Focusing on Eye Disease

The main eye complications of T1DM are cataracts and retinopathy.

I Cataracts are opaque areas of the lens. Cataracts occur in no more than 1 percent of children with T1DM. In both children and adults, if the cataract is blocking vision, the cataract is removed by surgery and a new lens is implanted, restoring vision.

I Retinopathy is considerably more common than cataracts, varying from 15 percent to 50 percent occurrence in patients with T1DM in different studies. It's considerably less common today than it was before the era of intensive diabetic treatment.

In order to understand retinopathy, you need to know the normal appearance of the eye and its structures. Figure 5-1 shows the structure of the eye.

In a nutshell, vision works this way: Light enters the eye through the lens, where it's bent and focused upon the retina. The place in the retina where the lens focuses is called the macula. The retina collects the image and transfers it to the optic nerve, which carries it to the brain where the image is interpreted. Between the lens and the retina is a transparent material called the vitreous body. The eye muscles surround the eye on all sides and are attached to it, permitting you to look up, down, and sideways without moving your head. These eye muscles are important in the discussion of diabetic nerve damage called neuropathy, which I cover later in this chapter in the section "Knowing about Nerve Disease."

Retinopathy is broken down into two major forms depending upon the potential to cause vision loss: background retinopathy and proliferative retinopathy. In both forms, the major damage takes place on the retina. Figure 5-2 shows a normal retina, a retina with background retinopathy, and a retina with prolifera-tive retinopathy. You can see that in Figure 5-2A, the normal retina shows a dark spot, the macula, which is the central spot that the image focuses upon. The light area is the optic nerve from which small blood vessels branch out, cascading toward the macula.

In the following sections, I explain the symptoms, prevention, and treatment of background retinopathy and proliferative retinopathy.

Because diabetic eye disease takes years to develop, the current recommendation is to have your or your child's eyes examined by an ophthalmologist or optometrist when T1DM is first detected, five years after T1DM is diagnosed, and once a year thereafter as long as the examination remains normal. See Chapter 7 for more about eye checks.

Figure 5-2:

A normal retina (A), background retinopathy (B), and proliferative retinopathy (C).

Figure 5-2:

A normal retina (A), background retinopathy (B), and proliferative retinopathy (C).

Retina

Macula

Macula

Artery

Fovea centralis

Fovea centralis

Optic Blot disc hemorrhages

Artery

Optic Blot disc hemorrhages

Venous beading

Soft exudates (cotton wool spots)

Optic

Dot microaneurysm

Venous beading

Soft exudates (cotton wool spots)

C. Neovascularization

C. Neovascularization

Vas cularization of the optic disc

Optic

Hard disc exudates (lipid/ protein)

Vas cularization of the optic disc

Adults in particular need to be aware of the following points about retinopathy, including behaviors and other conditions that are associated with it:

^ Males and females develop retinopathy at about the same rate.

^ The longer a person has diabetes, the more likely he or she is to develop diabetic retinopathy.

^ High blood pressure worsens retinopathy.

^ Smoking and heavy alcohol use worsen retinopathy.

^ Persons with severe diabetic retinopathy are at increased risk for heart attacks.

Background retinopathy

Figure 5-2B shows the more benign form of diabetic retinopathy. The signs of background retinopathy, which are detected by an ophthalmologist or optometrist, include the following:

^ Retinal aneurysms are the result of weakening of the capillaries of the eye, appearing like tiny balloons on the capillaries. This first symptom of the condition appears as small red dots on the retina. They usually disappear over time.

il Sometimes the weakened capillaries rupture and release blood, forming retinal hemorrhages and hard exudates. The hard exudates are yellowish and appear round and sharp. They're actually scars left from the hemorrhage. If they extend into the macular area, they reduce vision. If the capillaries in the retina allow fluid to flow into the macula, the patient gets macular edema, which also reduces vision. These exudates and hemorrhages can last for years.

i As the capillaries close, there's a decreased blood supply to the retina, and cotton wool spots or soft exudates appear. They appear as small areas of yellowish-white discoloration on the retina.

These changes usually don't cause complete loss of vision but may develop into the more serious proliferative retinopathy if the T1DM isn't brought under control by making the blood glucose as normal as possible.

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Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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