14 Oct Diabetes Unlikely to Cause Blindness
Today’s post is about one of my own observations from over 15 years in practice. While it is a fact that significant vision loss from diabetes is declining, it is not widely known that there is also a very finite time where patients with diabetes can go blind, there is only a finite time while the risk of blindness is highest. In short, the chance of a diabetic patient going blind these days is much less than 0.5%, especially when under the care of an eye doctor.
Let me explain. Recently, I wrote about the decline in the incidence of diabetic patients going blind. The statistics say that severe vision loss was reduced to about 0.3% by 2005-2007 (read the article “Vision Problems in Type I Diabetes on the Decline”). This is truly great news.
I have two observations; 1) I have never had a patient with diabetes go blind if I had been following them before they developed any complications from proliferative diabetic retinopathy, and 2) in most cases, when patients develop signs of proliferative diabetic retinopathy, the retinopathy usually becomes controlled within a year and becomes stable. This means they are highly unlikely to lose vision or to go blind. The patients that have gone blind usually wait until they have lost vision before seeking medical attention.
What does this mean? There are two major points. My observations are consistent with published data that correlates early detection of diabetic retinopathy with an excellent long term visual prognosis. In other words, the earlier we can detect diabetic retinopathy, the better chance that you will never lose vision. Second, there is a small window of a year or so (my personal observation) that patients are susceptible to vision loss once proliferative changes are noted. Once diagnosed with proliferative diabetic retinopathy, a patient is NOT destined to loss of vision or blindness.
So, chances are that most diabetics will not lose vision. We are stressing early examination to detect diabetic retinopathy early. Last, diabetics are not a ticking timebomb; waiting for blindness to ensue.
It’s really good news that seems to get lost in this information gap.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
JoannePosted at 14:06h, 15 October
I like the informative and intersting article format of your blog, Dr. Wong, You write it as if you are talking to a patient in the office; clear and direct, using good examples. You need to get the word out there that this helpful info is here for patients! The Glossary is also very helpful. Thanks.
Randall V. Wong, M.D.Posted at 15:43h, 15 October
Thanks for your support. With your help, I hope that this site becomes a useful and credible resource for my patients and their “non-retina” doctors.
Murray NewcombPosted at 10:45h, 23 October
I am reading your site.
Will see you thursday at 9:00 AM
My co-workers gave me a eye patch today. Should I wear it or not.
JoshuaPosted at 23:16h, 25 November
I have been a T1 Diabetic since 1980. Been a patient of Joslin since then and go to regualr eye appointments every 6 months at Beetham. I am 37 now and had T1 for 32 years. I have been an average diabetic for most of my life, periods of rebellion in my teenage years. I was Diagnosed with MILD NPDR in 2000, ( which as we all know is not atypical). Since then, I have progressed to Moderate NPDR ( 6 years ago) and have had non clinically significant DME for many more. Focal leakage only. I have over the years WRACKED my brain checking online about progression statistics. Over the past 10 years I have done more reseach than a typical med student to try and understand the pathologies. As we all know It all comes down to compliance with the appointments and taking control of the A1c. I am happy to say I am mostly in the 7s. But even that is too high for my liking, as I want to assure I wont progress to Severe NPDR…as I find by then the momentum to be more risky to PDR.
I wanted to thank you for writing this. My opthamologist is wonderful, and a very well respected Dr in his field, but a very old school man with not the most approachable bedside manner, so you speaking in laymans terms… about what I exactly wanted to hear.. was a huge blessing. I got off the phone with my Endo today who also said almost exactly the same thing as you, so the timing of me finding this will hopefully help me sleep a little better at night. The gap in info between pure statistics and shock tactics to get people awake to the importance of going to appointments… sometimes those compliant but scared patients need to hear some reassurance, that what they are doing WILL matter in the long run, and not all of us are destined to severe vision loss. The DCCT results can only do so much to calm us. THANK YOU.
Randall V. Wong, M.D.Posted at 08:40h, 26 November
Hang in there. If you are this motivated to find out so much information about your disease, you should find a doctor who can relate to you, too.
I trained with the famous Dr. Kletzky. Can you go back to Joslin?
JoshuaPosted at 15:31h, 26 November
Thanks for the response.
I go to Joslin every 6 months. I am a patient of the Sr Beetham ophthalmologist there who is also a specialist in trial studies . Who is a very excellent dr. I have been going to him since I was a kid in fact. So almost 22 years. I just think I am a very nervous person who likes to have as much information as possible. Some Dr’s are not all as forthcoming as you, but at the same time, I think he is so conservative, that unless he seems concerned about my condition, I try to keep it in perspective. Both he and My endo ( who is also really one of the tops Joslin Drs there, whos specilaty is Complications in T1s) think I will not go to PDR simply because I am so hyper aware of anything in my vision and that it has not progressed. I have a BP of 116/75 on average, low body fat, take lisinoprel and lipator for prevention, no other complications and low body fat, and work out 3-4 xs a week. I usually get most bothered by CWS every once in a while, but they are usually a result of a very wide fluctuation in my BG. (Actually it is not the CWS, but the infarct at the root of them that cases visual disturbance. ) I had not had an A1c below a 7.5-8.0 in a number of years, and both feel once I get into the low 7 high 6 range and keep it stable that then on. This I think is key, as the consistency seems more important than an A1c. My goal is to create a long term memory for the Retinopathy in the next 3-4 years 😉 and hopefully that will result in less changes. I find A1cs to be misleading about actual control. You can have wide swings in BG together and somehow get a low A1c. Even in the DCCT, the tight control group was only in that range, and the conventional was in the 9s…. much higher than current guidelines.
Long story short, It is more years of me even after being told I would fine if I followed the path, and then freaking out because I would have changes in my vision due to the CWS every so often, which would make me spiral into obsessive research behaviors and only finding grim stats. . Low blood sugars seems to have a worse effect due to the lack of nutrients and glucose the the eyes… so I have been trying to lower the BGs more gradual without Hypos.. But to be honest, I would think it would be more a case of lowering from a long term 10 down tot a 6 quickly that would cause this temporary decline. I am interested in why the retinal blood flow increases in those patients with transient worsening. There is so much contradictory info out there.
At the end of the day, All I need from an emotion standpoint is someone to tell me, what I am doing can prevent Moderate NPDR ( only micos and occasional CWS with stable Non Clin focal DEM which has reabsorbed in the past) to either make it stable or even potentially reverse a little to Mild , if I could normalize glucose levels long term. I have kept it at Moderate NPDR for 6 years, and to be honest with myself I could do even more by lowering the A1c <7. Because of this I have been told the likelihood of progression is small. But there is always a voice in the back of your head saying you could still be a statistic. I think many eye Dr's forget how much guilt Diabetics have when they arrive at complications of any kind. But Retinaopathy is by far the most emotionally devastating for the majority.
Sorry for the rant. 😉 I had a lot on my chest. Lol
Thanks again for humoring ,
JoshuaPosted at 15:36h, 26 November
I meant DME not DEM. 😉 Sorry too many typos from typing quickly.
JoshuaPosted at 15:57h, 26 November
By the way, you mean Deborah Kletzky Schlossman? I know a few people who go to her. I hear a very nice Dr with a good bedside manner.
JoshuaPosted at 17:35h, 26 November
By the way, what is the definition of Severe vision loss? Vision better than 20/200? Obviously no Diabetic wants to lose even “Moderate” vision. Mild one can deal with, but I am always curious about the subjectivity of what avoiding Severe vision loss means. 😉 If one has 20/20 vision, does this mean despite any controls, they will not maintain that if they do all the precautions? Sorry for all the questions, I just never had anyone to ask before.