Diabetes is a significant cause of blindness in the United States. The sad part is that it doesn’t have to be that way. When your body is exposed to high levels of sugars in the blood stream, the levels of blood nitric oxide drops. Nitric oxide helps the blood vessels relax and dilate, and when there isn’t enough of it, the blood vessels can get damaged. Constricted and damaged blood vessels can lead to higher blood pressure, plaque buildup in the arteries, heart disease and blockages. The tiny blood vessels like the ones found in the eyes and around nerves are the most at risk.

Retinal blood vessels begin to malfunction and leads to ischemia (lack of oxygenation) of the retinal tissue. The retina adheres to the back wall of your eye and collects light, which is converted to electrical energy and transmitted to the brain via the optic nerve.

The retina is rich in very fine blood vessels and dependant on these channels for oxygen. These tiny vessels malfunction in diabetes and high blood pressure and the retina doesn’t get enough oxygen.

This lack of oxygen (ischemia) leads to formation of new blood vessels in the retina which are fragile and tend to leak blood and protein into the retina itself causing swelling and dysfunction of the retina. If the growth of these new blood vessels continues, they can begin to pull on the retina and cause it to detach from the back wall of the eye and lead eventually to retinal detachment and blindness.
 
The best way to avoid this horrible cascade of events is to prevent it. Close control and monitoring of your blood sugars is key in disease prevention. A low carbohydrate and high protein diet coupled with regular daily exercise is a potent control mechanism for blood sugars. You must partner with your primary care doctor and be active and honest in the management of your sugars by keeping logs of your levels throughout the day in a glucose diary.

Regular annual examination with your ophthalmologist (eye specialist) is essential to monitor for the growth of these fragile new blood vessels. Your vision can be fine and you can have no ocular symptoms until it’s too late. At the first sign of abnormal bleeding or blood vessel formation in the retina, your ophthalmologist will begin therapy. This may start as more aggressive blood sugar control with medicines, diet and exercise. If this fails, he may use laser therapy to shrink or clot off these abnormal vessels. There are many new medications, which can be given directly to the eye to reduce these abnormal vessels as well.

Diabetes is a like a snowball going downhill, it gains momentum as it gets worse. So see your ophthalmologist on a regular basis and preserve your precious sight. 

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