Diabetes + the Eyes

Developed by Prevent Blindness

Living with Healthy Vision

Overview of Risks and Symptoms Expires 04/2021

Made possible by funding from the Allergan Foundation

POWERPOINT SCRIPT(Target audience: Community Health Workers and Diabetes Educators)

Introduction

Welcome to the Diabetes + the Eyes Presentation. This is a short presentation developed by Prevent Blindness to build awareness around diabetes and how to live with healthy vision. This presentation will provide you with an overview of risks and symptoms of diabetes-related retinopathy, diagnosis and treatment of diabetes-related retinopathy, and prevention of diabetes-related eye disease. The mission of Prevent Blindness is to help you have healthy vision for life. Promoting lifelong vision health is done through education, research and programs. You can learn more about Prevent Blindness at preventblindness.org.

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SCRIPT SLIDE 2:

WHAT IS DIABETES?Diabetes is a disease in which glucose levels in your blood (also known as blood sugar) are high. Blood glucose is the body’s main source of energy and it comes from the food you eat. The body makes a hormone called insulin that helps glucose from food get into cells to be used for energy. The body of people living with diabetes may not make enough insulin or any insulin or your body is not able to use insulin well. This causes glucose to stay in the blood and not get to cells for energy.

Many people are able to live long and healthy lives with diabetes. A person living with diabetes can manage diabetes through diet, exercise and taking medication as prescribed. Without management, the high glucose levels in the blood can cause damage to the heart, kidneys, feet, ears, and eyes. Staying healthy will make it easier to manage diabetes and maintain good vision and eye health, exercise, and follow the treatment advice of doctors.

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HOW COMMON IS DIABETES? Many people have diabetes, including more than 30 million people in the United States. One in four living with diabetes do not know they have diabetes. The number of people living with diabetes has increased greatly over the past forty years. Diabetes is more common among certain populations such as African Americans, Hispanics, American Indians, Asian Americans, and Pacific Islanders. A person is more likely to get diabetes if they are over 45, have a family history of the disease, high blood pressure, or have excess weight. The good news is that a person living with diabetes can manage diabetes by taking good care of themselves through healthy meal planning, regular exercise, and taking medications as prescribed.

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SCRIPT SLIDE 4: Before we start this section, let’s go over some terms. There are some terms we will use in this section that are different words but have the same meaning. The following terms refer to the same condition and can be used interchangeably. According to the American Association of Diabetes Educators and the American Diabetes Association, using terms with “diabetes” instead of “diabetic” puts the person first, instead of the disease. It also avoids defining someone by his or her disease. There is much more to a person than having diabetes.

• diabetes-related eye disease = diabetic eye disease• diabetes-related retinopathy = diabetic retinopathy• diabetes-related macular edema = diabetic macular edema

WHAT IS DIABETES-RELATED EYE DISEASE?Prevention of complications like diabetes-related eye disease is a priority. Diabetes-related eye disease can cause trouble reading, seeing faces across the room, seeing at night or even blindness. There are two forms of diabetes-related eye disease: diabetes-related retinopathy and diabetes-related macular edema.

In general, the longer someone has diabetes, the greater their risk of developing diabetes-related vision complications including retinopathy. Retinopathy occurs when small blood vessels leak and bleed in the retina—affecting and impairing vision over time. The retina is a layer of cells in the back of the eye that acts like the film in the camera of the eye. In some people with diabetes-related retinopathy, serious damage to the eye can occur when abnormal or weak blood vessels grow on the surface of the retina. This can cause the retina to detach and can cause severe vision loss or even blindness.

Diabetes-related retinopathy is common and is a leading cause of blindness in American adults. It affects over one in four people living with diabetes, while 4% of people have severe cases of retinopathy. From 2010 to 2050, diabetes-related retinopathy is expected to almost double from 7.7 million people to 14.6 million people among Americans ages 40 and older.

Diabetes-related macular edema is a swelling that occurs with retinopathy. It happens when the small blood vessels in the center of the retina, called the macula, become leaky and cause the retina to swell. It can cause vision to become blurry. Vision loss from diabetes-related macular edema can progress over a period of months and make it impossible to focus clearly.

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SCRIPT SLIDE 4 (continued):

WHAT OTHER EYE DISEASES ARE COMMON AMONG PEOPLE LIVING WITH DIABETES?Cataract and glaucoma are other eye diseases that are common among people living with diabetes.

Cataract is the clouding of the lens in the eye. A cataract will block or change the passage of light into the eye. It can cause vision to become blurry and colors to become dull. Generally, cataracts are treatable with surgery that can help restore vision. Cataracts are a leading cause of blindness among older adults in the United States. More than half of Americans age 80 and older have cataracts or have had cataract surgery. Aside from aging, diabetes is the most common risk factor for the development of cataract.

Glaucoma is often called “the silent thief of sight” because a person usually does not notice signs of the disease until a significant amount of vision has been already lost. Glaucoma causes loss of sight by damaging the optic nerve. The optic nerve sends information from the eyes to the brain. Glaucoma is usually caused by an increased in fluid pressure inside the eye, which causes damage to the optic nerve and possible loss of side vision. Over time glaucoma can also damage central vision and eventually lead to blindness. Medications and surgery can delay progression of this disease. Once lost to glaucoma, vision cannot be restored. More than 2.2 million people in the United States age 40 and older have open angle glaucoma, the most common form of glaucoma. And at least half do not even know they have it because there is usually no pain involved or noticeable early symptoms. A person living with diabetes can reduce their risk diabetes-related eye diseases by living a healthy lifestyle and visiting an eye doctor annually.

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SCRIPT SLIDE 5: (OPTIONAL)

MEET JOSÉHi, my name is José. I am 50 years old and I work in construction, just like my father. I recently made a doctor’s appointment because I was always thirsty, eating a lot but losing weight, and was constantly visiting the restroom. I am also Hispanic and a bit overweight. I was previously told that I was at risk for diabetes. My father and grandfather had diabetes and I was nervous that I was going to have it too. I saw how hard my dad worked to manage his diabetes.

At my appointment, my doctor told me I had diabetes. She told me that I could manage diabetes by eating a proper diet, exercising, and taking my prescribed medication. I also learned from my doctor that by managing my blood glucose, I could protect my heart, kidney, feet, ears, and eyes. My doctor told me to see an eye doctor (an ophthalmologist or optometrist) to check the health of my eyes. I remembered my grandfather had lost his vision in his left eye and I shared that with my doctor. My doctor explained the importance of getting my eyes checked by an eye doctor, who performs a complete eye exam with dilation of my pupils because sometimes there are no symptoms. The eye doctor can see things going on in our eyes that we cannot feel. Even though I did not notice any eye problems, I am so glad that my doctor encouraged me to pay attention to my eye health and prevent any issues from arising!

I am convinced that my eye health is important and I plan to make an appointment with my eye doctor annually. I am happy to find out that I could use my medical coverage to help with the expense of the eye doctor visits. I am going to do everything I can to stay health and support my family while managing my diabetes!

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SCRIPT SLIDE 6:

WHAT ARE THE SYMPTOMS OF DIABETES-RELATED RETINOPATHY?Early detection and treatment is the best way to reduce the risk of diabetes-related retinopathy. There are usually no symptoms in the early stages. A person with diabetes should have an eye exam every year, or as directed by their eye doctor.

Vision changes due to diabetes-related retinopathy usually affect both eyes. The most common symptoms include:

• Sudden increase in eye floaters which can appear like spots and/or dark cobweb-like strands.

• Blurred vision • Sudden loss of vision in one eye • Halos around lights • Flashing lights • Poor night and color vision

If a person living with diabetes experiences any of these symptoms, have them contact their eye doctor right away.

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WHAT PUTS A PERSON WITH DIABETES AT HIGHER RISK FOR DIABETES-RELATED RETINOPATHY?Often there are no symptoms or early warning signs in the early stages of diabetes-related retinopathy. A person can have retinopathy without any symptoms or changes to vision. Early detection and treatment are important for diabetes-related retinopathy. This is why regular eye exams and a healthy lifestyle are so important for people living with diabetes.

For a person living with diabetes, there are different factors that can decrease and increase your risk for developing diabetes-related retinopathy. You can help to protect your eye health!

The longer a person has diabetes, the greater their risk of developing diabetes-related retinopathy.

Blood glucose management can reduce the risk of retinopathy and vision loss. A person living with diabetes can work with their healthcare provider to be sure their blood glucose level is in the recommended target range.

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SCRIPT SLIDE 7 (continued):

Some racial and ethnic groups are at higher risk. African Americans, Hispanics, American Indians, Asian Americans, and Pacific Islanders are at increased risk of developing diabetes-related retinopathy.

Smoking increases a person’s risk of developing retinopathy. Quitting smoking can reduce risk of developing diabetes-related retinopathy.

Managing blood pressure and cholesterol levels will reduce the risk of eye disease and protect your heart, kidneys, feet, ears, and eyes. Healthy meal planning, regular exercising and/or taking medication as prescribed will also help to improve blood pressure and cholesterol levels, which will reduce the risk of diabetes-related retinopathy.

Women with diabetes prior to pregnancy have an increased risk of developing diabetes-related retinopathy quickly and should see their eye doctor regularly during their pregnancy. Women who develop gestational diabetes are at lower risk and not required to get an eye exam.

There is a close relationship between kidney disease and diabetes-related retinopathy. Preventing kidney disease, which is a complication of diabetes, will also decrease the risk of diabetes-related retinopathy since they are both a complication involving small blood vessels. Preventing complication with the kidneys will also help prevent retinopathy in the eyes.

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SCRIPT SLIDE 8: (OPTIONAL)

MEET ANDREAHi there, my name is Andrea, I am an English teacher and I am 58 years old. I have been living with diabetes for the last 7 years. I was excited to learn that, although I have diabetes, I could prevent complications that would affect my vision. Since I was diagnosed, I have been going to the eye doctor every year. Each time I go to the eye doctor, I go prepared with questions. The eye doctor conducts a full eye examination that includes dilating my eyes by placing drops in my eyes which makes me sensitive to light for a few hours.

At my last visit, the doctor told me my eyes were doing well and talked to me about staying healthy. I learned that the longer I have diabetes, the more likely I will be to develop diabetes-related retinopathy. I have learned that there are many things I can do to help prevent diabetes-related retinopathy. I can manage my blood glucose levels, blood pressure, and cholesterol by eating healthy, taking my medicine, exercising, and carefully keeping track of my glucose levels. I have learned that being African American puts me at higher risk of developing diabetes-related retinopathy. I am going to continue to work on healthy lifestyle changes to reduce that risk. Luckily, I do not smoke, so that really helps too!

I was told to come back in a year to get my eyes rechecked so the eye doctor can monitor any changes, and I am going to make sure I never miss appointments. The doctor informed me to look out for the following symptoms and to come see him right away if I experience any of them – a sudden increase in eye floaters (spots and/or dark cobweb-like strands), blurred vision, sudden loss of vision in one eye, halos around lights, flashing lights, or poor night or color vision. If I do develop problems in the future, we will work together to determine the best treatment options for me to protect my vision so that I can enjoy watching my grandchildren grow.

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SCRIPT SLIDE 9:

HOW IS DIABETES-RELATED RETINOPATHY DIAGNOSED? A person living with diabetes should have an eye exam at least once a year, or more often as recommended by their eye doctor (ophthalmologist or optometrist). The eye examination should include dilation. Dilation of the eyes is done using eye drops to widen the opening on the front of the eye, called the pupil. This allows the eye doctor to see into the back of the eye. This is an important step to take when getting an eye exam for people living with diabetes. The temporary side effects of dilation eye drops are blurring of vision, especially up close, and sensitivity to light. They only last a few hours or less, but the benefit can be enormous.

Sometimes people living with diabetes may not be able to make it to an eye doctor appointment every year for many reasons. These individuals can work with their primary care doctor to have photos taken of their retina in each eye to screen for diabetes-related eye disease. These photos are examined by an eye doctor to determine if there is any diabetes-related eye disease. The photos can be used to compare the images taken in past and future exams. This helps monitor the health of the eye to determine if retinopathy is present and need a complete dilated eye exam. The eye doctor can then use the pictures to show what is happening in the eye along with developing a treatment plan. Timely treatment of diabetes-related retinopathy can help reduce the risk for vision loss.

Optometrists and ophthalmologists are both eye doctors. What is the difference? An optometrist is an eye doctor who has earned the Doctor of Optometry (OD) degree. Optometrists can perform eye exams, prescribe eyeglasses and contact lenses, diagnose disease, prescribe medications to treat certain eye problems and diseases, and may also provide pre- and post-operative care for an eye surgery performed by an ophthalmologist.

An ophthalmologist is a medical doctor (MD) or an osteopathic doctor (DO). Ophthalmologists are trained to perform eye exams, write prescriptions for eyeglasses and contact lenses, diagnose and treat disease, prescribe medications, and perform eye surgery.

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SCRIPT SLIDE 10:

HOW IS DIABETES-RELATED RETINOPATHY TREATED? In the early stages of diabetes-related retinopathy, annual dilated eye exams (or more often as recommended by the eye doctor) are important for monitoring retinopathy. In more advanced stages, there are a range of options for treatment including medications, laser procedures, and surgery. Talking with the eye doctor and working together on a treatment plan is the best way to determine the next steps.

People living diabetes need to know that damage in the retina often happens before they notice changes in their vision. Everyone with diabetes should have a dilated eye exam annually or at least retinal photographs evaluated by an eye doctor to catch any eye disease in its early stage to ensure healthy vision. The eye doctor can decide if more frequent exams and/or treatment are needed.

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SCRIPT SLIDE 11: (OPTIONAL)MEET JOEHi there, my name is Joe. I work as a lawyer and am looking forward to retirement in the next 5 years. I found out I had diabetes when I was 54 and have been living well with diabetes for 6 years now. When I was diagnosed, I wanted to make some changes to my eating habits and quit smoking, but it was hard! I felt that I was too busy to take time to do all the things my doctor told me to do. Not managing my glucose levels caused me to feel faint and tired. I did not feel like my normal self. Then one day I was looking at my phone and the screen was blurry. This made me nervous and I was not sure what I should do. This continued for a few days and I decided it was time to make an appointment with an ophthalmologist.

The doctor conducted a full eye examination that included dilating my eyes with drops. This made me sensitive to light for a few hours but it did not hurt. The doctor told me I had early stages of diabetes-related retinopathy. I was shocked since I did not have any issues with my eyes before. He told me that I did not need treatment right now, but it was important to consider those healthy eating habits and join a support group that would help me quit smoking. I was ready to make some changes!

The doctor informed me to look out for the following symptoms and to come see him right away if I experience any – a sudden increase in eye floaters (spots and/or dark cobweb-like strands), sudden loss of vision in one eye, halos around lights, or flashing lights. If my diabetes-related retinopathy gets worse in the future, my eye doctor and I will work together to determine the best treatment options for me. For now, I am embracing the advice from my doctors (and my wife) and paying more attention to my health. I want to be sure I can enjoy my retirement and be able to see the ball when I am playing golf!

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SCRIPT SLIDE 12:

HOW TO PREVENT DIABETES-RELATED EYE DISEASE? A person living with diabetes can manage their health to help prevent diabetes-related eye disease by:

• Managing their blood glucose, blood pressure, and cholesterol levels

• Getting an annual dilated eye exam and/or at least obtaining photos of the retina in each eye that are examined by an eye doctor

• Maintaining a healthy lifestyle that includes regular exercise, not smoking, and healthy meal planning. Talk to a dietitian or diabetes educator about their eating habits and creating an exercise routine.

REMEMBER THE ABCs OF DIABETES TO PROTECT EYE HEALTH.

A1C: Manage your blood glucose. Have your A1C checked every 6 months.

BLOOD PRESSURE: Manage your blood pressure to protect your heart, kidney, and eye health.

CHOLESTEROL: Manage your cholesterol levels.

DON’T SMOKE: Don’t start smoking and if you smoke, quit.

EYES: Get a comprehensive dilated eye exam annually.

SCRIPT SLIDE 13:

RESOURCESVisit the webpage listed on this slide for more information about diabetes-related eye disease. These resources are here to help you maintain healthy vision.

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www.preventblindness.org/diabeteswww.preventblindness.org/diabetes-resources