My friend, who has type 1 diabetes, has already had laser surgery on both retinas, she middle stage cataracts in both eyes, and she also has ulcerated cornea in one eye. There is a very deep fear — she believes that her vision may not be helped by treatment. The healing of the ulcerated cornea is progressing very slowly, and her doctors say they do not want to address treatment for the cataracts until this is healed. My friend and housemate’s vision has degraded to the point that she has to ask who is in the room because she is terrified that this is irreversible, and that she will be totally blind soon. If my friend follows medical direction as well as possible, will the problems with degenerating vision be correctable? Can vision return to previous conditions?

I can understand your and your friend’s concern. It is unfortunate that her diabetes complications has progressed this far. I can only be direct in answering your questions. If medical advice is followed as best possible for her systemic and her ocular condition, this may salvage useful vision and may help to prevent total loss of vision.

It is a cruel fact that diabetes is a blinding disease. Those with diabetes or who have risk factors for diabetes need to have respect for this potentially devastating disease. It is not to be taken lightly. I apologize for being dramatic, but the disease process will ravage not only the eyes but the whole body so when diabetes is diagnosed it needs to be taken seriously from day one. However, it is better to have late control then no control.

Vision cannot return to “normal” nor is damaged tissue, the retina, “correctable”. It is manageable, and with medical and laser intervention, the hope is to preserve useful vision. The amount of useful vision is dependent on how well controlled, over what percentage of the history of the disease and how early any vision threatening situations were treated. The corneal ulcer is a risk factor for blindness, and it needs to be managed aggressively by a corneal specialist. Blood sugar control is very important for corneal repair. Cataract surgery can improve one’s vision but will have to wait until the cornea is healthy.

CAG
Additional comments from Dr. Dilo DeAlwis:
First, it is very sensible not to attempt to operate on the cataracts until
the corneal ulcer is sorted. Secondly, it is important to know why your
friend has poor vision. If the problem is due mostly to diabetes affecting
the retina (retinopathy), then removing the cataracts might not lead to a
great deal of improvement. If, however, the main problem causing the poor
vision is in fact the cataracts, then cataract surgery will probabaly lead
to significant improvement in vision.

Did you friend have fairly good vision after she had laser treatment to the
retina, prior to developing cataracts? If so, it is likely that she
will benefit from cataract surgery.

DDA