Protect, Prevent, Preserve Your Eyes Podcast: EPISODE 2
Elizabeth Nystrom & Olivia Mohney
Elizabeth: Hi again, welcome back to Protect, Prevent, Preserve Your Eyes. Once again, my name is Elizabeth Nystrom, a Master of Public Health Student at Michigan State University, and this is Olivia Mohney, a public relations student at Baylor University.
Olivia: We will be your guides for this educational podcast which will look at various eye conditions, risk factors for developing these conditions, and what you can do to aid in preventing some of these conditions.
E: We both work for Association for the Blind and Visually Impaired (ABVI), a nonprofit organization focused on helping those with vision loss thrive in a sighted world. More background information on ABVI, the services offered, and ways to donate or get involved can be found on the website abvimichigan.org.
O: For today’s episode, we will be discussing how the various forms of diabetes can affect eye health. We’ll also provide some basic background information on diabetes as well to help set the stage. Finally, we will welcome our first guest speaker, Liz, one of our resident occupational therapy interns for a little Q and A session.
O: Diabetes is a disease that is characterized by higher-than-normal blood sugar (also known as glucose) levels. Blood sugar rises and falls in relation to what we eat, or don’t eat. For instance, if you eat a donut, your blood sugar will rise much higher than if you eat a meat stick. There are two main forms of diabetes, type 1 and type 2. Blood sugar levels are maintained by insulin, which helps your cells take up the glucose from foods that you eat and turn this into energy.
E: Type 1 diabetics have a condition in which their body does not make insulin. Without enough insulin, all the sugar that you eat just stays in your blood and your body cannot use it for energy. Therefore, type 1 diabetics must take insulin to replace the insulin they lack. Type 1 diabetes is also known as juvenile diabetes because it typically begins during childhood and is genetic.
O: Type 2 diabetes is sort of similar in the sense that your body will not make insulin very well or it may make insulin just fine but be unable to use the insulin. This is called insulin resistance. Too much glucose in your blood can cause serious health problems including damage to the blood vessels, damage to nerves (leading to chronic nerve pain), heart damage, kidney damage, and damage to the eyes.
O (continued): We mentioned that the primary risk factor for type 1 diabetes is genetics, but risk factors for type 2 diabetes include obesity, age, family history, smoking, and alcohol use. The single most important thing that you can do to treat or prevent diabetes is to maintain healthy blood sugar levels, and this can be obtained through a healthy diet and exercise.
E: Many people may not think of diabetes affecting their eye health, but diabetes should be recognized as a huge risk factor when it comes to the health of one’s eyes.
Eye Health and Diabetes
O: In developed countries, such as the United States, diabetic retinopathy is the leading cause of preventable vision loss and blindness among the working age population. The World Health Organization (WHO) estimates that by the year 2030, the total number of individuals with diabetes will double what it was in the year 2000.
E: With this increasing population of diabetics, there will likewise be an increase in the number of diabetes related diseases, including eye conditions such as diabetic macular edema (DME), severe non-proliferative diabetic retinopathy, and proliferative diabetic retinopathy. The incidence of these conditions is expected to rise exponentially by the year 2030. For reference, incidence is a public health measure of the number of new cases of illness or disease as it relates to the total population.
O: We’ll begin with diabetic retinopathy. If you were with us last week, we provided more detailed background information on this condition, but we’ll mention it again briefly in case you missed it. In short, diabetic retinopathy has two forms, proliferative and non-proliferative. This condition causes damage to the blood vessels in the retina causing them to leak and create scarring or the retina and eventual blindness can occur.
E: Diabetic retinopathy has been found to be more common among type 1 diabetics than among type 2 diabetics. Studies have shown that for type 1 diabetics, tight control of blood sugars can be associated with a reduction in the risk for developing diabetic retinopathy by about 76% and it can reduce the risk of progression of the disease by about 54%. If you recall, the non-proliferative form of diabetic retinopathy can progress into the proliferative form, which is associated with loss of vision, so this is what we’re referring to here. And for type 2 diabetics, tight control of blood sugar has been shown to be associated with a reduction in the risk for developing diabetic retinopathy by about 25%.
O: Additionally, studies have shown that proliferative diabetic retinopathy can be prevented for up to 20 years among type 1 diabetics who keep their hemoglobin A1c below 7.6%. For those of you who may not know, a hemoglobin A1c is a measure of average blood sugar levels over a three-month period, and this is measured by a simple blood test.
E: In addition to diabetic retinopathy, other eye conditions can result because of poorly managed diabetes including corneal dysfunction, cataracts, glaucoma, ischemic optic neuropathy, and diabetic macular edema. Now, I know there were a lot of new and unfamiliar terms just thrown out, but don’t worry, we’ll elaborate and clarify.
O: Let’s begin with the ones that we’ve talked about beforehand, cataracts and glaucoma. For glaucoma, the literature is conflicted on whether either form of diabetes is associated with an increased risk of developing this condition. Some studies have found an association while some have not. While for cataracts, the link between diabetes and cataract development is high blood sugar.
E: Like diabetes, cataracts can result from unmanaged blood sugar levels. Cataracts form because of high sugar levels inside the aqueous humor in the eye. The aqueous humor is essentially the fluid inside your eyeball between the lens of the eye and the cornea. It functions to supply nutrients and oxygen to the lens. When blood sugar levels rise, the lens swells, resulting in blurred vision. If you recall from our last episode, the only treatment for cataracts is surgical removal.
O: Corneal dysfunction encompasses multiple conditions that affect the cornea because of poorly managed diabetes. Roughly 70% of diabetics suffer from some sort of corneal complication. These complications include recurrent erosions, delayed wound healing, ulcers, and edema (or swelling). This means that if the eye suffers an injury, it takes much longer to heal and scarring of the cornea is possible. Similar to cataracts, corneal scarring is treated primarily with surgery.
E: Ischemic optic neuropathy is another condition that can be associated with diabetes. This condition is characterized by blockage of the blood supply to the optic nerve which can lead to impaired function and vision loss. There are two forms, non-arteric and arteric. The non-arteric form of ischemic optic neuropathy occurs more often.
E (continued): In addition to diabetes, risk factors for this condition include age, high blood pressure, and smoking. The arteric form of ischemic optic neuropathy is more common among older adults, as in age 70 and older. Vision loss associated with this condition is very rapid, occurring over minutes to sometimes days and it can involve one or both eyes. There is no treatment for this condition, however, about 40% of individuals who suffer from non-arteric ischemic optic neuropathy do regain some vision.
O: Much like diabetic retinopathy, diabetic macular edema involves damage to the tiny blood vessels in the retina because of high blood sugar. In order to develop this condition, you must first have diabetic retinopathy, which was previously discussed. Diabetic retinopathy damages the vessels and diabetic macular edema occurs when the vessels swell and leak fluid and blood into the retina. This causes swelling of the central part of the retina which is associated with detailed vision loss and blindness. The primary method of treatment for this condition involves laser surgery.
O: We will now shift into the Q and A portion of our podcast. For this segment, we will be asking Liz ABVI’s occupational therapy intern some very common and interesting questions regarding diabetes and diabetic eye conditions. Liz, welcome to the Triple P podcast, we are so happy to have you for this episode. Would you care to introduce yourself and let us know a little bit about you?
E: Welcome! We’ll start off easy. Why did you choose to go into occupational therapy?
ANSWER & freestyle back and forth commenting on her answer.
O: What are the ranges of diabetic retinopathy that you have seen as an intern so far?
O: How does diabetic retinopathy affect your vision and are there any common misconceptions that you hear from patients?
E: Is there any treatment for diabetic retinopathy?
E: Which types of in-home aids do you typically provide for diabetic individuals with low vision? Do you have any specific education that you provide to them?
O: This might seem silly, but can diabetic retinopathy occur in someone who does not have diabetes or may be pre-diabetic?
E: Do you have any suggested prevention tips or advice that you’d provide to anybody who has pre-diabetes or diabetes to help reduce the risk of developing diabetic related eye conditions?
O: What is the coolest or weirdest condition that you’ve had the opportunity to look at while being an intern?
E: I have found that since starting work here at ABVI, I have become increasingly aware and sort of fearful of eye conditions in the sense that I frequently think to myself “please don’t lose my vision”. Do you find yourself having similar fears? Or do you take comfort in your practice?
O: Liz, thank you so much for joining us today on this second episode of our podcast. It has been a pleasure to have the opportunity to interview you and you have provided such valuable insight into some of these conditions.
O: And thank you all for joining us once more today and listening to our podcast. Next week, we’ll talk a bit about how smoking impacts eye health.
E: As with all of our episodes, the references from this episode will be uploaded to ABVI website should any of the studies interest you, I will admit though, they are quite technical in their reporting. Thanks so much for listening to the Triple P Podcast if you would like to connect with us in between podcasts make sure to follow us on Instagram and Facebook, @abvimichigan and make sure to join us next week, thanks for listening to the Prevent, Protect and Preserve Podcast.
Diabetes and Cataracts: Causes, Symptoms, and Treatments. (2021, May 3). Healthline. https://www.healthline.com/health/diabetes/diabetes-cataract
Diabetes Control and Complications Trial Research Group, Nathan, D. M., Genuth, S., Lachin, J., Cleary, P., Crofford, O., Davis, M., Rand, L., & Siebert, C. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England journal of medicine, 329(14), 977–986. https://doi-org.proxy2.cl.msu.edu/10.1056/NEJM199309303291401
Ischemic Optic Neuropathy—Eye Disorders. (n.d.). Merck Manuals Consumer Version. Retrieved June 29, 2021, from https://www.merckmanuals.com/home/eye-disorders/optic-nerve-disorders/ischemic-optic-neuropathy
Klein, B. E., Klein, R., & Jensen, S. C. (1994). Open-angle glaucoma and older-onset diabetes. The Beaver Dam Eye Study. Ophthalmology, 101(7), 1173–1177. https://doi-org.proxy2.cl.msu.edu/10.1016/s0161-6420(94)31191-2
Lutty, G. A. (2013). Effects of Diabetes on the Eye. Investigative Ophthalmology & Visual Science, 54(14), ORSF81–ORSF87. https://doi.org/10.1167/iovs.13-12979
Nordwall, M., Abrahamsson, M., Dhir, M., Fredrikson, M., Ludvigsson, J., & Arnqvist, H. J. (2015). Impact of HbA1c, followed from onset of type 1 diabetes, on the development of severe retinopathy and nephropathy: the VISS Study (Vascular Diabetic Complications in Southeast Sweden). Diabetes care, 38(2), 308–315. https://doi-org.proxy2.cl.msu.edu/10.2337/dc14-1203
Tielsch, J. M., Katz, J., Quigley, H. A., Javitt, J. C., & Sommer, A. (1995). Diabetes, intraocular pressure, and primary open-angle glaucoma in the Baltimore Eye Survey. Ophthalmology, 102(1), 48–53. https://doi-org.proxy2.cl.msu.edu/10.1016/s0161-6420(95)31055-x
Ting, D. S. W., Cheung, G. C. M., & Wong, T. Y. (2016). Diabetic retinopathy: Global prevalence, major risk factors, screening practices and public health challenges: a review: Global burden of diabetic eye diseases. Clinical & Experimental Ophthalmology, 44(4), 260–277. https://doi.org/10.1111/ceo.12696
UK Prospective Diabetes Study (UKPDS) Group. (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet (London, England), 352(9131), 837–853.