How Eye Exams Can Help You Detect Diabetes: Q&A with Dr. Jeffrey Neighbors

Posted on November 23, 2020 in Healthy Living

The skills involved in being an optometrist seem pretty straightforward on the surface – providing examinations and analyzing results to diagnose ocular and vision issues to help patients have the best vision they can for as long as they can. But did you know that regular eye exams could detect symptoms of high blood pressure, thyroid diseases, certain types of cancer, diabetes, and more? During the month of November, we’re focusing on diabetes awareness. We asked Dr. Jeffrey Neighbors of EyeCare Associates of Ankeny to help us understand the connection between your eye health and diabetic disease.

What are some common warning signs of diabetes that are revealed in an eye exam?

Dr. Neighbors: Diabetes often causes the lens of the eye to swell. The most common warning sign isn’t necessarily visible to me, it’s listening to the patient describe what is happening. Many times the description is a sudden change in their vision from crisp and clear to blurry – either with or without corrective lenses. A common situation is a patient that is busy and active and perhaps hasn’t taken the time for an annual physical. They experience blurry vision, which interferes with their work and recreation. Naturally they assume it’s their vision, but upon examination, we see certain changes that may point to their blood sugar and A1C being high. We encourage them to see their primary care provider for an exam to rule out diabetes or pre-diabetes. If they are able to make changes to bring blood sugar and A1C down, their vision typically improves to the previous levels.

So, blurry vision might be the only early symptom of diabetes for some people?

Dr. Neighbors: Yes, here’s a recent example. A patient who had updated corrective lenses earlier in the year noticed that while he was golfing he could clearly spot where his ball landed in June. He came in for an appointment in August and said he was struggling to find his golf ball and thought he needed a stronger prescription for his glasses. We did an exam and based on the rate of change, I asked if he had seen his doctor lately. He went to see his doctor for blood work and, sure enough, he was diabetic. He had not had any other physical symptoms of diabetes such as excessive thirst, weight gain or loss. So, it’s important to keep your regular eye appointments, but it’s also vital to keep up with your other medical wellness checkups for overall health.

Do patients sometimes struggle to see the connection between their eye health and their overall health?

Dr. Neighbors: Our practice focuses on medical eye care so we are examining not only their eyes, but we’re asking for a full medical history so we can be aware of how other health issues are interacting with their vision. The Affordable Care Act has helped different medical specialties interconnect for whole patient care. One of the requirements for patients with diabetes is that they see their eye doctor regularly. This helps us stay on top of any changes and encourage the patient to regulate their blood sugar for optimal eye health.

What can happen to a person’s vision if diabetes is not regulated?

Dr. Neighbors: Across the scope of my career, I’ve seen most diabetic patients manage their diabetes well and remain relatively stable. Diabetes is a disease that has levels of impact on other parts of your body and their ability to function properly. How you manage your diabetes has a direct impact on your long-term vision.

• If a patient maintains near normal levels, we see very little impact.
• With moderate control, we might see some hemorrhaging, some scarring on the retina, faster development of cataracts and other issues. We estimate about 70% of the diabetics population falls into this category.
• With uncontrolled diabetes, we see a cascade of diabetic problems in the eye. Scarring of the retina, hemorrhaging, cataracts – and the body tries to repair the hemorrhages by growing new blood vessels, which are thinner and break easier. Fluid then builds up and damages the eye permanently. This can result in loss of vision and in some cases blindness. Once this damage occurs, there is no way to repair it. These are always tough cases because our patients and research tells us that losing vision is far more psychologically damaging than losing a limb to diabetes.

What advice do you have for non-diabetic patients as we gain awareness during the month of November?

Dr. Neighbors: Diabetes can strike anyone – the lines between type 1 and type 2 can be blurred – and it isn’t always about heredity or weight or other commonly held beliefs. Make it a priority to make and keep your wellness checkups with your family physician and your optometrist. Maintain a healthy lifestyle and pay attention to any changes in your vision.

What advice do you have for newly diagnosed diabetics?

Dr. Neighbors: It’s a marathon, not a sprint. Embrace routine and consistency. Being regimented about monitoring your blood sugar, attending all of your appointments and taking your medication (if prescribed) is the best way for you to live the life you desire. Patients who approach diabetes this way are the ones who outlive the disease.