I am asked this question all the time. A friend encouraged me to readdress the subject. How do patients with diabetes avoid diabetic retinopathy?
First, let me offer some caution; there is a lot of bad information about diabetic retinopathy out there! Let’s consider some points;
1. The incidence of diabetes mellitus continues to rise in the United States. In patients that do develop diabetic retinopathy, they have been diagnosed with diabetes mellitus for 7 years. The incidence increases with the number of years a patient has diabetes.
2. The prevalence of diabetic retinopathy is about 40% (this means that if you took all persons with diabetes and examined them, right now, 40% would already have diabetic retinopathy).
3. One of the greatest risk factors that leads to diabetic retinopathy is the number of years that a person has been diabetic. The prevalence of diabetic retinopathy exceeds 80% if a patient has had diabetes for over 30 years.
4. Sugar control may affect the severity of the disease, but we don’t know if good sugar control prevents the disease. This is a very important point I make to all of my patients with diabetes as I don’t want them to be discouraged, when they are diagnosed.
5. Good or tight sugar control is very helpful (see remark above), but diabetic retinopathy is still likely to develop.
6. There are no proven supplements or diets that prevent either diabetes mellitus or diabetic retinopathy.
In my opinion, it is very likely that almost every patient with diabetes will eventually develop diabetic retinopathy, so, we should reaaly reword the question;
How to Prevent Vision Loss due to Diabetic Retinopathy?
This is a much better question.
The ADA, the NEI, the AMA, etc. all recommend that every diabetic undergo, at the very least, a yearly dilated eye exam. Why?
While doctors can not prevent diabetic retinopathy from developing, we want to identify the disease and treat, if necessary, before there is any change in your vision. We can do wonders for preventing vision loss, but are not as successful in regaining lost vision. Off the top of my head, I do not know the statistics, but patients that are identified with diabetic retinopathy early, rarely have significant visual loss in their lifetime. Lots can be done to prevent swelling of the macula/retina and to preserve excellent vision and function. Patients who establish a routine of regular examination rarely go blind. Those patients that wait until the vision is lost, have a higher chance of blindness.
In the end, you can’t control the number of years that you may have diabetes, but you can make sure that you are examined early and regularly to do everything you can to prevent vision loss due to diabetic retinopathy.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist