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The diabetes-glaucoma connection - Special section: diabetes

Ebony, March, 2004

GLAUCOMA affects 3 million people and is the leading cause of preventable blindness. But that only tells part of the story. The greater tragedy is that half of the people with glaucoma don't know it, and 90 percent of the 120,000 Americans blinded by the disease didn't have to be.

Glaucoma is a group of diseases that can lead to damage to the eye's optic nerve and loss of vision (usually peripheral vision at first). Most, but not all, of these diseases are characterized by increased fluid pressure inside the eye. Because it usually has no early symptoms, glaucoma is often called "the sneak thief of sight."

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"By the time a person notices any vision loss, 75 percent of the damage has already been done," says Dr. Edward N. Burney, who is a professor at Case Western Reserve University Medical School in Cleveland. He also is director of ophthalmology at the Veterans Administration Medical Center and director of glaucoma at University Hospitals Health System.

Anyone, at any age, can develop glaucoma. While everyone is at risk, people of African descent are especially at risk, doctors say. One in 13 has glaucoma, and the disease occurs 4 to 6 times more often in Blacks than in Whites. In addition, glaucoma often occurs earlier in life and more frequently results in blindness in Blacks. There are some theories that the optic nerve in African-Americans are more susceptible to damage than other races. Until recently, many Blacks had received less aggressive treatment than needed, primarily, doctors say, because of inaccurate pressure readings due to thinner corneas in Blacks.

While some studies have shown an association between glaucoma and diabetes, with the presence of glaucoma increased in people with diabetes, Dr. Leon Herndon, associate professor of ophthalmology at Duke University Medical Center, says, "If there is an association between the two, it is weak." Herndon says the correlation may be simply that people with diabetes go to the doctor more, which in turn may lead to an increased diagnosis rate for glaucoma.

Whatever the connection, glaucoma and diabetes are two of the leading causes of blindness in the United States. Despite the fact that both diseases can be detected early and treated, both often lead to progressive ocular damage. Several studies have investigated the associations between the two diseases, with the data suggesting that glaucoma patients with diabetes appear to be more susceptible to nerve damage with resulting visual field loss at a lower intraocular pressure than those patients with glaucoma alone. There has also been found to be a significant qualitative difference in the pattern of visual field loss between glaucoma patients with and without diabetes.

It is suspected that the same vascular factors (such as intraocular pressure and low blood flow) that contribute to diabetes may predispose people to develop inferior visual field defects, although to what extent these factors influence nerve fiber damage and visual field abnormalities is not known. "The risk of vision loss is even greater in people with diabetes, because of the effects diabetes has on circulation," Burney says.

And that makes early detection and treatment even more critical to save a person's sight. There is no cure for the disease, but its ravaging effects can be controlled and blindness prevented. Testing for glaucoma is simple, quick and painless. The best way to detect the disease is through comprehensive eye examinations on a regular basis, including checking sight at various distances, testing the fluid pressure in the eyes, inspecting the optic nerve for signs of damage, and, if necessary, measuring visual field to determine if any peripheral vision has been lost.

Treatments may include eye drops (the most common form of treatment), pills, laser surgery (performed when eye drops do not stop deterioration of the field of vision), or surgery (performed when eye drops and laser surgery have been unsuccessful.) "Studies have shown that if diabetes is controlled within the first five years, the chances of eye damage is greatly reduced," Burney says.

THE FOLLOWING IS GOOD ADVICE FOR ANYONE CONCERNED WITH GLAUCOMA OR DIABETES:

* Keep your blood sugar within recommended levels.

* Reduce high blood pressure.

* Get a dilated eye exam by an eye doctor every year.

SEE YOUR EYE DOCTOR IF:

* Your vision is blurry.

* You see double.

* You see spots or floaters.

* One or both eyes hurt.

* You feel pressure in your eyes.

* You can't see things at the sides as well as you used to.

The diabetes-glaucoma connection - Special section: diabetes

Ebony, March, 2004

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