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Thursday, May 23, 2013
Quality Health Care and You - Diabetes
Speed of development of diabetic retinopathy
Background: I am a 37 male normal weight and height, who due to sphincter of Odi dysfunction and complications underwent a Total Pancreatectomy and Islet Cell Auto-transplant. Unfortunately, the auto-transplant was less than successful and I require around 80-100 units of insulin daily. I underwent this surgery about one and half years ago. I have had several incidents of hyperglycemia, developed some acid-base irregularities, but not full blown DKA and have been admitted a few times for this. In the past 30 days, I have noticed irregularities with my vision acuity and sometimes floaters. Sometimes my vision becomes rather blurred, once badly enough for me not to drive until it cleared up. It has always resolved itself and I had a false sense of security that I have been insulin dependant too short a time for retinopathy to develop.
Questions: How rapidly can retinopathy show itself in a relatively new diabetic that has some blood sugar control issues? Is it likely I am seeing this in myself, and where does one go if one has a sudden acute instance of very poor acuity?
Let me generalize the issue a bit and I will address the question more specifically in that context.
There are several different forms of eye problems which can develop with diabetes. The one we worry about most is diabetic retinopathy, disease of the retina which is the layer of the eye where the light detecting cells are located. This is generally thought to require years to develop and can become irreversible. We worry that the damage to blood vessels in this layer of the eye will result in blood loss and injury. Blood loss can compromise vision as can the scarring which can result both from the blood loss and from the injury I mentioned. In people with diabetes in whom we have a pretty good idea of when the diabetes starts, the early stages of this process, background retinopathy, are rarely seen before 5-7 years of diabetes and the damage that affects vision rarely before 10 years of diabetes. In people in whom we don't know the duration of diabetes, which includes most people with type 2 diabetes which may be silent for many years, the onset may come sooner after the diagnosis of diabetes. Until a severe event happens, there is rarely an effect of background retinopathy on vision.
Problems with blurry vision which comes and goes either early or anytime in the course of diabetes is most commonly related to sudden changes in blood sugar levels. Either very high sugars after a period of normal or very low sugars after a period of high sugars can cause the lens of the eye to accommodate poorly. This is a temporary problem which goes away with better blood sugar control and a period of days to weeks. That is the likeliest cause of your complaints.
Other eye disorders commonly associated with diabetes include cataracts, glaucoma and a variation on diabetic retinopathy called macular edema. These also generally take a long time to develop. Cataracts are frequently amenable to surgery, glaucoma, depending on type, to either medical therapy or surgery. Macular edema is thought to improve with blood sugar control although I don't believe that is proven; it frequently requires laser treatment, similar to that used for more common forms of diabetic retinopathy.
In summary, I doubt the symptoms you are experiencing are due to retinopathy and they may or may not be due to the diabetes. It may be worthwhile to see your eye doctor soon for an evaluation. If the judgement is that you need a change in eye glass prescription and your diabetes has been in poor control, it is important to get it into good control for a period of at least 3-4 weeks before being fitted for your glasses.
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati