Diabetes

Over 3 million Canadians have diabetes. It is the leading cause of blindness in North Americans under 65 years of age. Diabetes is a condition where the body produces little to no insulin (type 1 diabetes) or cannot respond properly to insulin or make enough of it (type 2 diabetes). Insulin is important because it moves glucose, a simple sugar, into the body's cells from the blood. Glucose, which is used by the cells as a source of energy, comes from the food people eat. If insulin isn't available or doesn't work correctly to move glucose from the blood into cells, glucose will stay in the blood, leading to high blood sugar levels.

High blood sugar levels damage the blood vessels, including the tiny blood vessels in the eye. This leads to an eye disease known as diabetic retinopathy. The retina is an area at the back of the eye that changes light into nerve signals. With diabetic retinopathy, some blood vessels in the retina are lost, and some of the other blood vessels begin to "leak" blood. This causes the retina to swell, and gradually cuts off its supply of oxygen and nutrients. Eventually, the retina starts to grow new blood vessels to replace the damaged ones. Unfortunately, these new vessels are not as strong as the old ones and are more likely to break, causing bleeding in the eye.

At first, people with diabetic retinopathy will not notice any symptoms. As the disease gets worse, they may notice blurred vision, black spots or flashing lights. Eventually, it can progress to blindness. Everyone with diabetes is at risk for diabetic retinopathy, and the risk increases the longer you've had diabetes.

Fortunately, you can reduce your risk. If you do not have diabetes, but think you may be at risk for this condition, visit your doctor to be screened for diabetes. If you do have diabetes:

• Have frequent eye check-ups:
• People with type 1 diabetes who are 15 years of age and older should have an eye check-up every year, starting 5 years after they are diagnosed with diabetes.
• People with type 2 diabetes should have an eye check-up every 1 to 2 years, starting as soon as they are diagnosed.
• Pregnant women with diabetes are especially at risk. They should have an eye check-up while they are planning a pregnancy, during the first trimester, as needed during pregnancy, and within the first year after the baby is born.
• Make sure you monitor your blood sugar frequently and use your medications as recommended by your doctor. There is evidence that keeping your blood sugar under tight control can slow down eye damage.
• If you have high blood pressure, follow your recommended diet and medications to keep it under control. If you are not sure whether you have high blood pressure, or whether your blood pressure is under control, discuss this with your doctor.

If you begin to develop diabetic retinopathy, there are treatments that can slow down the damage, although they do not cure the condition. Laser surgery is used to seal "leaky" blood vessels in the eye and prevent new ones from forming. Vitrectomy is used for people who have a lot of bleeding in the eye. The cloudy eye fluid is replaced by a salt solution to improve the sight.

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