I am 39 years old, have had type 2 diabetes for six years, and for last two years, my left eyeball is fixed and does not respond in dark light affecting my sight. My eyesight is 5/6 in my left eye and 6/6 in the right eye. My blood sugars are about 200 mg/dl [11.1 mmol/L] fasting, 250-260 mg/dl [13.9-14.4 mmol/L] postprandial, and I take two Glynase pills a day. I have gone through CAT scanning, eye pressure and vision tests, etc. Senior doctors have diagnosed this as an accommodation problem. Can my sight delay be cured?

First, I do not know what you mean by a fixed eyeball. If the pupil is fixed and not reacting to light and dark, this is an indication of a neurological problem. The exact cause for this needs investigating, and I assume it has been since you have had a CAT scan. There are some benign conditions that may affect pupil response, chronic disease such as diabetes also can and some very serious conditions. I would mention your concerns to your doctor and perhaps pursue a neurological work up with additional imaging studies such as MRI if deemed appropriate.

Secondly, if all has been found to be non-contributory, elevated blood sugar can decrease the accommodation response and so can the approaching age of 40 (presbyopia). Uncompensated vision problems at distance and/or near can produce these problems.

It may turn out that all you are needing is a prescription for glasses. From the information available by e-mail, I cannot advise you what to do first — an expensive neurological work-up or a check-up for glasses. Perhaps you have already done both.

Finally, your blood sugar is not in control and you need a team approach to help with this. You are an integral part of the team and only with your participation can the goal be reached. The goal is normal blood sugar control, and it may involve a combination of diet, exercise, oral medications (one drug or a combination) and insulin, along with nutrition and social counseling.

CAG

[Editor’s comment: There’s another problem that can affect one eye, and lead to double vision (which doesn’t seem to be quite what is described above): it’s called an “extraocular muscle palsy” and is due to damage to one of the nerves that allow the eyeball to rotate up and down and left and right. If the nerve is damaged, the eye won’t fully rotate, and the patient will describe double vision (diplopia) when looking in one direction, but no double vision when looking in another. It’s quite annoying, but if due to diabetes, it gradually disappears over several months. Since it can also be caused by non-diabetic problems, CAT-scans and other testing is routinely advised even if diabetic EOM palsy is suspected, to exclude other serious conditions.

WWQ]