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While the world recovers from the aftermath of the COVID-19 pandemic, a deadlier epidemic ravages on. Diabetes, the silent epidemic, claims 4.2 million lives around the world every year – just as many deaths as COVID-19 has claimed since the beginning of the pandemic.
While the COVID-19 pandemic is slowing down, Diabetes is on the march, with experts predicting that one in ten of us will be affected by 2045. The “Diabesity” epidemic (obesity and type 2 diabetes) is likely to be the biggest epidemic in human history.
In the United States alone, more than 30 million individuals have diabetes. Due to a variety of factors, African Americans are more likely to be diagnosed with this disease and its myriad complications.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. One of the most serious complications is diabetic eye disease, which may lead to severe vision loss and even blindness.
Diabetic eye disease encompasses three main entities affecting your eyes. While anyone with diabetes may develop vision complications, African Americans are 2 to 3 times more likely to do so. This may be due to a multitude of factors including lack of access to care, delayed diagnoses, co-existing conditions like high blood pressure, and poor health awareness.
Diabetic eye disease includes:
Diabetic retinopathy: High blood sugar in diabetes damages blood vessels located in the retina, the sensory layer of the eye. Damage to the retinal vessels leads to hemorrhages and lipid deposits in the retina, diabetic macular edema (DME: a collection of fluid in the retina) and eventually retinal detachment.
According to the Centers for Disease Control and Prevention, more than 16% of African Americans have diabetes. Among African American adults with diabetes, one in three suffer from diabetic retinopathy. Not all diabetic retinopathy will cause severe vision loss, but vision-threatening cases tend to occur about three times more often in African-Americans.
Glaucoma: Glaucoma is considered to be the leading cause of blindness among all individuals from all racial backgrounds over 60 years old. Glaucoma is caused by an increase in eye pressure, which progressively damages the optic nerve and leads to irreversible blindness. Unfortunately, the risk of developing glaucoma is significantly higher among African Americans. While glaucoma primarily affects older generations, research has shown that African Americans are more susceptible to developing glaucoma at a younger age.
Glaucoma strikes earlier and progresses faster in African Americans, occurring about five times more frequently and about 10 years earlier. While glaucoma does not always lead to blindness if a person receives timely treatment, blindness due to glaucoma is six times more likely in African Americans who hold of higher risk of developing glaucoma, including those who are older than age 40 years, have diabetes, have hypertension, are nearsighted, and engage in prolonged steroid use.
Cataract: The leading cause of blindness around the world, a cataract occurs when the natural lens in the human eye becomes cloudy. This causes blurry, hazy vision or dulled perception of color tones. Many minorities with diabetes develop cataracts, worsening vision as the lens of each eye becomes cloudy. African Americans are at an increased risk of developing diabetic cataracts and associated blindness.
To summarize, all three major eye pathologies associated with diabetes occur more commonly and more severely in African Americans. It is estimated that diabetic retinopathy will affect over 1 million African Americans by 2030. Additionally, African Americans with diabetes are twice as likely to develop glaucoma, and two to five times more likely to develop cataracts.
Just as with other organs, diabetes affects the eyes slowly and silently. There are usually no symptoms in the early stages of diabetic eye disease, but over time, as high levels of blood sugar damage your eyes, you may notice a plethora of symptoms including:
If left untreated, diabetic eye disease may eventually cause total blindness. While several treatment options are available in our armamentarium against diabetes, it is better to prevent diabetic eye disease altogether.
Preventing diabetic eye disease starts with getting your diabetes under control. If you live with untreated diabetes, working with your doctor is the best way to develop a plan for controlling blood sugar levels.
Additionally, maintaining a healthy lifestyle goes a long way in keeping your diabetes in check. There are important steps people with diabetes can take to keep their health on TRACK:
Take your medications as prescribed by your doctor.
Reach and maintain a healthy weight.
Add physical activity to your daily routine.
Control your ABC’s—HbA1C, blood pressure, and cholesterol levels.
Kick the smoking habit.
Beyond controlling your blood sugar, it is important to monitor your eye health regularly. Yearly comprehensive dilated eye examinations help your doctor detect eye changes early, so that treatment can begin sooner.
Early detection of diabetic complications is key to preventing further damage and maintaining your vision. Early detection, timely treatment, and appropriate follow-up care can reduce a person’s risk for severe vision loss from diabetic eye disease by 95 percent.
Zimmet, P.Z. Diabetes and its drivers: the largest epidemic in human history?. Clin Diabetes Endocrinol 3, 1 (2017). https://doi.org/10.1186/s40842-016-0039-3
Rabb MF, Gagliano DA, Sweeney HE. Diabetic retinopathy in blacks. Diabetes Care. 1990 Nov;13(11):1202-6. doi: 10.2337/diacare.13.11.1202. PMID: 2261843.
Roberta McKean-Cowdin, mina torres, Bruce Burkemper, Alicia Fairbrother-Crisp, Xuejuan Jiang, Farzana Choudhury, Tien Y Wong, Rohit Varma; Prevalence and Risk Factors for DR in the African American Eye Disease Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1089.