vision loss. Patients with controlled diabetes do better than those with uncontrolled diabetes. However, even a person whose diabetes is under perfect control can still develop diabetic retinopathy hence, the need for yearly retinal exams. Dr. Slonim Q: Does diabetic retinopathy get progressively worse? F.R. A: Yes. When left unrecognized and untreated, diabetic retinopathy can get worse and eventually lead to blindness. Diabetic retinopathy can even get worse despite use of the best treatments that currently exist for it. Dr. Slonim Q: My father has type 2 diabetes and he is seeing double. We went to the hospital about a week ago and they said the diabetes had affected a nerve on the right eye. Can medicine get his sight back to normal? W.C. A: Diabetes can affect any one of the three cranial nerves that are responsible for movement of the eyes. Diabetes is one of the more common conditions associated with sixth nerve (Abducens nerve) palsies. Paralysis of this nerve affects the lateral rectus muscle that allows the eye to look outward. There is no specific medicine for this. The paralysis can be temporary and last a few months or it can be permanent. Dr. Slonim Q: Can diabetes cause you to have eye infections such as pink eye and frequent styes? K.M. A: That's a great question! Yes, people with diabetes are more likely to get bacterial infections, incl Continue reading >>
What To Expect At Your Eye Exam
If you are lucky enough to have good eyesight, you may be surprised when your diabetes care team recommends that you make an appointment with an eye doctor. If your vision is stable, and your eyes don’t bother you, why should you have your eyes checked? The answer is that many potentially devastating eye problems develop without causing discomfort or distorting vision. Glaucoma and cataract are examples of eye problems that occur commonly in older adults and more frequently in people with diabetes. Generally, these conditions are treatable, but if not caught early enough, they can lead to vision loss or even blindness. In addition, there’s diabetic retinopathy, a serious complication that is more likely to occur in people with Type 1 diabetes but may develop in anyone with diabetes. Tight blood glucose control can significantly reduce the incidence and severity of diabetic retinopathy, but the only way to identify this and other eye problems in their earliest and most treatable stages is to have regular, comprehensive eye examinations. -- Keep an eye on your vision! Learn about preventive steps and treatments for diabetic retinopathy from retinal specialist Dr. Charles Wykoff. >> There’s no reason to avoid an eye exam; it involves a series of painless tests that check your visual acuity and general eye health and screen for signs of disease. Before we discuss what to expect at the exam, let’s take a look at the eye and how it works. The eye The eye is a hollow organ about the size of a Ping-Pong ball, with an opening at the front that lets in light, and a gelatinous substance called vitreous filling most of the inside. It functions in a manner similar to a camera. The aperture through which light enters the eye is the pupil, the black-seeming hole in the middle Continue reading >>
Annual Eye Exam
~ Deborah K. Schlossman, M.D. Diabetes is the leading cause of preventable new onset blindness in working-age adults. Anyone with type 1 or type 2 diabetes can have diabetic eye disease and not know it, as it is painless and often has no symptoms until very advanced stages. But with appropriate care you can reduce the risk of blindness and increase your chances of preserving sight. Joslin Diabetes Center has been on the cutting edge of diabetes-related eye disease prevention since its inception and has set standards across the world for the treatment and care of eyes. At Joslin we have developed clinical guidelines that recommend you take a three-pronged approach to preserving your vision: 1.Maintain excellent A1C and blood glucose levels. 2.Keep your blood pressure and other health factors, such as your cholesterol, in check. 3.Make sure you get your eyes checked annually through a dilated eye exam (an exam in which the doctor places drops in your eyes) or specially validated photographs of your retinas (the inside of the eyes). Eye exams for people with diabetes are very thorough and may take up to 2½ hours. Part of the exam includes applying drops to dilate your pupils, so the doctor can have a good look at what is happening at the back of your eye called the retina. No portions of the exam are painful, but when you have your pupils dilated you should be prepared to wear sunglasses after the appointment as you’ll be sensitive to light. Diabetic retinopathy is the most common eye disease for people with diabetes. It occurs when the small blood vessels in the eye are damaged by high levels of glucose in the blood. Although there are a variety of treatments to treat diabetic retinopathy, the earlier it is diagnosed the more effective the treatment. Although diabetes Continue reading >>
Diabetes Eye Exams
Diabetes can harm your eyes. It can damage the small blood vessels in your retina, or the back of your eye. This condition is called diabetic retinopathy. Diabetes also increases your risk of glaucoma and other eye problems. You may not know your eyes are harmed until the problem is very bad. Your doctor can catch problems early if you get regular eye exams. This is very important. The early stages of diabetic retinopathy don't cause changes in vision and you won't have symptoms. Only an eye exam can detect the problem, so that steps can be taken to prevent the retinopathy from getting worse. Even if the doctor who takes care of your diabetes checks your eyes, you need an eye exam every 1 to 2 years by an eye doctor who takes care of people with diabetes. An eye doctor has equipment that can check the back of your eye much better than your regular doctor can. If you have eye problems because of diabetes, you will probably see your eye doctor more often. You may need special treatment to prevent your eye problems from getting worse. You may see two different types of eye doctors: An ophthalmologist is a medical doctor who is an eye specialist trained to diagnose and treat eye problems. An optometrist is a health care provider trained to diagnose and treat problems with your vision. Many can do screening exams for damage from diabetes. Once you have eye disease caused by diabetes, you need to see an ophthalmologist. The doctor will check your vision using a chart of random letters of different sizes. This is called the Snellen chart. You will then be given eye drops to widen (dilate) the pupils of your eyes so that the doctor can better see the back of the eye. You may feel stinging when the drops are first placed. You may have a metallic taste in your mouth. To see the b Continue reading >>
Cost Of A Community-based Diabetic Retinopathy Screening Program
The prevalence of diabetes in the U.S. has steadily increased over the last few decades (1). Although adults with diabetes are at increased risk for ocular disease and blindness, primarily related to diabetic retinopathy (2), many are not evaluated for retinopathy. Barriers to vision-screening adherence among adults with diabetes include the perception—and often the reality—that examinations are expensive and a poor understanding of the increased risk of vision loss (3). The goal of this study was to determine the costs of a community-based program to screen adults for diabetic retinopathy. In this study, free ocular health screening was offered over a 17-month period at a community health center in a low socio-economic area. Fundus photographs were taken, uploaded to a HIPPA-compliant secure Web site, and reviewed for any clinical pathology and specifically for diabetic retinopathy. We collected information on all costs of the screening program. Costs were assessed in three ways in a base model: the costs per participant for 1) screening, 2) detection of ocular abnormalities, and 3) referrals for diabetic retinopathy treatment. Sensitivity analyses were conducted varying the wages of ocular technicians and estimates of time devoted to research versus screening. Overall, 607 adults with diabetes were screened. The sample was 65.6% female, 45.5% non-Hispanic black or Haitian, and 52.2% Hispanic. The average age was 55.8 years (SD 9.2). Most (78.4%) did not have insurance, 45.2% had not had an eye exam in the last 2 years, and 10.9% reported never having an eye exam. Based on the reading of the fundus photographs, 61.8% were identified with some clinical pathology and 24.4% were referred with diabetic retinopathy. More Hispanics (12.3%) than non-Hispanic blacks (9.5%) Continue reading >>
Annual Eye Exams Can Detect Diabetic Eye Disease
Having an eye exam each year is important for people with diabetes. Diabetes that is not well managed can lead to diabetic retinopathy and other eye-related problems. An annual eye exam can help detect diabetic eye diseases so they can be treated early. A description of diabetes Diabetes causes people to have too much sugar in their blood. This happens when people aren’t producing insulin in their bodies (Type 1) or when the body is resistant to insulin (Type 2). Insulin is a hormone that helps reduce sugar (also called glucose) in the blood stream. Too much glucose can lead to serious health issues, affecting the heart, kidneys and eyes. Diabetic eye diseases Diabetic retinopathy is a serious concern for people with diabetes and the number-one cause of vision loss. If a person’s blood sugar level is not in control and remains chronically high, blood vessels in the eye can be damaged and impair vision, potentially resulting in blindness. Another concern is diabetic macular edema, which can occur when high blood sugar causes fluid to seep into the retina. Get annual eye exams Doctors recommend that adults with diabetes get an annual dilated eye exam to check for micro-vascular issues that affect people with diabetes. The eye doctor checks the retina (back of the eye) for signs of retinopathy, as well as the macula (center of the retina) for diabetic macular edema. At an annual eye exam, the eye doctor will: Dilate your eyes to look at the retinas See if you need corrective lenses Check your eye pressure for signs of glaucoma Identify other concerns unrelated to diabetes, such as cataracts and dry eye Manage your diabetes To stay healthy, it is important to: Test your blood sugar regularly Take the medicines prescribed by your doctor to help manage your blood sugar Ea Continue reading >>
Facts About Diabetic Eye Disease
Points to Remember Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma. All forms of diabetic eye disease have the potential to cause severe vision loss and blindness. Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision. Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults. DME is a consequence of diabetic retinopathy that causes swelling in the area of the retina called the macula. Controlling diabetes—by taking medications as prescribed, staying physically active, and maintaining a healthy diet—can prevent or delay vision loss. Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year. Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss. Diabetic retinopathy can be treated with several therapies, used alone or in combination. NEI supports research to develop new therapies for diabetic retinopathy, and to compare the effectiveness of existing therapies for different patient groups. What is diabetic eye disease? Diabetic eye disease can affect many parts of the eye, including the retina, macula, lens and the optic nerve. Diabetic eye disease is a group of eye conditions that can affect people with diabetes. Diabetic retinopathy affects blood vessels in the light-sensitive tissue called the retina that lines the back of the eye. It is the most common cause of vision loss among people with diabetes Continue reading >>
What Is A Comprehensive Dilated Eye Exam?
You may think your eyes are healthy, but visiting an eye care professional for a comprehensive dilated eye exam is the only way to really be sure. During the exam, each eye is closely inspected for signs of common vision problems and eye diseases, many of which have no early warning signs. Annual comprehensive dilated eye exams are generally recommended starting at age 60. However, African Americans are advised to start having comprehensive dilated eye exams starting at age 40 because of their higher risk of glaucoma. It’s also especially important for people with diabetes to have a comprehensive dilated exam at least once a year. Key elements of a comprehensive dilated eye examination include dilation, tonometry, visual field test and a visual acuity test. Dilation is an important part of a comprehensive eye exam because it enables your eye care professional to view the inside of the eye. Drops placed in each eye widen the pupil, which is the opening in the center of the iris (the colored part of the eye). Dilating the pupil allows more light to enter the eye the same way opening a door allows light into a dark room. Once dilated, each eye is examined using a special magnifying lens that provides a clear view of important tissues at the back of the eye, including the retina, the macula, and the optic nerve. This video describes what a doctor sees when examining the retina, optic nerve and macula after the pupils are dilated. In a person with diabetic retinopathy, the most common diabetic eye disease and a leading cause of blindness in the United States, the exam may show swelling or leaking of blood vessels in the retina, the light-sensitive layers of tissue at the back of the eye. The eye care professional may also see abnormal growth of blood vessels in the retina Continue reading >>
Eye Exams: Importance And Costs
Vision care insurance can help with costs of regular eye exams, which can help you maintain a good quality of life. Understand the Importance and Costs of Eye Exams Eye exams don’t just detect vision problems, but can signal, or help prevent, future health problems. The cost of an eye exam can run as little as $50 and can go up to over $100, depending on who performs the eye exam and on whether or not you have vision care insurance. The basics of an eye exam You can have your eye exam performed either by an ophthalmologist or an optometrist. An ophthalmologist, according to allaboutvision.com, is an eye doctor with either an MD (medical doctor) or OD (osteopathic doctor) credential to practice medicine and surgery; an optometrist is an eye specialist with a Doctor of Optometry degree who’s not a medical doctor. The cost of an eye exam is generally lowest (often about $50), when you have it performed by an optometrist at a retail store (like Target or Costco) or at an optical chain. Eye exam cost is highest when conducted by an ophthalmologist in a clinic or an office. Here, the cost of an eye exam can run well over $100. Doctors generally recommend that you have your eyes examined every one to two years, depending on your age, according to allaboutvision.com. More specifically, if you’re over 60, you should have annual eye exams, while if you’re between the ages of six and 60, you should have an eye exam once every two years. Children under the age of six generally have eye exams at six months of age and then again at three and six. During an eye exam, the ophthalmologist or optometrist will generally perform the following procedures, according to the Berkeley Eye Center: Distance vision test, using a chart with letters that decrease in size Eye movement test, a Continue reading >>
Yearly Eye Exam
How often is it covered? Medicare Part B (Medical Insurance) covers a yearly eye exam for diabetic retinopathy by an eye doctor who's legally allowed to do the test in your state. Who's eligible? All people with Part B who have diabetes are covered. Your costs in Original Medicare You pay 20% of the Medicare-approved amount for your doctor's services, and the Part B deductible applies. In a hospital outpatient setting, you pay a copayment. To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like: Other insurance you may have How much your doctor charges Whether your doctor accepts assignment The type of facility The location where you get your test, item, or service Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them. Continue reading >>
What You Should Know About Diabetes And Eye Exams
Overview Diabetes is a disease that profoundly affects many areas of your body, including your eyes. It increases your risk for eye conditions, such as glaucoma and cataracts. The primary concern for eye health in people with diabetes is the development of diabetic retinopathy. Diabetic retinopathy is a condition that develops when the blood vessels in your retina become damaged. The retina is the light-sensitive portion of the back of your eye. As the damage worsens, you may begin losing your vision. Your eyesight may become blurry, less intense, and begin to disappear. This condition can affect people with type 1 or type 2 diabetes. The longer you live with diabetes, the more likely you are to develop complications like diabetic retinopathy. This is why adopting lifestyle changes and learning to manage diabetes is so important. In its earliest stages, diabetic retinopathy may cause no symptoms. The initial symptoms may be barely noticeable or mild. Over time, the condition can worsen and lead to partial and then complete blindness. You should see your doctor if you experience any of these symptoms: floaters, or dots and dark strings, in your field of vision dark or empty areas in your field of vision blurry vision difficulty focusing vision changes that seem to fluctuate altered color vision partial or total vision loss Diabetic retinopathy most often affects both eyes at the same time and in equal measure. If you’re experiencing issues with only one eye, it doesn’t mean you don’t have diabetic retinopathy. However, it might indicate another eye issue. Make an appointment to see your doctor to find an appropriate treatment plan. The buildup of excess sugar in your blood can lead to a number of health issues. In your eyes, too much glucose can damage the tiny ves Continue reading >>
Diabetes: Eye Exams
www.CardioSmart.org A dilated eye exam lets your eye doctor see the back of your eye. This test can detect eye problems like diabetic retinopathy. Before the test, your eye doctor will use eyedrops to widen, or dilate, your pupils. This makes it easier for the doctor to see into your eye. The eyedrops take about 15 to 20 minutes to fully dilate your pupil. Your doctor may also use eyedrops to numb your eyes. Who should get a dilated retinal exam? Everyone with diabetes should have regular dilated retinal exams. Diabetes can lead to eye problems that cause vision loss or blindness. The longer you have diabetes, the more likely you will have eye problems. By the time you notice any vision problems, your eyes may already be seriously damaged. A thorough exam can help detect symptoms early. Early treatment may help protect your vision. People with diabetes are also at a higher risk for glaucoma. This is increased pressure inside the eye, which can cause blindness. An eye exam can check for this condition along with diabetic retinopathy. How often should you be tested? If you have diabetes, get tested every year, or more often if your doctor says to. If your eye exam results are normal, your doctor may consider follow-up exams every 2 years instead of every year. But if you are diagnosed with diabetic retinopathy, youmay need frequent eye exams. Who performs a dilated retinal exam? This test can be done by: • An ophthalmologist. Ophthalmologists are medical doctors who diagnose and treat eye problems, diseases, and injuries. • A licensed optometrist. Optometrists are health professionals who diagnose and treat vision problems and eye diseases. They also do routine vision testing and prescribe eyeglasses and contact lenses. An optometrist is not a medical doctor, Continue reading >>
Diabetes Discovery – Via The Eyes
Did you know that an eye exam can be the first clue to detecting diabetes and other hidden health concerns? Finding health issues early can give patients a better chance at preventing damage through early treatment and management. A routine eye exam can show so many things. Some can be downright life changing – and life-saving – for that matter. One doctor found out first-hand when she did the same thing she does every day – she looked into a patient's eyes. But this was no ordinary exam. When Kathleen Clary, OD, peered into her 48-year-old patient’s eyes, she saw blood and other fluids seeping out of fragile and miniscule vessels in her retinas. The retina is the light and sight-sensing back part of the eye – and without it, you don't see. “As soon as I noticed the leaking fluids and the hemorrhaging, I suspected that they might be symptoms of diabetes,” recalls Dr. Clary, who practices in the Washington, D.C., suburb of Ashburn, Virginia. “In my 12 years of experience as an eye doctor, that kind of bleeding usually signals that a buildup of sugar in the patient’s bloodstream has begun to break down the capillaries that feed the retina. The result is often what we call diabetic retinopathy – a condition in which continuing damage to retinal tissue from diabetes can lead to impaired vision or even blindness, if left untreated.” The eye exam was the very first clue the patient had that she might have diabetes. Dr. Clary talked with her patient about what she saw and explained what it could mean. “I want you to have your blood sugar level checked right away by your family doctor,” she told her patient. “Tell the doctor you need to be evaluated for diabetes with a fasting blood sugar test, because your optometrist noticed some retinal bleeding. Continue reading >>
Diabetic Eye Disease: Diagnosis, Causes, And Symptoms
By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV Diagnosing Diabetic Eye Disease How Diabetes Affects the Eyes and Vision: Diabetic Retinopathy Eye Examination Guidelines Diagnosing Diabetic Eye Disease Diabetic retinopathy usually has no early warning signs. It can be detected only through a comprehensive eye examination that looks for early signs of the disease, including: Leaking blood vessels Macular edema (swelling) Pale, fatty deposits on the retina Damaged nerve tissue Any changes to the retinal blood vessels To diagnose diabetic eye disease effectively, eye care specialists recommend a comprehensive diabetic eye examination that includes the following procedures: Distance and near vision acuity tests A dilated eye (or fundus) examination, which includes the use of an ophthalmoscope. In a dilated eye examination, it is the pupil that is dilated—not the entire eye. This allows the examiner to see through the pupil to the retina. Visual acuity tests alone are not sufficient to detect diabetic retinopathy in its early stages. A tonometry test to measure fluid pressure inside the eye. A fluorescein angiography test, if more serious retinal changes, such as macular edema, are suspected. Fluorescein angiography is an eye test that uses a special dye and camera to look at blood flow in the retina. Optical coherence tomography (OCT) testing may be used to gain a clearer picture of the retina and its supporting layers. OCT is a type of medical imaging technology that produces high-resolution cross-sectional and three-dimensional images of the eye. Also, an Amsler Grid test can detect early and sometimes subtle visual changes in a variety of macular diseases, including diabetic macular edema. The first image below shows an Amsler Grid as seen with unimpaired vis Continue reading >>
Annual Diabetic Eye Examinations In A Managed Care Medicaid Population
Karen Davis, PhD, APN; Christine Buttorff, PhD; Bruce Leff, MD; Quincy M. Samus, PhD; Sarah Szanton, PhD, APN; Jennifer L. Wolff, PhD; and Farhan Bandeali, MSPH Annual Diabetic Eye Examinations in a Managed Care Medicaid Population Elham Hatef, MD, MPH; Bruce G. Vanderver, MD, MPH; Peter Fagan, PhD; Michael Albert, MD; and Miriam Alexander, MD, MPH The American Journal of Managed Care > May 2015 Published on: June 06, 2015 Annual Diabetic Eye Examinations in a Managed Care Medicaid Population Elham Hatef, MD, MPH; Bruce G. Vanderver, MD, MPH; Peter Fagan, PhD; Michael Albert, MD; and Miriam Alexander, MD, MPH We assessed challenges and barriers to annual diabetic eye examinations for a managed care Medicaid population and make recommendations to improve population-level screening. In 2004, the American Academy of Ophthalmology recommended single-field photography of the retina as a sufficient screening method for the presence of DR, but insufficient in the management of this condition in the United States.27 With the development of telemedicine technology for DR screening, various DR screening programs have been tested in the United States and around the world. The new telemedicine technology has made it possible for diabetic patients to get their annual diabetic eye exam without an ophthalmology visit. With this technology, healthcare service located in shops, workplaces, residences, schools, and primary care physician offices could obtain retinal images without the need for pupil dilation or the presence of an ophthalmologist or retina specialist.12 These healthcare services, in connection with an ophthalmology center, would complete the annual eye exam, review the scanned images, and contact patients regarding the result and necessity for further medical diagnostic Continue reading >>
