With early treatment, serious vision loss from glaucoma can often be prevented. Prescription medicines that cause the eye to make less fluid or that help fluid drain from the eye can help lower eye pressure. A procedure called laser trabeculoplasty can also help fluid drain out of the eye. This procedure can typically be done in a physician’s office and is usually very effective in reducing eye pressure. However, the use of prescription medicines for glaucoma usually must be continued after laser trabeculoplasty.
If neither medicines nor laser trabeculoplasty control your eye pressure, conventional surgery to create a new opening for fluid to leave the eye may be recommended. This surgery may be done in an eye clinic or hospital, and it is more likely to be successful if you haven’t had any previous eye surgery.
Your plan of defense
Your first best defense against diabetes-related eye problems is maintaining optimal blood glucose control. Research has shown that doing so can substantially reduce both the risk of developing diabetic retinopathy and its progression, should it occur. (See “Blood Glucose Targets.”) Your other best defense is to keep your blood pressure at the recommended level as well. (See “Optimal Blood Pressure.”) If you smoke, quitting smoking will help to prevent cataracts as well as most of the major complications associated with diabetes. Smoking also raises the risk of developing age-related macular degeneration, a disease that destroys sharp, central vision and is the major cause of vision loss in Americans over age 60.
The presence of nephropathy (kidney disease related to diabetes) raises the risk for retinopathy, and in women with Type 1 diabetes, pregnancy may raise the risk. Pregnancy can also cause a rapid increase in the progression of retinopathy in women who already have diabetic retinopathy before becoming pregnant. It has been theorized that this progression may be caused by a rapid improvement in blood glucose control during early pregnancy.
According to the American Diabetes Association, adults and adolescents with Type 1 diabetes should have a comprehensive dilated eye examination by an ophthalmologist or optometrist within five years of the onset of diabetes. Those with Type 2 diabetes should have an initial dilated eye examination by an ophthalmologist or optometrist shortly after being diagnosed with diabetes. After your initial eye examination, you should meet with the eye specialist once yearly. The only exceptions might be if you have eye problems that require more frequent visits, if you are planning a pregnancy, or if you are pregnant and your eye specialist deems that more frequent exams are needed. Also, if you have a normal eye exam, your eye specialist may recommend less frequent examinations.
The eye specialist (ophthalmologist or optometrist) that you see should be knowledgeable about and experienced in treating diabetes eye disorders. During your eye examination, a visual acuity test will likely be done to measure how well you see at various distances. After drops are placed in your eyes to numb them, a tonometer will be used to measure the pressure inside the eye to check for glaucoma. It is likely that a visual field test to measure your peripheral (side) vision will be performed. Additional drops will be placed in your eyes to dilate, or widen, your pupils. Your eye specialist uses a special lens to magnify and examine your retina and optic nerve for signs of damage. He may take photographs of your eyes to compare to any previous photographs (or any future photographs) to see if any changes have occurred.