Scrubbing In: Vision checkups crucial for diabetics

It was during Game 3 of the World Series last fall, when the Phillies played the Tampa Bay Rays, that my patient couldn't quite see Chase Utley and Ryan Howard hit back-to-back homers. A cobweb floated around everywhere he looked, blocking his line of sight.

After the game ended and he filed his story as a sports reporter, my patient, 50, from Philadelphia, drove to the Wills Eye emergency room, worried that something was seriously wrong with his eyes.

The cobweb was a hemorrhage inside his eye from a frail blood vessel that had burst. The doctor on call that night diagnosed him with advanced diabetic eye disease.

My patient knew he was at risk for problems since he had been diagnosed with diabetes 15 years earlier. But he had decided to skip his annual eye exam for the last 10 years.

Now, seven months after the Phillies' big win, he's blind in one eye and rapidly losing sight in the other.

He also wishes he could go back in time. "It wasn't that I was in denial," he says. "It's just that I thought I would be OK. I took a gamble."

Diabetes afflicts 23.6 million people in the United States, or 8 percent of the population, according to the Centers for Disease Control and Prevention. It is the leading cause of new cases of blindness among adults ages 20 to 74.

Diabetes wreaks havoc on blood vessels, making them leaky and unstable, and causing all sorts of problems throughout the body. It can injure the heart, kidneys, brain, limbs, and nerves, while also making patients susceptible to infections such as influenza.

But these terrible consequences can all be delayed, if not prevented.

As an ophthalmology resident, I see many patients with diabetes because they all need at least an annual eye exam.

I love to finish my exam and say, "Looks great! See you next year!"

But I've had too many grim discussions with patients who haven't been seen by doctors in many years when they finally come in with advanced disease.

The week I saw the sports reporter, I also saw a 57-year-old woman, who was blind in one eye from diabetes and had started noticing some dark spots in her other eye.

Her sugars were recently as high as 360 - normal is less than 125 if you are fasting - and she knew she needed to see her primary doctor to control her diet and get medicines.

I sent her to our retina clinic because she would need to consider surgery on her better eye to preserve whatever vision she had left. Any surgery carries risk but the stakes are especially high when it involves the patient's sole good eye.

My tearful patient looked at me and asked: "Will I go blind?" And the answer was clear to both of us. It was a possibility but we would both fight it to the end.

A few patients later, a 32-year-old man with diabetes and hypertension came in with good vision but also with prominent diabetic changes that needed laser surgery. We caught him early and I discussed with him in detail the importance of following up for his appointments.

Luckily, a new way to care for diabetics and other patients with chronic diseases is coming. Called "the medical home," it's designed to provide each patient with a team, including a primary-care doctor and staff, to coordinate care. What's unique is that these doctors and their staff will now get paid for tasks such as phoning and e-mailing patients to bring them when they're overdue.

The sports reporter admits he didn't do his part. Over the last few years, his blood sugar would stay in the 400-to-500 range for weeks. He was overweight, and did not go to the doctor when he knew he should.

Now he has what he calls the "diabetic plagues." Besides eye problems, his kidneys are failing. A surgically placed tube now rests in his arm in anticipation of starting dialysis. And he recently suffered through an aching dental abscess, underscoring how diabetics are also susceptible to gum disease and infections.

Most saddening to him, he says, is that his dream job as a sports reporter is now too difficult.

He is applying for disability and has moved in with his parents: "I went from functional to barely functional," he says.

It's hard to watch so many patients take these losing gambles.