Diabetic Retinopathy: A Sight to See

"Diabetes can cause blindness." That line is simultaneously a dire warning and the dumbest thing anyone can say. Then again, A LOT of statements about the complications of diabetes are stupid. "You could wind up with a foot being amputated." "Your kidneys could shut down." Here's one to dread: "You could experience erectile dysfunction." (If you're of the female persuasion, don't laugh at the plight of me. When I cover neuropathy, you'll learn that you don't escape sexual dysfunction, either.)

Want to know why such statements are stupid? BECAUSE NO ONE EVER EXPLAINS HOW THOSE THINGS COULD HAPPEN! And all of those things "could" happen. Allow me to correct those statements. If you don't manage your diabetes, those things WILL happen!

Am I trying to scare you? You bet your sweet bippy, I am! Because if someone gently takes your hand and tries to sweettalk you into taking care of yourself, there's the inclination to dismiss the warnings. And if the person warning you isn't a diabetic...? Then really, what the hell do they know? "How many years of pre-med, med school, and internship? THEY KNOW NOTHING!" 

But how about a warning from a diabetic who's been through it? It's a very different story, because now it's not the voice of education and research. It's the voice of experience.

So buckle up, my non-existent audience, as I tell you about the very first complication of diabetes to affect me.

I was 24 and working for my father. Up at 6:30, groggily get my contacts in, get dressed, stop at a deli for some form of breakfast, and then make the 45 to 60 minute drive into Brooklyn. There's one word in that last sentence that complicates matters. "Groggily." My contacts would sit overnight in a peroxide solution that would be turned to some harmless chemical by morning. I'd rinse them with saline and pop them into my eyes. But you know what was missing at the time? A way to differentiate between the peroxide solution and the saline. Same-sized bottle. Same screw-top caps. Same white color.

And so it was that I rinsed my lenses with the peroxide before popping them into my eyes. Boy-howdy, did that hurt! When I finally cottoned on to my error, I rinsed the lenses and my eyes directly with saline, and then went off to work.

Note: they eventually made the spout on the peroxide solution a bright red.

By the time I'd arrived at work, my eyes were no longer burning. Dad was already there. He asked how my morning was going, to which I reported quite casually how I'd almost chemically burned my eyes out of my skull. Dad was WAY less casual! He made me go home and call an ophthalmologist.

I went home, called an eye doctor, and was told they could see me in a month. A month. So I used the magic words that habitually opened a doctor's schedule instantly. "I'm a diabetic." And what do ya know? They had an opening that afternoon!

When I saw the doctor, he said that there was a degree of extremely mild irritation still visible, but complimented me on having the presence of mind to rinse using saline. No, nearly burning out my eyes was less a concern to him than the beginnings of diabetic retinopathy.

Okay, this gets a wee bit complicated. Lack of control of diabetes causes damage to small blood vessels. Exactly how the damage is done is far too complicated to describe here. I’ve tried researching it, but I lack a medical degree to make heads or tails of it all. To quote one of my online sources, “Diabetic retinopathy is the result of microvascular retinal changes.  Hyperglycemia-induced intramural pericyte death and thickening of the basement membrane lead to incompetence of the vascular walls.” I can do the “medical speak” fairly well, but I have my limits. The best I can tell you is that the eye is filled with microscopic blood vessels. Damaged vessels become weak, will balloon, and even hemorrhage. These leaks tend to scar the retina. But wait! It gets worse! You see, the eye needs blood and oxygen delivered to the right places in order to function. The loss of this optical nourishment is called ischemia. In a wondrous little process called neovascularization, new vessels start growing in the eye. Good news, right? Wrong! These new vessels are weaker than the original blood vessels. They, too, will hemorrhage, and usually much easier than the original equipment. Eventually, blood will flow into the vitreous gel of the eye, blocking vision. The scarring that can occur without treatment can cause the retina to detach. The happy little visual receptors, commonly known as rods and cones, stop working because they are no longer attached to the cells beneath them. These detached areas become blank spots in the vision. Get enough of these areas and the diabetic becomes completely blind.

I’ll try to simplify this. And please, for the love of everything good in the world, don't try this! Just imagine it. 

Let’s say we’re not talking about the microscopic parts of the eye, but a finger. Imagine taking a rubber band and twisting it around your finger until you cut off the circulation, and then leaving it like that for a good 72 hours. Choking off the blood supply to your finger would cause your flesh to literally die, and you’d soon find yourself facing surgery to remove it. That’s what happens to the eye. It loses its proper supply of blood, effectively “killing” the cones and rods. The retina detaches, creating a very blind diabetic.

A little comparison for you. Enjoy it while

you can still see.

Back to the diagnosis...

It’s strange how the mind works. I didn’t know all that much about retinopathy back then. All I knew was that it was the cause of diabetic blindness. Here’s what the doctor said: “We caught it early.  I want you to get a fluorescein angiogram.  We’ll follow up in a few months.” Here’s how my mind translated it: “We caught your blindness early. I want you to get a fluorescein angiogram because you’re going blind. We’ll follow up in a few months, when you may start to notice that you’re going blind.” 

What does a tough guy from New York do in the face of adversity? Go home and weep, obviously! I didn’t associate my eye problems with the fact that I took terrible care of my diabetes throughout my teen years. Weeping as if the end of the world was nigh, I blamed every single living person and every god in every pantheon I could think of.

Then there were my friends, bless ‘em. There’s nothing like a little dark humor to shed light on my terrors and banish them… temporarily. They spent hours after I shared the news making terrible jokes about getting a seeing eye dog that would bark so many times to rate the beauty of women I could no longer see. On a scale of one to ten, one bark meant run for the hills and ten barks meant she definitely worth sleeping with. (Like I'd care about looks if I was blind.) Jokes even greater in their lewdness followed about “seeing with my hands.” To them, it was the perfect excuse to feel-up numerous women and have a legitimate excuse. After being humored enough, I joined in, suggesting that I wasn’t blind yet, but it made for a great pick-up line. “Excuse me, miss… I’m going blind, and I wish to see as much beauty as possible before that happens. Would you allow me to see you naked?” It was cheesy, but it got laughs.

The fluorescein angiogram was my next adventure. My father went with me, as I was told I wouldn’t be able to see properly for four to six hours after the test.

We got to the test center, signed in, and waited. And waited. And waited.

I got hungry, so I went to the cafeteria and had a tuna sandwich. I remember exactly what I ate, and you’ll understand why shortly.

Upon my return, I was given drops to dilate my pupils. After the drops were applied and starting to take effect, I was handed a piece of paper to read about the test I was about to endure. Couldn't let me read that beforehand, right? The information sheet said I could expect to pee orange for twenty-four hours after the test, and that three percent of all patients experience nausea from the dye that’s injected into the blood.

No problem. Peeing orange might be entertaining. And the nausea? I’d been nauseous before. With my seemingly perpetual bad luck, I’d be part of that three percent, so I’d be nauseous for a bit. So what?

One other thing to note before I go on: bright lights and dilated pupils don’t go well together. Bright lights can actually be painful.

The test took place in a room the approximate size of a sardine can. They set up an IV line in my arm, had me rest my head in a frame that would help me hold still while they took pictures of the inside of my eye. I was all set. They camera was ready. The technician was ready. The nurse was standing by to inject the dye. Once in my blood, they would have only a few minutes to snap their pictures before the dye was diluted too much to be worth anything.

The nurse injected the dye.

I was perfectly fine before the dye went in. But remember the warning about possible nausea? Not only was I part of that three percent, but I discovered it was much more than mere nausea. It hit like lightning once the dye was in me. I started vomiting without any delay, and I couldn’t get my head in the nearest garbage pail fast enough. This is why I can recall exactly what I ate at the cafeteria. It involuntarily came back for seconds.

So I’m puking, the technician is explaining quite firmly that I have to stay still for the test. Then he shined a light that I would have sworn was brighter than the sun in my eyes and snapped his pictures.

Puke, blinding light, snap. Puke, blinding light, snap. Puke, blinding light, snap. 

I was sure on the next fluorescein angiogram to go with an empty stomach. While extremely nauseous, there was no vomiting.

Such a description might tempt other diabetics to avoid this test. I’m almost willing to agree with you on that one… except there’s a necessity for having it done. You wouldn’t want a doctor to treat something as delicate as your eye using guesswork, would you? Especially if your power of sight hanging in the balance? (You should be answering “no” to both of those questions!) The fluorescein angiogram provides an interior map of your eye to the doctor, allowing them to see which pathways have been damaged and what can be repaired.

In the end, there was nothing much to worry about. Did I have retinopathy? Yes. Was I hemorrhaging yet? No.

This is a pretty long post, and I still have so much more to say about retinopathy. Because this isn't the scary stuff. This is early detection and preliminary care. The scary stuff... is coming.