Diabetes Awareness Month

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Imagine for a moment that there exists a disease that could potentially take 15 years off your lifespan. Let’s say, for the sake of this discussion, that this same disease could also significantly increase your risk of heart attack, stroke, kidney disease, and blindness. And now, let’s say that almost one third of the entire Canadian population either has this disease or is on the verge of acquiring it. Would this disease be something worth speaking about? Where would you rank this disease on your list of health concerns? What would a disease with such significant and wide-reaching effects be called?

Well, it turns out we already have a name for it; we call it diabetes.

 

Yes, diabetes. The same diabetes that seems to have nonchalantly found its way into the lives of so many Canadian families. The same one that, all too often, is spoken about like it’s a minor nuisance rather than a potentially serious illness. As if having high blood sugar is some sort of innocuous topic of discussion instead of a truly ominous indicator of poor health.

 

This same disease is the leading cause of acquired blindness in Canadians under the age of 50. It contributes to 30% of strokes, 40% of heart attacks, and 70% of non-traumatic limb amputations. In fact, the effects of diabetes on the public health care system have been so dramatic, it has officials at Diabetes Canada pleading with the federal government to develop a national strategy for intervention, calling it an epidemic. There are currently over 3.5 million Canadians living with Type 1 and Type 2 diabetes. It is projected that number will reach over 4.6 million by 2028. That is a 32% increase in one decade.

 

However, what is more concerning about diabetes is the insidious nature of its onset. It is well documented that, by the time a patient with type 2 diabetes is officially diagnosed, they have likely already had the disease for about 5 years. According to Diabetes Canada, it is estimated that there are currently over 7 million Canadians who are either undiagnosed or pre-diabetics. That means that, all together, there are over 10 million people (28% of the population) who are potentially at risk of suffering from the negative effects of diabetes.

 

What is diabetes?

 

Diabetes is a chronic disease that occurs when the body either does not produce enough insulin or cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. The increase in blood sugar that occurs due to the lack of insulin (or the ineffective use of it) is called hyperglycemia. Over time, hyperglycemia can lead to serious damage to many of the body’s tissues.

 

Diabetes and the eye

 

Diabetes is a leading cause of vision loss in Canada. The risk of blindness is 25 times higher for patients with diabetes compared to those without diabetes.

 

The primary condition that is related to this vision loss is called diabetic retinopathy. Over time, increased levels of glucose in the bloodstream cause damage to the small blood vessels in the back of the eye (retina). Eventually, this can lead to weakening of the blood vessel walls, which leads to leakage of blood and fluid into the retina. Diabetic retinopathy can have consequences of varying degrees. Patient symptoms can range from mild blurriness to severe vision loss due to conditions like retinal detachments and large hemorrhages. Diabetes can also increase a person’s risk of developing other ocular conditions such as glaucoma and cataracts.

 

The most reliable way to confirm the presence and the degree of diabetic retinopathy is to have comprehensive eye exam. During this examination, doctors will often use drops to dilate the patient’s pupils allowing them to take a more detailed look at the retina.

 

Studies have shown that signs of diabetic retinopathy in type 2 diabetics can often be detected even before blood sugar levels reach diagnostic levels. This means that regular eye exams can be vital in early diagnosis of the disease.

 

As an optometrist, over the years, I have seen patients on both ends of the diabetic retinopathy spectrum. On one end, I have seen the devastating long-term vision loss that can result from uncontrolled hyperglycemia, along with the decreased quality of life and the loss of hope that come with losing one’s eyesight. However, on the other hand, I have seen the incredible rejuvenation of patients who were once on the verge on significant ocular disease. I have had the pleasure of witnessing patients turn their lives around by making the necessary changes in their lifestyle that have led to weight loss, improved vision, and overall better lives.

 

Finding a solution to the greater problem of the diabetes epidemic seems like a daunting task. With one third of an entire nation at risk of acquiring this potentially devastating disease, it’s hard to fathom where to even start. Without doubt, it will require a complicated and multi-factorial approach by the government, the health care system, and the public. However, if we narrow our focus, we will find that the starting point is actually quite clear. Start with you. Make the changes that you know are necessary to live a full, healthy life. Eat well, get some exercise, and talk to your doctor. It can be done. I’ve seen it with my own eyes.

 

The Average Person

The "average person" will probably not recognize what the image above shows. But the "average person" is exactly who needs to understand the importance of what is happening.

A couple of days ago, I had 19 year old healthy young man come to see me for an eye exam simply because he was noticing a little bit of blurriness in his distance vision. Everything else seemed fine. No pain, no redness, no injuries, no medications.

A quick refraction (the "which is better, one or two?" test) provided a very simple prescription for glasses and we discussed the fact that my friendly patient's vision was actually better than 20/20 with the glasses. As far as he knew, he was good to go.

In fact, if this patient had gone to an optician for a sight test, he would've been. That would've been the end of the process and the patient would be on to buying glasses.

But our next step was to examine the health of our patient's eyes. And that's where this image comes in. What you see here is an image of a large retinal tear and detachment in this patient's right eye (green areas along the bottom and right side of image). A condition that can easily lead to permanent loss of vision if it is not dealt with in short order.

It's very difficult to convey in words the significance of this very real scenario. This is the "average person". This is the person who "just needs glasses". This is the person who's vision has been stable for years so he buys a new pair of glasses or contacts online using his old prescription. Or the person who says "my vision has always been good, so I don't need any eye exam". This could be anyone. And this person could've been blind tomorrow.

Deregulation in BC has made it possible for any Tom, Dick, or Harry to sell glasses and contact lenses. This was done under the ruse of "consumer benefit". Tell me which consumer benefits from an undiagnosed retinal detachment or glaucoma or any number of eye conditions that can quietly lead to permanent vision loss.

Having regular eye exams is not just about keeping your glasses or contact lens prescription updated. It's about keeping your eyes healthy for the long term. And in some cases, it might even be about saving your vision.

An Ophthalmologist, an optometrist, and an Optician Walk into a Bar...

Ok, there's no funny punch line here. I just thought that was a catchy title.

What's the difference between an ophthalmologist and an optometrist? What about an optometrist and an optician? Are they similar in some ways? This is the conversation of The Three O's of Eye Care. Or, as my cousin from the UK who loves White Spot would rather call it, Triple O's.

Ophthalmologists are medical doctors. After completing their MD, they complete residency training (usually 4 years) in ocular disease treatment and ocular surgery. Then, they will normally do another couple of years of sub-specialty training (cataract, retina, laser refractive, etc...).
Ophthos mostly see the more complicated eye issues and do surgery for said issues. Patient's will most often require a referral from their optometrist or GP to see the ophthalmologist.

Optometrists are generally considered to be primary eye care providers. Kinda like seeing your GP for a stomach issue, which her/she will then either treat him/herself or refer to a specialist for further evaluation. Optoms have a bachelor's degree and Doctor of Optometry degree (OD), which is a 4 year program focused specifically on vision and ocular disease. ODs will of course checking your glasses and contact lens prescriptions, but we can also examine for, diagnose, and treat a wide variety of conditions. We can also see and treat patients who have experienced eye injuries, scratches, infections, and of course dig stuff out of the cornea if necessary. We also examine for systemic conditions such as high blood pressure, diabetes, cholesterol, and others than can directly affect your eyes.

Opticians are licensed professionals who are trained in the fabrication and fitting of visual aids, such as contact lenses and glasses. They do not, however, examine for or treat any eye conditions or ocular disease.

Sight Testing is not an Eye Exam

Unfortunately, due to deregulation of health care in BC and other provinces, it is possible to have your vision tested and glasses prescription using automated instruments, without examination of ocular health. This is called sight testing and will usually be seen at optical stores.

It is very important to understand the vast difference between a sight test and a comprehensive eye exam. So, next time you're in to get your eyes checked, be sure to ask if they will be examining for ocular conditions like cataracts, glaucoma, and others that can affect your eye health and vision!