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Vision

2011-10-24 14:45:07

Diabetes and vision loss

Q: I was diagnosed with diabetes eight years ago and have been having difficulty with my vision, which has affected my driving, performance at work and reading. I have also had a feeling of great fatigue and, as a result, generally feel depressed. I do not know what to do.

A: Diabetes now affects approximately 26 million Americans, so you are not alone. Your immediate short-term goal is to normalize the blood glucose and control of your blood sugar level. Your A1C (hemoglobin), HDL/LDL (cholesterol) and blood pressure are extremely important to short and long term implications of your diabetic disease and vision. Having said that, you need to schedule an appointment immediately with your physician, emphasizing the chief concerns that you have expressed to me. If you do not see a Certified Diabetic Educator (CDE), I strongly advise that you see one in the very near future to assist you in making important lifestyle changes. Living well with diabetes requires active, diligent, effective self-management of the disease. Self-management is an important concept to emphasize because you need to make choices that positively affect your health on a regular and recurring basis. I would be happy to help you locate a CDE in your area, should you wish. Simultaneously, you should also schedule an appointment with your optometrist or ophthalmologist to determine the cause of your reduced vision. This is critical for you, due to your visual complaints and the duration of disease. Manifestations of diabetic retinopathy are most often asymptomatic until vision loss occurs. Diabetes is also a progressive disease with systemic risks that include increased risk of falls, impaired range of motion, neurological and cardiovascular disease, peripheral neuropathy, compromised wound healing and decreased blood flow, which can result in amputation. I have found that early referral for low vision rehabilitation, even with near normal to mild visual impairment, greatly assists in the educational and rehabilitative process of patients with progressive eye, neurological and systemic disease, both short-term and over time. Referral for low vision rehabilitation of the diabetic patient (and other visually impaired patients) is often poor and untimely, resulting in decreased quality of life, decreased job performance, lack of adequate diabetic management and depression. It can also have a significant negative socioeconomic impact to healthcare costs, both to you and society at large. Overcoming this dilemma can be accomplished by obtaining early education and seeking available resources. These resources include coordination of interdisciplinary care, training or therapy to aid you in maintaining the ability to perform occupational and avocational tasks, orientation in the use of assistive devices, and addressing psychosocial and psychological manifestations before they seriously impact your life. An evaluation by a low vision rehabilitation team consisting of a low vision practitioner (optometrist or an ophthalmologist) and/or an occupational/physical therapist in the same clinical environment, can dramatically and expeditiously initiate improvement in visual function and provide patient education about resources, therapeutic interventions and environmental adaptations along with enhancing overall quality of life. I have also found that meticulous refraction and change in prescriptive lenses may improve visual acuity and performance in most or all daily activities, such as driving, job-related tasks, reading and avocations important to that individual. If you have significant loss of vision, or reduced field of vision that affects your life, talk to your current eye care practitioner about referral to alleviate the concerns you have with your daily life.