If you smoke, quit. Smoking constricts blood vessels, thereby raising blood pressure and increasing the risk of diabetic eye disease. Nicotine, the primary addictive ingredient in cigarettes, reduces the ability of red blood cells to carry oxygen, resulting in retinal hypoxia (oxygen starvation) that further damages the eye. Smoking also generates free radicals, chemical compounds that damage cells. This is why smokers are much more likely to develop cataracts at a younger age than nonsmokers and much more likely to develop macular degeneration, the leading cause of vision loss in people over 50 in the Western world. We all know that smoking is bad for health. If you have diabetes, quitting smoking is arguably the single best thing you can do for your eyes (as well as your heart, lungs, kidneys, dental health, etc.).
Regular dilated eye exams
Make sure you get a dilated eye examination every year by an optometrist or ophthalmologist knowledgeable about and experienced with diabetes and diabetic eye disease. It is estimated that 40% to 50% of people with diabetes do not get annual dilated exams. This is tragic, because most cases of severe vision loss from diabetes are preventable with early diagnosis and timely treatment. For example, laser therapy for severe, vision-threatening cases of diabetic retinopathy has been shown to decrease the risk of severe vision loss by 50% to 75%, and vision loss from glaucoma can be largely prevented with drugs, laser treatment, and/or surgery. Unfortunately, by the time people have symptoms of diabetic eye disease, very often, irreversible eye damage has already occurred, and the prognosis for successful treatment is poorer. This is why it is so critical for people with diabetes to have their eyes examined on a regular basis. Remember that all people with diabetes, whether they have Type 1 or Type 2 diabetes and whether or not they use insulin, are at increased risk for losing vision.
Why is dilation of the eyes so important? Dilating, or enlarging, your pupils allows the eye doctor to see more of the inside of your eye, view it more easily, and view it in stereo (in 3-D), factors that greatly improve the chances of early diagnosis. Remember that good vision (on an eye chart test or in the real world) does not mean there is no diabetic eye disease. Many people with diabetic retinopathy and glaucoma, two potentially blinding eye diseases, have 20/20 or better vision and absolutely no symptoms at the time they are diagnosed. If you have diabetes and wait for symptoms of eye disease, it may very well be too late. However, if you follow the guidelines described here, your annual visits to the eye doctor are more likely to end with the words, “Everything looks normal and healthy. Keep doing what you’re doing and we’ll see you next year!”
Round up a diabetes team
Seek out health-care professionals who are knowledgeable, communicate effectively, and serve as your advocates. Knowledge is power, and you want a health-care team with plenty of both. Members of your diabetes team should explain their findings and recommendations in understandable language and should encourage you to ask questions and actively participate in the management of your diabetes. You, the person with diabetes, must also strive to become knowledgeable. This will empower you to make educated health-care decisions, to ask better questions, and to get better care.
Effective communication also means that members of your health-care team should communicate well and often with each other, because diagnoses and treatments given by one specialist often affect the treatments and recommendations offered by others. In short, you want your team members to be on the “same page.” Insist that your eye doctor send timely reports to your other doctors and health advisors, and ask them to send reports to your eye doctor. Because good diabetes care requires frequent visits to members of your health-care team, it is very important that each one encourages you, advocates for you, and works with you and the other team members in your best interest. Put simply, this is what good health-care professionals do, and if you’ve got diabetes, you cannot settle for anything less.