My friend has type 1 diabetes and the doctor suggested keeping sugar lever low and taking care of diet. Are there more things to be done with goal of preventing eye problems?

While type�1 diabetes can lead to a number of different eye problems, I will concentrate on diabetic retinopathy (where there is damage to the retina) which is the main cause of damage to vision in diabetes. There has been, as you might expect, lots and lots of research into preventing damage to sight in diabetes. There are several measures that have been clearly identified, and proven by research, to reduce the risk of visual loss:

Blood sugar control: This is the single most important step. There have been several recent clinical studies that have shown us that tight control of diabetes can make the risk of developing sight-threatening retinopathy much less likely. Furthermore, if someone already has sight-threatening retinopathy, tightening of the control can often prevent progression and, in some cases, can make things better.

The best measure of how well controlled sugar levels are is a test called the hemoglobin A1c which measures the average sugar levels in the blood and gives an idea of how things have been for two to three months. The A1c is, therefore, a much better test than the normal blood sugar tests which only tell you what the level of sugar is at the time of the test. Studies have shown that the best A1c level, in order to prevent problems, is less than 1% above the upper limit of normal for the lab performing the test.. So, the next time your friend sees the doctor, he/she should ask what the A1c is.

If the A1c is higher than recommended, your friend must not try to improve things without supervision. Sudden changes of blood sugar levels can sometimes make retinopathy worse.

Blood pressure control: Again, there is good evidence that good control of blood pressure can reduce the risk of eye disease. Diabetes is associated with an increased risk of developing high blood pressure (hypertension). Not only has it been shown that people with diabetes and hypertension get more eye problems, but even in those with “normal” blood pressure, those with lower “normal” pressures appear to have less problems with eye disease than those with higher “normal” pressures. The evidence from various studies is such that, in the United Kingdom, for example, the British Hypertension Society and Diabetes UK both recommend that the ideal blood pressure for a person with diabetes should be at least 10 mm Hg less than for someone without diabetes of similar age.

Cholesterol and fats (Lipids): Keeping lipid levels under control, both by reducing the total amount, as well as keeping the balance between the different types of lipids right, can also play an important role.

The next most important step is to have regular eye examinations (retinal screening). Taking photographs of the retina is the best way to do this. This means that the doctor has a permanent record of what the retina looked like at each visit and, in the future, can compare any changes with older photos. These days retinal photos are taken with special digital cameras so if there is a change in doctors, a move to another city, etc., the photos can be on disc or CD to carry along.

Finally, if your friend does, unfortunately, develop retinal disease, in most cases laser treatment can reverse these changes.

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