If someone has Diabetes and macular degeneration, Do they still need to have a yearly dilated eye exam?
Holly asked:
I have a couple of diabetic patients that state they do not need to have a dilated eye exam since they have macular degeneration. If this is true,what is the rationale behind this?If not true, what is the rationale?
I have a couple of diabetic patients that state they do not need to have a dilated eye exam since they have macular degeneration. If this is true,what is the rationale behind this?If not true, what is the rationale?
I would find it hard to believe that with diabetes and macular degeneration that their opthalmologist would not want to do a complete eye exam on them annually. Why would you want to take a risk with your vision (or what you have left) since you have two diseases that rob you of your vision?
They need it more than most. They already have a problem that needs to be followed. Since they have macular degeneration, which generally always starts as the dry form, they are at higher risk of wet macular degeneration, which does have a treatment.
Your pt.s are mistaken.
“How can I take care of my vision now that I have AMD?
Dry AMD. If you have dry AMD, you should have a comprehensive dilated eye exam at least once a year. Your eye care professional can monitor your condition and check for other eye diseases. Also, if you have intermediate AMD in one or both eyes, or advanced AMD in one eye only, your doctor may suggest that you take the AREDS formulation containing the high levels of antioxidants and zinc.
Because dry AMD can turn into wet AMD at any time, you should get an Amsler grid from your eye care professional. Use the grid every day to evaluate your vision for signs of wet AMD. This quick test works best for people who still have good central vision. Check each eye separately. Cover one eye and look at the grid. Then cover your other eye and look at the grid. If you detect any changes in the appearance of this grid or in your everyday vision while reading the newspaper or watching television, get a comprehensive dilated eye exam.”
Do they mean they’re getting dilated exams for their macular degeneration and don’t need a separate one for retinopathy? I can’t imagine an ophthalmologist saying they don’t need any kind of exam at all for either condition.
Macular degeneration (MD) is just one of the complications of diabetes affecting the eye. With MD, one’s visual acuity certainly goes down but can still perceive light & gross motion (blurry). So the eye is still useful.
The dreaded complication however is retinopathy. As everywhere in the body, vessels in the eye are also affected (due to excess of glucose in the blood, certain products are formed that deposit in the vessel wall. This makes them stiff and narrow) So with retinopathy,
1. The stiff vessels are not flexible & can burst causing a bleed in the eye rendering it completely blind.
2. The narrow stiff vessels lead to less oxygen delivered to the retina. Due to body’s intrinsic reflexes, certain chemicals are released in the areas that do not get blood (oxygen) which forms new blood vessels in an attempt to increase oxygen delivery. However, these “new” blood vessels aren’t perfect and easily burst & bleed leading to complete blindness.
3. Small bleeds (that do not cause blindness) eventually heal with scaring (like a contusion anywhere else in the body). The scar tissue contracts. This detaches the retina from its “bed” leading to retinal detachment and eventual degeneration and consequent complete blindness.
I dont intend to give a lecture in ophhtalmology, but you see, it is imperative for regular eye check up in diabetics. Needless to say, pristine glucose control is imperative!
Good luck with your patients… convincing them is quite a job (my mom is a diabetic with retinopathy so I know what it takes to get her to the doc!)