According to the American Diabetes Association, in 2012 there were over 29 million Americans with diabetes. Of these 29 million, many are contact lenses wearers. In the past, contacts were not recommended to patients with diabetes. Now contacts are recommended to diabetics as an vision option. Yet, optometrists need to be on the lookout for possible complications. They include:
Studies have shown that half of eye patients with Type 2 diabetes have dry eye symptoms. Also, the higher the diabetic’s A1C levels, the higher the rate of dry eye. The reason for this is automatic neuropathy, which deceases corneal sensitivity and affects lacrimal gland secretion.
To best address the needs of the diabetic patient, one optometrist recommends that patients come in for two separate visits. One visit is for the standard diabetic exam and another visit is for ocular surface problems. During the ocular surface exam, measure the A1C levels to get an accurate picture of the disease.
Speaking of which, an A1C level of 6.5 percent is a sign of diabetes, when they go up to the 7 and 8 percent level, that’s when daily wear disposable contacts are recommended. If the A1C levels go up to 10 percent, then the patient isn’t a good candidate for contact lenses. No matter the A1C level, both patients and doctor have to be vigilant against abrasions. If the patient experiences abrasions, then he or she has to start making changes regarding contact lenses.
Corneal Abrasions & Ulcerations
With diabetes comes reduced corneal sensitivity. This leads to corneal abrasions caused by high glucose levels suppressing the epidermal growth factor receptor known as phosphatidylinositol 3-kinase/AKT pathway. Because of that, corneal abrasions in diabetics have resulted in deeper damage than in those without diabetes. Abrasions can lead to ulcerations and since ulcerations can lead to loss of vision, the abrasions need to be treated before they get to the ulceration stage. Of course, an ounce of prevention is worth a pound of cure, so it is important to stress proper cleaning and disinfecting protocols to both diabetic and non-diabetic contact lenses wearers. To the diabetic patient, be sure to also explain the need to keep glucose levels in check. Higher glucose levels lead to a fragile epithelium, which contributes to abrasions and ulcerations.
It is not uncommon for patients to not know their glucose levels. That is why keeping an eye on glucose and educating patients about regular glucose testing is so important. Thankfully, home monitoring systems make it very simple for people to know their glucose level. Once a patient knows his or her glucose level, that patient can better control it. Studies have shown the advantages of at home glucose testing devices, the biggest of which is that these devices encourage people to better control their glucose.
Patients with diabetes face many challenges, but if they keep their glucose in check and live a healthy lifestyle, they should be able to decrease their risk for corneal ulcers caused by contact lens wear.