Diabetic Eye Disease Management

People with diabetes have a 60% and 170% higher prevalence of correctable and uncorrectable vision impairment, respectively than those without diabetes. Diabetes can cause damage to your eyes that can lead to vision impairment (VI) or even blindness. Moreover, diabetes is the most common cause of vision loss in working-age adults.

The group of eye problems that affect people with diabetes are called Diabetic Eye Disease. These conditions include diabetic retinopathy, diabetic macular edema, cataracts and open angle glaucoma.

Risk factors for Diabetic Eye Disease

• Aging.
• High blood glucose.
• High blood pressure.
• High cholesterol levels.
• Smoking.
• African American, Hispanic/Latinos, American Indian, Pacific Islanders, Alaskan Natives.
• Pregnancy.

How to treat Diabetic Eye Disease

• Hemoglobin A1c, cholesterol and blood pressure management.
• Smoking quitting.
• Anti-VEGF medications are injected to block the growth of fragile blood vessels and stop fluid leakage. Sometimes vision loss can stop or improve.
• Laser treats leaky blood vessels and extra fluid called edema. This treatment can keep the vision loss from getting worse but cannot bring back lost vision.
• Vitrectomy removes the gel that maintains the shape of the eyeball. Treats and clears up severe bleeding and manages scar tissue on the retina thus preventing retinal detachment.
• Cataract removal for removing cloudy cataract and replacing it with an artificial lens. This will improve vision, but vision may depend on damage done by diabetic retinopathy or macular edema.
• Open angle glaucoma can be treated just like someone without diabetes. This could include eye drops, laser, or surgery to lower the pressure in the eye.

Rehabilitation of the patient with vision loss

Rehabilitation in adaptive techniques may be obtained by a certified diabetes care and educational specialist (CDCES), an occupational therapist (OTR/L) or a vision rehabilitation therapist (CVRT) specifically trained in diabetes self-management for those with vision loss or a combination thereof.

Services by a CDCES are covered by insurance. You need to check with your insurance if they cover adaptive training by an OTR/L. The services of a VRT are covered by grants, the Veteran’s Administration and other sources. There is generally no fee for VRT services.

Below is a list of some of the self-care behaviors adopted as a framework by the American Association of Diabetes Care and Education Specialists and the basic adaptations that address them:

Vision aids. A person with diabetes and low vision may benefit from using a magnifier, organization, use of contrast, and adaptive equipment.

Healthy eating. Some people use the plate method where half the plate is a vegetable, one-0quarter is protein, and one-quarter is a starch. Several additional starches can be added such as a fruit, a piece of bread, total starches depending on your weight and gender.

Try to use a plate colour that contrasts with your food. For portion control you can use nested measuring cups for products like cereal and canned peach slices and half-cup and one-cup hot measuring tools for products like mashed potatoes and corn purchased in a grocery store.

Ask your diabetes nutritionist to send you your meal plan on the computer so you can make it as large as you need it to see it or ask them to print it in large print using a bold, black marker on contrasting lined paper you bring to your appointment.

Physical activity. Seek the guidance of your eye care specialist before engaging in physical activity so that you will know appropriate precautions if you have retinopathy.

Use a stationary treadmill or cycle at home or walk with a friend. Mark off your yard with a guide wire or rope or walk around the block if you feel comfortable. Use a talking pedometer to gauge your progress.

Swim near the wall of the pool or participate in water aerobics. If you attend classes stand close to the instructor and ask them to provide clear, descriptive instructions.

Blood glucose monitoring. Some blood glucose meters have large and/or high contrast displays and there are also a couple of talking blood glucose monitors available on the market, the Prodigy Voice, and the Advocate Redi-Code. Both are insurance reimbursed with a physician’s prescription.

These talking meters verbalize the result, the results in memory, setting up the time, low battery, and other features. Others “talking” meters are available, but they only announce the result and do not announce anything else.

Use a high contrast tray to hold your equipment and so sharps do not get away from you and a task lamp. You can also monitor your weight and blood pressure via talking models.

Insulin injection. This can be performed by those without sight or who have limited sightedness by counting the clicks of the dosage dial of an insulin pen up to 100 units. You can vary your dose with the pens. Usually, one click equals one unit of insulin. A pen intended for a child may be one click for half a unit.

There are also two devices to measure insulin with a syringe. One is called the Safe Shot, and is intended for a person whose dose is “fixed”, does not change or changes infrequently. The other device in the Count-a-Dose which allows you to draw up any dose you want up to 50 units and is a variable dose as it can be different in amount whenever you need it to be.