Why eye exams matter for people with diabetes

After Peter Hultman was diagnosed with diabetes in his early 50s, one of his first stops was the eye doctor.

His eyes were healthy that time, but a year later during his eye exam, he was diagnosed with glaucoma. The condition can damage the optic nerve, which is essential for good vision, and is one of the leading causes of blindness for people over 60.

While diabetes doesn’t cause glaucoma, people with diabetes are more likely to develop it. Diabetes also is a major cause of other types of vision conditions and vision loss.

“It comes in quick,” said the 67-year-old Taunton, Mass., grandfather, about his vision problem. “I started wearing ‘cheaters’ because I used to have 20/20 vision, and I didn’t want to believe I had problems with my eyesight.”

Hultman said he was fortunate to find a glaucoma specialist, who he sees every year for a thorough eye exam, and who prescribed eye drops that have helped keep his glaucoma from progressing.

He also does his best to manage his diabetes with medication and a good diet – including a bowl of Grapenuts with blackberries and a banana for breakfast, and dinner that includes meat or fish – and he’s lost about 25 pounds in the past year.

He makes a point of getting an annual eye exam because his doctor recommends it, but also because he has seen how diabetes can steal one’s sight, including that of a friend who can’t drive any more.

He was glad to learn his annual eye exam is covered at no cost by his Blue Cross Blue Shield of Massachusetts Medicare Advantage plan after speaking with a representative who is part of an innovative new Diabetes Navigator Program at the health plan.

The program provides tailored support and resources to the approximately 15,000 Blue Cross Blue Shield of Massachusetts Medicare Advantage members with diabetes or prediabetes.

“Our goal is to educate members about how to manage their diabetes – including getting recommended preventive screenings such as an annual retinal eye exam – so they can lead happy and healthy lives,” said Blue Cross Blue Shield of Massachusetts member services manager Michelle Suplee, who manages the program. “We try to make it easy for members to understand and connect with all of the benefits, programs and resources that can help them manage their condition.”

Hultman encourages everyone with diabetes to try to get it under control and to schedule important exams with their doctor and eye doctor.

“I’ve known people who don’t pay attention to their diabetes, and you pay the piper. It’s up to each person to try to keep it under control.”

Diabetes and eyesight

Diabetes is one of the most prevalent health conditions in the U.S., affecting 38.4 million Americans, a number that has been steadily increasing.

People with diabetes either cannot produce the hormone insulin, which is needed to prompt cells to absorb sugar for energy, or their bodies cannot effectively use the insulin they produce. As a result, glucose builds up in the blood of people with diabetes and can lead to a variety of serious health conditions such as heart disease, vision loss, and kidney disease.

About 90% of people with diabetes in the U.S. have what is known as type 2 diabetes, often linked to risk factors such as excess weight or a lack of exercise. Its exact cause is unknown and there is no cure, but lifestyle changes can be key to preventing, managing, and even improving, the condition.

Eye disease is one common complication of diabetes.

Diabetes can cause blood vessels at the back of the eye to leak. This can impact the retina, a layer of tissue in the back of the eye that senses light and sends images to the brain, causing a decrease in vision.

“Diabetes is a major cause of eye disease,” said Dr. Lloyd Paul Aiello, ophthalmologist and director, Beetham Eye Institute of Joslin Diabetes Center. “Patients who have diabetes are at risk for losing vision.”

While Aiello says most patients with diabetes will experience some damage to the retina, lifestyle changes and proper treatment can help them retain their eyesight.

“If diabetes patients can control their blood sugar, blood pressure, lipids and cholesterol, and increase physical activity, they can dramatically reduce the risk of vision loss,” he said.

There are a variety of effective treatments for diabetic eye disease, Aiello said.

“That’s why it’s important that all individuals with diabetes go to an eye specialist at least once a year who can dilate their eyes and look at the back of the eye,” he says.

Most health insurers, including Blue Cross Blue Shield of Massachusetts, cover exams as part of their medical plan benefits for members including Medicare Advantage members. Blue Cross Blue Shield of Massachusetts also offers a stand-alone vision plan, Blue20/20, which covers additional exams and testing for members who have been diagnosed with type 1 or 2 diabetes.

The problem, Aiello said, is that only about 50% of people in the world with diabetes know they have it, and nearly half of those don’t get their recommended yearly eye exam.

“It’s important for patients to see their doctor and manage their diabetes, and it’s critical that they get eye care to prevent significant loss of vision.”

^{PHOTOS OF PETER HULTMAN BY CHRIS EVANS}