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Cataracts, a common eye problem related to aging, is a loss of the transparency in the normally clear lens of the eye. At least 40% of those over the age of 75 develop an opacity of the lens causing diminishing vision. Cataracts are more common in individuals with diabetes, develop earlier, progress more rapidly and accelerate the development of diabetic retinopathy. Symptoms may be gradual, painless with increasingly blurred vision of double vision. Halo’s or blurriness around lights, increased sensitivity to light and glare, dulled color perception, milky or yellow appearance of the lens and difficulty driving at night are symptoms of cataract development. Because cataract developement may not be detected by the individual due to gradual changes, drops placed in both eyes and examined using acuity measurements may indicate a problem before symptoms occur. The best examination for cataract detection is with the use of a slit lamp, a high magnification and narrow light, while looking through a dilated pupil. This procedure should periodically monitor the progression of the disease. initially, a small hazy spot may appear in the field of vision and gradually, as the lens grows more opaque, vision becomes more blurry. A cumulative exposure to the sun’s ultraviolet rays over a lifetime, physical injury to or inflammation of the eye, the long term use of corticosteroid drugs, hereditary factors and birth defects may be contributing factors that lead ot cataracts.
Cataracts are extracted surgically with the implantation of intraocular lens, providing a normal post-operative visual correction for most individuals. With those who have diabetes, however, this may be contraindicated because their lens may cause diabetic retinopathy to become worse, possibly due to surgical trauma. Researchers feel cataracts are found more in diabetic individuals because the enzyme aldose reductase converts the sugars, such as glucose and galactose, into sugar alcohols. The alcohols cannot readily diffuse out of the lens, causing an imbalance in osmotic pressure, resulting in a swelling of the lens due ot fluid accumulation. This allows for the changes in the refractive power of the lens causing cloudy vision.
Surgery is determined based on the age, health and the presence of other ocular disease and the degree to which the patient feels handicapped. Extraction may become medically necessary if a person has a narrow angle glaucoma. It is primarily important to prevent cataract development. No diet has been proven to delay the formation of cataracts in healthy individuals, however the contribution of dietary control on blood glucose may help prevent cataracts and complications in those with diabetes. There has been research to support the idea that cataracts may be caused by ultra violet light. Therefore, it is recommended individuals wear sun glasses marked ‘general ro specific purposes’ or those that block at least 95% of UVB (Ultra violet B) rays to filter out much of the radiation.
To minimize outdoor glare, a wide brimmed hat should be worn. Indoors, use large print books and newspapers, floor or desk lamps with incandescent bulbs instead of ceiling or fluorescent lights. Dimmer controls are also advised. Pinpoint halogen lights should be avoided because they cause pupils to constrict.
The importance of blood glucose control with cataracts was evidenced in the Epidemiology of Diabetic Intervention and Complication Trial, a follow up of the original Diabetes Control and Complications Trial Study, the DCCT, completed in 1993. The trial showed a 1% difference between a tightly controlled glucose group and a group less intensely managed in terms of A1c and a very noticeable difference in nephropathy, neuropathy and retinopathy. There was a reduced number of cardiovascular disease events in the intensely controlled group, but not statistically significant. It was found that if diabetes was controlled intensely early on, the best results were obtained in terms of reducing complications and decreasing the need for laser therapy, dialysis and renal transplantation.Definite benefits of blood glucose were recognized for the microvascular complications of nephropathy, neuropathy and retinopathy ans as patients continue to be followed, they are now seeing the benefits of microvascular complications, atherosclerosis the longer the patients are studied.
Annette Karnash, RN