Health & Fitness

Vision loss can develop without any symptoms

FOR THE MIAMI HERALD

When you have diabetes, a complication that can develop without major symptoms is vision loss.

Diabetic retinopathy, the leading cause of blindness in American adults, is caused by changes in the retina’s small blood vessels and is the most common diabetic eye disease, according to the National Eye Institute. People with both Type 1 and Type 2 diabetes are at risk, especially if they are not managing their glucose levels properly.

The illness can develop into its most severe form, proliferative retinopathy, without any symptoms. In this condition, the signals sent by the retina for nourishment trigger the growth of new blood vessels, which are abnormal and fragile. If they leak blood, severe vision loss and blindness can result.

South Miami resident Jordan Wellborn says she was almost one of these diabetics who did not recognize the signs until it was too late. Wellborn, 26, had been diagnosed with diabetes when she was 7, but it was not until later that she experienced abnormal vision. She says she knew something was off when she began seeing white dots two years ago.

“That was a major difference to me,” Wellborn said. “At the time, it was a big change to not be seeing clearly.”

She did not link her diabetes to her eye issues. But Wellborn was referred to the Center for Eye Care and Excellence in Kendall, where she learned she was one of the more than 4.2 million people in the country whose diabetic issues manifested itself in some state of retinopathy.

By the time of her diagnosis, Wellborn was in grave danger of becoming legally blind, says Dr. Andrew Schimel, a retina specialist at the center and professor of ophthalmology at Florida International University.

In her right eye, the retina was scarred and detached, rendering her blind.

“She had very severe diabetic retinopathy with a lack of oxygen getting to her retina in right eye,” Schimel said.

He said the left eye also was damaged and had a poor prognosis.

While nothing could be done to save her right eye, Wellborn began several courses of treatment to prevent further vision loss to her left. She underwent laser therapy and received medication injections into her eye, two of the main types of treatment.

But despite treatment, retinal detachment occurred in Wellborn’s left eye in December 2013.

“She was doing fine but then that December she lost her vision,” Schimel said. “She could barely see fingers in front of her face.”

He scheduled an emergency surgery to prevent permanent vision loss.

“We were able to get her back to 20/30 in the left eye, which will allow her to drive,” Schimel said. “We have been monitoring her since and she has been doing great.”

Schimel says advancements in treatment have led to better outcomes for more patients in recent years.

Laser treatments have been the standard for the last few decades, until about 10 years ago, when steroid injections were introduced. Both work to stop blood vessels from leaking.

At the University of Miami’s Bascom Palmer Eye Institute, medication injections have quickly become a favored treatment option, said Dr. Harry Flynn, a professor of ophthalmology at the institute.

Injections, also known as pharmacotherapy, could stabilize or improve vision by as much as 90 percent, he said.

“The use of these injections into the eye for improving diabetic retinopathy are based on clinical trials conducted by the National Eye Institute as well as the by industry-funded studies,” Flynn said. “These studies have shown that intravitreal injections work even better than traditional laser treatment.”

Flynn recommends that all diabetics go for annual eye exams to facilitate early detection, and consequently prevent or reduce vision loss. Routine eye checkups have also revealed undiagnosed diabetes, he said.

“Sometimes the ophthalmologist is the one who makes the initial diagnosis based on the problems seen in the eye,” Flynn said.

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