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How an eye check-up got me back on track with my diabetes management

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adult eye check

Regular eye checks are important and go beyond just checking the health of your eyes. Your eyes offer a unique window to your general health. There are several health conditions that may manifest in the eye, typically detected through routine eye checks. Early detection can lead to sight and/or life-saving referrals to the respective health professionals for prompt intervention.

In this article, you will read about how an eye check-up can reveal findings of a health condition that you didn’t know was advancing. This article was written from an eye care professional’s (ECP’s) perspective.

That all-important day when his eyes were checked

Mr. A, a 47-year-old gentleman, visited my Optometry practice to purchase contact lenses as his supply was running low. As per routine with all patients that visit my practice, regardless of the purpose of visit, I started asking the routine questions (at a repeat visit, an ECP will ask routine questions about new symptoms and/or changes in vision since their last visit). The questions asked are different and more thorough at a new visit to an ECP.

Mr. A mentioned that he had been experiencing blurry vision, despite using his prescribed glasses and described that his vision quality fluctuated throughout the day. Upon probing, he mentioned that his blurry vision started 3 to 4 months ago and presents in both eyes, however, worse in the right eye. Since I had his systemic health background on my computer, I checked and it showed that he was diagnosed with type 2 diabetes ten years ago and had been prescribed oral medications for the management of his diabetes. However, due to the side effects he was experiencing, he stopped taking the medications about a month prior to his visit to my clinic.

The endocrinologist (a doctor who specializes in treating disorders of the endocrine systems such as diabetes) that prescribed his medication was not aware of this and he had in fact missed his recent follow-up appointment and it had been more than eight months since he was last seen by the endocrinologist. I then asked about his latest blood glucose reading and he hadn’t checked it in about three months!

Upon hearing this, I was extremely concerned for Mr. A’s general health and his eye health. Although my area of expertise is in the eyes, as a healthcare professional, this was a red flag, as across all departments of healthcare, it is dangerous and not advised to cease or change treatment or medications prescribed by a healthcare professional without prior review. Side effects to medications are common and can be managed by switching medications, changing its dosage, and its frequency as recommended by the healthcare professional.

As we know, although the purpose of his visit was to replenish his supply of contact lenses, I decided that Mr. A required a comprehensive eye examination, and proceeded to explain this to him. Thankfully, he understood my concerns and agreed to do so.

During the examination of the retina (the light-sensitive tissue at the back of the eye) where the nerve and blood vessels are located, we observed signs of moderate non-proliferative diabetic retinopathy.

retina showing signs of diabetic retinopathy shown by an eye check

Figure 1. Mr. A’s retina showing signs of diabetic retinopathy (Source: Plano, 2021)

What is diabetic retinopathy?

Diabetic retinopathy (DR) is an eye disease that can lead to vision loss and blindness in people who have diabetes. DR occurs when high blood sugar levels cause changes in the blood vessels of the retina. These blood vessels that nourish the retina can swell and leak fluid, or they can even close, stopping blood from passing through. These include the leakages of blood from the blood vessels in the eyes.

How did I manage his condition?

After the eye check-up, I explained the results to Mr. A and advised him to resume the medications as prescribed by his endocrinologist for his diabetes and arranged a review with his endocrinologist. Since his DR needed intervention by an Ophthalmologist, I referred Mr. A to a colleague of mine, who specializes in the management of DR. Additionally, I advised Mr. A to reduce the frequency and hours of contact lens wear as a precaution as people with diabetes have an increased risk of infection and impaired wound healing.

complications associated with diabetes

Figure 2. Complications associated with diabetes. (Source: Educational portal of Protein Data Bank, 2017)

After visiting the endocrinologist, he was prescribed a different set of medications to control his diabetes. The Ophthalmologist that treated Mr. A then confirmed his diagnosis of moderate non-proliferative DR. He underwent a laser photocoagulation procedure to treat the leaking blood vessels.

As an ECP, I was glad that Mr. A‘s advanced diabetic eye disease was treated in a timely fashion. Three months after his laser procedure, I called Mr. A to check on how he was doing and was pleased to hear he was more compliant with taking his prescribed medications as well as regularly checking his blood glucose levels.

This story is just one of many similar situations that may occur during an eye check-up and just highlights that regular eye checks are important for our eye health and general health.

References

[1]        S. R. Flaxman et al., “Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis.“, Lancet Glob Health, vol. 5, no. 5, pp. 1221-34, 2017, doi:10.1016/S2214-109X(17)30393-5.

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