Safeguarding Vision: The Vital Role of Annual Dilated Eye Exams for Diabetics

Let's explore the three most common types of diabetes

1. Type 1 diabetes, also known as juvenile diabetes or insulin-dependent diabetes, typically manifests in childhood or adolescence. It occurs when the immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. As a result, the body cannot produce sufficient insulin, leading to elevated blood sugar levels. Individuals with type 1 diabetes require lifelong insulin therapy to manage their condition.
2. Type 2 diabetes, the most prevalent form of diabetes, usually develops in adulthood, although it is increasingly diagnosed in children and adolescents due to rising obesity rates. In type 2 diabetes, the body either becomes resistant to the effects of insulin or fails to produce enough insulin to meet the body's needs. Lifestyle factors such as poor diet, sedentary behavior, obesity, and genetics contribute to the development of type 2 diabetes. Initially, dietary modifications, exercise, and oral medications may be sufficient to control blood sugar levels. However, some individuals with type 2 diabetes may eventually require insulin therapy.
3. Gestational diabetes occurs during pregnancy when hormonal changes interfere with insulin action, leading to elevated blood sugar levels. Although gestational diabetes typically resolves after childbirth, affected individuals are at increased risk of developing type 2 diabetes later in life. Proper management, including dietary changes, exercise, and, in some cases, insulin therapy, is crucial to prevent complications for both the mother and the baby.

Now, let's delve into diabetic retinopathy 

Diabetic retinopathy is a serious complication of diabetes that affects the eyes, specifically the retina, the light-sensitive tissue lining the back of the eye. Prolonged exposure to high blood sugar levels damages the blood vessels nourishing the retina, leading to various eye problems. There are two main stages of diabetic retinopathy:

1. Non-proliferative Diabetic Retinopathy (NPDR): In this early stage, the blood vessels in the retina weaken and leak fluid or blood into the retina. This may cause blurred vision, fluctuating vision, or dark spots in the field of vision. If detected early, lifestyle changes and medical interventions can often slow or halt the progression of NPDR.
2. Proliferative Diabetic Retinopathy (PDR): As the disease advances, new, abnormal blood vessels may begin to grow on the surface of the retina. These fragile vessels are prone to leakage and hemorrhage, leading to severe vision loss and even blindness if left untreated. PDR may also cause scar tissue to form, leading to retinal detachment and irreversible vision loss.

Macular edema is another  common complication of diabetic retinopathy that can occur at any stage of diabetic retinopathy. It occurs when fluid accumulates in the macula, the central part of the retina responsible for sharp, central vision. As fluid builds up, it distorts the macula, leading to blurred or distorted vision. Macular edema can significantly impair visual function and quality of life if left untreated.

Risk Factors for Diabetic Retinopathy

Several risk factors contribute to the development and progression of diabetic retinopathy, a common complication of diabetes that affects the eyes. These risk factors include:

1. Duration of Diabetes: The longer someone has diabetes, the greater their risk of developing diabetic retinopathy. Individuals with type 1 diabetes are at risk soon after diagnosis, while those with type 2 diabetes may develop retinopathy several years after the onset of the condition.
2. Poor Blood Sugar Control: High blood sugar levels over time can damage the blood vessels in the retina, leading to diabetic retinopathy. Tight control of blood glucose levels through diet, exercise, and medication can help reduce the risk of retinopathy.
3. Other medical conditions: Elevated blood pressure and elevated levels of cholesterol and triglycerides in the blood can further damage the delicate blood vessels in the retina, exacerbating retinopathy and increasing the risk of vision loss. Diabetic retinopathy and diabetic nephropathy (kidney disease) often occur together, as both conditions are complications of diabetes. Individuals with diabetic nephropathy are at higher risk of developing retinopathy and experiencing vision loss.
4. Pregnancy: Pregnant women with diabetes, especially those with poorly controlled blood sugar levels, are at increased risk of developing diabetic retinopathy. Close monitoring of blood glucose levels and regular eye exams during pregnancy are essential to minimize this risk.
5. Smoking: Smoking is associated with an increased risk of diabetic retinopathy and can accelerate the progression of the disease. Quitting smoking can help reduce this risk and improve overall eye health.
6. Family History: A family history of diabetic retinopathy or other eye diseases can increase an individual's risk of developing retinopathy. Genetic predisposition and shared environmental factors may contribute to this association.

Symptoms of diabetic retinopathy

It's essential to note that diabetic retinopathy often develops without any noticeable symptoms in its early stages. Regular eye exams are crucial for individuals with diabetes to detect diabetic retinopathy early, when treatment is most effective in preventing vision loss. If you experience any changes in your vision, it's crucial to seek prompt evaluation by an eye care professional. However, As the condition progresses, you might notice the following:

1. Blurred Vision: Blurred vision is one of the most common symptoms of diabetic retinopathy. It can occur when fluid leaks into the macula, the central part of the retina responsible for sharp vision.
2. Fluctuating Vision: Individuals with diabetic retinopathy may experience fluctuations in their vision, with periods of clear vision alternating with periods of blurred or distorted vision.
3. Floaters: Floaters are tiny specks or spots that drift across the field of vision. They are caused by small flecks of protein or debris in the vitreous, the gel-like substance that fills the center of the eye.
4. Dark or Empty Areas in Vision: Some people with diabetic retinopathy may notice dark or empty areas in their field of vision. This can occur if the disease progresses to more advanced stages, leading to damage or loss of retinal tissue.
5. Impaired Color Vision: Changes in color vision, such as difficulty distinguishing between colors or noticing a faded appearance of colors, may occur in individuals with diabetic retinopathy.
6. Vision Loss: In severe cases of diabetic retinopathy, vision loss can occur. This may be partial or complete, depending on the extent of damage to the retina and optic nerve.

What to expect during your diabetic eye health exam

A comprehensive diabetic eye exam involves several key components to assess the health of the eyes, particularly for individuals with diabetes who are at increased risk of developing diabetic retinopathy and other eye complications. Here's what typically occurs during a diabetic eye exam:

1. Pre-Exam Assessment: The initial step in a diabetic eye exam involves a thorough review of the patient's medical history, including diabetes duration, management, and any prior eye issues. This assessment helps tailor the examination to the individual's specific needs and risks, laying the groundwork for comprehensive care.
2. Entrance Testing: Entrance testing evaluates baseline visual function and eye health parameters. It typically includes:

• Visual Acuity Test: Assessing the clarity of vision by reading letters or symbols from a chart at various distances.
• Intraocular Pressure Measurement: Screening for glaucoma, which is more prevalent in individuals with diabetes.
• Pupil Testing: Pupil testing involves assessing the size, shape, and reactivity of the pupils. This evaluation provides valuable information about the function of the nerves controlling pupil response, which can be affected by diabetic neuropathy. Abnormalities such as unequal pupil size (anisocoria) or sluggish pupil reactions may indicate underlying nerve damage.
• Cover Test: A cover test evaluates eye alignment and binocular vision. By covering one eye at a time, the eye care professional observes any deviations or movements, indicating strabismus (eye misalignment), which can occur due to diabetic nerve palsies or other underlying conditions.
• Extraocular Muscle (EOM) Testing: EOM testing assesses the function of the muscles controlling eye movements. Through coordinated movements in different directions, the eye care professional evaluates muscle strength and nerve function, identifying any restrictions or weakness that may result from diabetic neuropathy or cranial nerve palsies.

1. Dilated Eye Examination: Following entrance and specialized testing, the eye care professional administers eye drops to dilate the pupils, enabling a comprehensive examination of the retina, optic nerve, and other ocular structures. This facilitates the detection of diabetic retinopathy signs, such as microaneurysms, hemorrhages, or abnormal vessel growth.
2. Imaging: Imaging modalities like fundus photography and optical coherence tomography (OCT) provide detailed images of the retina, aiding in the diagnosis and monitoring of diabetic eye complications. These images serve as valuable tools for documentation, analysis, and treatment planning.

How often is an eye exam recommended?

The frequency of diabetic eye exams varies based on individual risk factors, disease severity, and established guidelines. According to the Canadian Association of Optometry (CAO), individuals with diabetes should undergo comprehensive eye examinations annually, regardless of their age or diabetes type. These recommendations align with the guidelines set forth by Diabetes Canada, emphasizing the importance of proactive eye care to prevent or manage diabetic retinopathy, diabetic macular edema, and other ocular complications. Based on the exam findings, your Calgary Optometrist near you may recommend more frequent exams. Diabetic eye health exams are covered by Alberta Health Care for patients of all ages. Please note that a diabetic eye health exam differs from a routine eye examination and does not include a prescription for eyeglasses or contact lenses.Treatment options for diabetic retinopathyFortunately, significant advancements have been made in the treatment of diabetic retinopathy, offering hope and improved outcomes for affected individuals.

1. Lifestyle Modifications: Lifestyle modifications play a crucial role in the management of diabetic retinopathy, especially in the early stages of the disease. Controlling blood sugar levels through diet, exercise, and medication is paramount in preventing or slowing the progression of retinopathy. Additionally, managing other risk factors such as high blood pressure and cholesterol levels can help reduce the risk of vision loss.
2. Intravitreal Injections: Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) medications have revolutionized the treatment of diabetic retinopathy, particularly diabetic macular edema (DME). These injections work by reducing abnormal blood vessel growth and leakage in the retina, thereby improving vision and preventing further damage. Anti-VEGF injections are administered directly into the eye in a clinical setting and may require regular follow-up injections to maintain efficacy.
3. Laser Therapy: Laser therapy, also known as photocoagulation, remains a cornerstone in the treatment of diabetic retinopathy. Laser treatment aims to seal leaking blood vessels, shrink abnormal blood vessels, and reduce swelling in the retina. Focal laser photocoagulation is often used to treat macular edema, while panretinal photocoagulation (PRP) is employed to reduce the risk of vision loss in proliferative diabetic retinopathy by shrinking abnormal blood vessels.
4. Vitrectomy Surgery: In advanced cases of diabetic retinopathy with significant vitreous hemorrhage or tractional retinal detachment, vitrectomy surgery may be necessary. During vitrectomy, the vitreous gel inside the eye is removed and replaced with a clear solution, allowing for better visualization and treatment of the retina. Additional procedures, such as membrane peeling or endolaser photocoagulation, may be performed concurrently to address retinal abnormalities.
5. Corticosteroid Implants: Corticosteroid implants, such as dexamethasone intravitreal implants, offer an alternative treatment option for diabetic macular edema resistant to anti-VEGF therapy or laser treatment. These implants release corticosteroids into the eye, reducing inflammation and fluid accumulation in the retina. While effective, corticosteroid implants may be associated with side effects such as increased intraocular pressure and cataract formation.

Regular diabetic eye exams are essential for early detection, monitoring, and management of diabetic eye complications, particularly diabetic retinopathy. By incorporating various diagnostic tools and techniques, a top Optometrist can comprehensively assess the eye health of individuals with diabetes, ultimately preserving vision and promoting overall well-being. Maintaining regular follow-ups and adhering to recommended screening intervals are paramount in mitigating the risks associated with diabetic eye disease. Our Southcentre Mall Calgary Eye Clinic has qualified Optometrists and all the gold standard technology to provide you with a thorough diabetic eye exam near you.