Everything You Need to Know About Diabetic Eye Disease

Melissa DeCapua, DNP, PMHNP-B-C
Tuesday December 13, 2016
Diabetic retinopathy causes more losses of vision worldwide than any other eye disease, affecting 33% of the 285 million individuals suffering from diabetes.1 It is absolutely essential that your patients with diabetic eye disease are educated about, and understand, this disease. This article aims to do just that.

Q: What is diabetic eye disease?
Anyone with diabetes can develop diabetic eye disease. Between 40% and 45% of those diagnosed with diabetes have some degree of eye disease. Patients with type 2 diabetes must take special care of their vision because they are at an increased risk for developing diabetic eye disease—any of a collection of eye problems, each of which can lead to partial or complete vision loss. Diabetic eye diseases include diabetic retinopathy, cataract, and glaucoma.2 Diabetic retinopathy is damage to the blood vessels in the retina. Cataract is the clouding of the lens of the eye. Glaucoma refers to increased pressure in the eye, which causes nerve damage.

Diabetic retinopathy is the most common form of diabetic eye disease, and it is the number-one cause of blindness in adults living in the United States.1 The condition results from changes in the blood vessels of the retina, which is the layer of cells at the back of the eye that are sensitive to light. Sometimes the blood vessels in the retina swell and begin to leak fluid. Often, abnormal blood vessels grow on the surface of the retina. The longer that you have diabetes, the more likely it is that you will develop diabetic retinopathy.

Q: What are the symptoms of diabetic eye disease?
Typically, you will not have any symptoms in the very early stages of diabetic retinopathy. You will not experience any pain, and your vision will not change until the disease has become severe. You may experience blurry vision, however, which occurs when the retina swells from leaking fluid. If abnormal blood vessels grow on the surface of the retina, they may result in blood on the eye, which will also block your vision.

Q: What is a dialated eye exam?
Because diabetic eye disease lacks any warning signs, it is essential that you have a comprehensive, dilated eye exam every year.3 The most effective way to prevent vision loss or blindness is to recognize and treat eye disease early. During the eye exam, the eye care professional will usually complete a dilation, tonometry, visual field test, and visual acuity test.3 Tonometry is a test that helps detect whether or not you have glaucoma.3 Your provider will direct a quick puff of air into each eye to evaluate the level of pressure inside your eye. To measure your peripheral, or side, vision, your eye care professional will conduct a visual field test.3 You will be asked to read an eye chart to help determine how well you can see at various distances. The eye care professional will then dilate your eye using eye drops that enlarge your pupils. When your pupils are dilated, health care providers can more easily see inside your eye and check for problems.3 Your provider will use a special magnifying lens to look at the very back of the eye, including your retina, macula, and optic nerve.

Q: What should you ask your nurse practitioner? 
Consider asking about your disease or disorder, treatment, and tests. The National Eye Institute recommends asking your nurse practitioner the following questions4:

• What is my diagnosis?
• What caused my condition?
• Can my condition be treated?
• How will this condition affect my vision, now and in the future?
• Should I watch for any particular symptoms and notify you if they occur?
• Should I make any lifestyle changes?
• What is the treatment for my condition?
• When will the treatment start, and how long will it last?
• What are the benefits of this treatment, and how successful is it?
• What are the risks and adverse effects associated with this treatment?
• What kinds of tests will I have?
• What do you expect to find out from these tests?
• When will I know the results?

It’s important to ask for clarification if you don’t understand your nurse practitioner’s responses to your questions.4 Consider bringing a notepad or tape recorder to help you remember important parts of the conservation. You can always ask your nurse practitioner to write down instructions, as well.

Q: How can I prevent diabetic eye disease?
Although diabetic eye disease cannot be fully prevented, you can do a few things to reduce your risk. By tightly controlling your blood sugar, you can actually slow the onset and progression of retinopathy.2 Better blood sugar control also reduces the need for laser surgery in cases of severe eye disease.2

The National Eye Institute provides a guide to help you, “Stay on TRACK to Prevent Blindness from Diabetes.” This guide, listed here, aims to help you remain focused on your treatment plan and live a healthy lifestyle5:

Take diabetes medication every day, at the correct time, as prescribed by your nurse practitioner.
Reach and maintain a healthy weight by setting attainable goals, exercising, and eating nutritious foods.
Add physical activity to your daily routine. You should aim for at least 30 minutes every day. You might run, walk, ride a bike, swim, or dance.
Control your ABCs; specifically, control your A1C, Blood pressure, and Cholesterol by following the treatment plan and recommendations from your nurse practitioner.
Kick the smoking habit. Smoking makes it more difficult for you to manage your insulin dosing and adequately control your diabetes, which increases your likelihood of developing eye disease.


Melissa DeCapua is a psychiatric nurse practitioner with a clinical background in psychosomatic medicine. She now works as a design researcher in the technology industry, guiding product development by combining her clinical expertise and creative thinking. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern health care. For more about Dr. DeCapua, visit her website at www.melissadecapua.com and follow her on Twitter @melissadecapua.


References: 

1. Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond). 2015;2:17. doi: 10.1186/s40662-015-0026-2.
2. National Eye Institute. Diabetic eye disease FAQ. NEI website. nei.nih.gov/diabetes/content/english/faq. Accessed October 5, 2016.
3. National Eye Institute. What is a comprehensive dilated eye exam? NEI website. nei.nih.gov/healthyeyes/eyeexam. Accessed October 5, 2016.
4. National Eye Institute. Talking to your doctor. NEI website. nei.nih.gov/health/talktodoc. Accessed October 5, 2016.
5. National Eye Institute. Staying on TRACK. NEI website. nei.nih.gov/diabetes/content/english/track. Accessed October 5, 2016. 


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