A vision change might signal diabetes onset
Many Americans require corrective lenses and visit their optometrist on a regular basis for a thorough eye exam; some of them may have undiagnosed diabetes. Dr. Roger Phelps is an optometrist affiliated with VSP, a network of eye specialists that stresses regular eye exams. He has a special interest in diabetes, due partly to the fact that he is a type 1 diabetic. He has found that a sudden change in refraction not uncommonly is related to the onset of diabetes.
Dr. Phelps is a certified diabetic educator whose practice is located in Ojai, California, a city situated in the Ojai Valley, northwest of Los Angeles and southeast of Santa Barbara. He has a healthy relationship with both the family practitioners in the area and the ophthalmologists (MDs who specialize in diseases of the eye). He explains that once every month or two, he encounters a patient who presents for a routine eye exam who has developed diabetes. He notes that occasionally these patients have had a recent blood glucose that was in the normal range. He recommends that all patients with a sudden vision change should seek an immediate appointment with their family physician and have a hemoglobin A1C drawn, which can diagnose diabetes and also determine how well one’s diabetes is under control.
Dr. Phelps' mantra is: “You can’t go blind.” He stresses that regular eye exams can preserve vision for both diabetics and non-diabetics. He notes that cataracts are more common in diabetics; however, he feels that glaucoma is not necessarily higher in diabetics. He explains that cataracts can be treated with a surgical procedure in both diabetics and non-diabetics. He explains that some diabetics develop glaucoma, and if they do, they present a greater treatment challenge than a non-diabetic with the condition. The major risk for blindness in diabetics is retinopathy; thus, he checks his diabetic patients regularly for its development. He also stresses that his patients maintain the best possible control of their diabetes.
Dr. Phelps referred me to one of his patients, Rick, who was recently diagnosed with diabetes. Rick illustrates the relationship of diabetes and vision changes and how recognition and treatment of diabetes can restore one’s health and preserve vision.
Rick is a 52-year-old man who works in the financial field and logs many hours in front of a computer monitor. He was diagnosed with myopia (near-sightedness) in the third grade and has undergone regular eye exams since that time. He admitted that before he was diagnosed with diabetes, he was “overweight but not obese” and he had not exercised much over the past five years. Last December, he noticed that he was losing weight and urinating more frequently. Several weeks later, he noticed that his vision was becoming blurred, particularly in the evening. He was due for his annual exam in about a month; however, because of the vision change, he sought an appointment with Dr. Phelps.
Dr. Phelps conducted a comprehensive eye exam with pupil dilation and noted a significant change in refraction. He then queried Rick regarding other symptoms such as weight loss or frequent urination. When Rick admitted to those symptoms, Dr. Phelps requested that he make an immediate appointment with his family physician to check for diabetes. At the visit, a blood glucose test was done, which was “above the limit” of the measuring device. He was placed on metformin and advised regarding a diabetic diet.
While he was undergoing the regulation process of his diabetes, as Dr. Phelps had warned him, his refraction changed multiple times. In a period of two months, he required different lenses. He purchased the cheapest glasses available at the drug store during this phase. It took about five months to get his diabetes under control. He has had no change in vision over the past three months. He––and his entire family––are now on a healthy diet, which Rick notes was “a major change.” He now exercises regularly. He walks during half of his lunch break and takes longer walks on weekends.
Rick’s story in one of success; however, many like him are plodding along with undiagnosed diabetes and are at risk for serious health problems, including blindness. His success is due to Dr. Phelp’s recognition of a problem, his wife’s support, and his willingness to seek treatment. In today’s times, medical care can be hurried and incomplete. If the doctor who conducted his eye exam had simply written a new prescription and sent him on his way, his treatment would have been delayed. I remarked to Rick that, in general, women are more compliant patients than men and often a man visits a physician at his wife’s or significant other’s prodding. That was true in Rick’s case. His wife not only was concerned about his welfare but also was distressed by him waking her up at night for his bathroom excursions.
November is National Diabetes Month—be aware of the symptoms of diabetes.