What is Prediabetes?

Diabetes illness concepts word cloud illustration. Word collage concept.

I ask each patient about his general health. I often hear prediabetes as a health issue. Prediabetes means the blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. This is the stage where lifestyle changes can significantly improve health and prevent the development of diabetes.

Research shows that you can lower your risk for type 2 diabetes by losing 7% of your body weight (that’s 15 pound if you weigh 200 pounds) and exercising 30 minutes a day.

Symptoms are not always present with prediabetes. To accurately diagnose prediabetes your doctor will do some blood tests.

  • A1C measures your average blood glucose for the past 3 months.

Normal           less than 5.7%

Prediabetes    5.7% to 6.4%

Diabetes          6.5% or higher

  • Fasting Plasma Glucose tests your blood glucose after you have not eaten or drank anything for at least 8 hours.

Normal            Less than 100 mg/dl

Prediabetes     100 mg/dl to 125 mg/dl

Diabetes           126 mg/dl or higher

People with prediabetes are at higher risk for developing type 2 diabetes and cardiovascular disease. If you are prediabetic you may have no symptoms or you may have the same symptoms as someone with diabetes. The best way to find out if you’re prediabetic is to see your doctor and have your blood tested.


Keep Your Vision Healthy

Clear View

Did you know your eyes are windows to your general health? Many systemic conditions can be detected with a dilated eye examination. Looking into a dilated eye, I can see a view of the blood vessels and assess vascular health. Your eyes can tell a lot about your visual health and overall wellness.
Besides helping you see better, annual eye exams can aid in detection of serious eye conditions, like glaucoma and cataracts and health conditions like diabetes and high blood pressure. This is important since you won’t always notice the symptoms yourself – and some of these diseases cause irreversible damage.

If it’s been at least a year since your last eye examination, call the office and schedule an appointment. (707)762-8643. Schedule online.


Diabetes A1C Test

Diabetes illness concepts word cloud illustration. Word collage concept.

What is a diabetes A1C test? The hemoglobin A1C is a blood test that is a regular part of diabetic care. It is done every 3-4 months. The benefit of the A1C test is that it provides a measure of how your blood glucose levels have averaged over the past 2-3 months and provides a “picture” of overall blood sugar control. Sugar builds up in your blood and combines with your hemoglobin, becoming “glycated,” the average amount of sugar in your blood can be found by measuring your hemoglobin A1c level.

The daily blood glucose checks that are done at home or in the doctor’s office measure the blood glucose level at that moment. The A1C test measures the blood sugar over time and is extremely important for monitoring how well your diabetes is controlled.

For people without diabetes, the normal range for the hemoglobin A1c test is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher indicate diabetes. Because studies have repeatedly shown that out-of-control diabetes results in complications from the disease, the goal for people with diabetes is a hemoglobin A1c less than 7%. The higher the hemoglobin A1c, the higher the risks of developing complications related to diabetes.
One of these complications due to high blood sugar is diabetic retinopathy. Since diabetes primarily affects the blood vessels, it is very important to have a dilated eye examination at least once a year. The retina inside the eye is the only place in the body where blood vessels can easily be examined.


How Does Diabetes Damage Your Eyes?

November is Diabetes Awareness month. High amounts of blood sugar can harm the internal structures of the eye. Below are some of the things that diabetes can do to the eyes.

  • Blurry or Double Vision. Fluctuating blood sugar and fluctuating vision are connected. A change in glucose levels affects the eye’s ability to maintain sharp focus. It may take several months after your blood sugar is well controlled for your vision to stabilize.


  • Diabetic Retinopathy. The leading cause of diabetes-related vision loss is diabetic Diabetic Retinopathy retinopathy. This condition damages the network of blood vessels supplying the retina with blood and oxygen. It also causes abnormal growth of blood vessels on the retina. When these vessels leak they damage  the retina causing permanent vision loss.
  • (the picture on the left is an example of fluid and blood leakage in diabetic retinopathy.)



  • Cataracts. People with diabetes have a much greater risk of developing cataracts and at an earlier age. A cataract is clouding of the eye’s natural lens and results in glare and obscured vision.
  • Glaucoma. Diabetes also increases your risk of developing glaucoma. This condition results from an increase in fluid pressure inside the eyeball, which causes damage to the retina and optic nerve. If untreated, glaucoma leads to gradual but permanent vision loss.

Actions to take right now include the following: Eating sensibly, the American Diabetes Association recommends filling half your plate with vegetables, a quarter of the plate should be lean protein and the rest a carbohydrate. Make time for 30 minutes of exercise everyday. Take your medicine as prescribed and know your blood sugar level.

Preventing diabetes is the best way to avoid diabetic damage to the eyes, but if you already have diabetes, regular eye examinations can prevent permanent damage to the eye due to elevated blood sugar.



Heart Disease and the Eyes

heart in hands

The eyes are the window to the soul

In honor of Valentine’s Day, I want to explain why the eyes are the window to the heart.
Abnormalities of the blood vessels in the retina can be used to indicate complications for diabetes, hypertension, stroke and heart disease.
The retina is a membrane that lines the eyeball and receives light and converts it into signals that reach the brain and result in vision. During a dilated eye exam, Drs. Griffith and Staton examine the retina and blood vessels. Changes in the vessels such as narrowing or ballooning is suspicious of cardiovascular disease. Systemic diseases, that affect the body or its organs, such as hypertension, diabetes, AIDS, Graves’ disease, lupus, atherosclerosis, multiple sclerosis, rheumatoid arthritis and sickle cell anemia often cause changes in the eye that show up as red dots or small blood clots. Blood vessels of the eyes are so predicative because they are part of the brain’s vascular system, so they share anatomical features and respond similarly to stress and disease.

Normal Retina Photo

Normal Retina

In fact, eyes are so transparent compared to the rest of the body that they are the only organ that allows doctors to directly see blood vessels. The use of digital fundus photography allows the doctor to analyze the retina and vessels and compare the pictures to previous photos taken.

Let us gaze into your eyes.


How does Diabetes Damage the Eyes?

Vision Loss

Over time uncontrolled blood sugar and poor circulation can harm the internal structures of the eye.
Blurry or Double Vision
Fluctuating blood sugar and fluctuating vision are connected. A change in glucose levels affects the eye’s ability to maintain sharp focus. It may take several months after your blood sugar is well controlled for your vision to stabilize.
Diabetic Retinopathy
The leading cause of diabetes-related vision loss is diabetic retinopathy. Diabetic retinopathy can damages the network of blood vessels supplying the retina or cause the growth of  abnormal  blood vessels on the retina. When these fragile blood vessels leak, the fluid and blood damage the retina and can cause permanent vision loss.
People with diabetes have a much greater risk for developing cataracts and at an earlier age. A cataract is clouding of the eye’s natural lens and results in the inability to focus light, glare and compromised vision,
Diabetes also increases your risk of developing glaucoma. Glaucoma causes irreversible damage to the retina and optic nerve. If untreated, this damage leads to vision loss.

Scheduling regular eye exams can help detect diabetes-related eye diseases before they cause irreversible damage.
Exercise, a healthy diet and keeping glucose levels and blood pressure controlled can also help control eye problems.


Aging Eyes


It’s a fact of life that vision can change over time, resulting in a number of noticeable differences in how aging adults see the world around them.
Common age-related vision problems include difficulty seeing things up close or far away, problems seeing in low light or at night, and sensitivity to light and glare. Some symptoms that may seem like minor vision problems may actually be signs of serious eye diseases that could lead to permanent vision loss, including:

  • Age-Related Macular Degeneration (AMD). An eye disease affecting the macula, the center of the light sensitive retina at the back of the eye. AMD can cause loss of central vision.
  • Cataracts. A clouding of the lens of the eye that usually develops slowly over time and can interfere with vision. Cataracts can cause a decrease in visual contrast between objects and their background, a dulling of colors and an increased sensitivity to glare.
  • Diabetic Retinopathy. A condition occurring in people with diabetes, which causes progressive damage to the tiny blood vessels that nourish the retina. The longer a person has diabetes, the more likely they are to develop the condition, which can lead to blindness.
  • Glaucoma. An eye disease leading to progressive damage to the optic nerve due to rising internal fluid pressure in the eye. Glaucoma is one of the leading causes of blindness.
  • Dry Eyes. Dry Eye occurs when there is insufficient tears to nourish the eyes. This can be caused by medications, hormones and environmental factors. Poor tear quality can cause dry eye symptoms too.

Many eye diseases have no early symptoms and may develop painlessly; therefore adults may not notice changes in vision until the condition is quite advanced. Healthy lifestyle choices can help ward off eye diseases and maintain existing eyesight. Eating a low-fat diet rich in green, leafy vegetables and fish, not smoking, monitoring blood pressure levels, exercising regularly and wearing proper sunglasses to protect eyes from Ultraviolet (UV) rays can all play a role in preserving eyesight and eye health. Early diagnosis, treatment of serious eye diseases and disorders is critical and can often prevent a total loss of vision, improve adults’ independence and quality of life.

The best way to prevent eye disease and continue leading an active productive live is to maintain yearly eye exams or follow the doctor’s recommendations.


Diabetic Awareness Month

If you have diabetes, it requires attention every day of the year, not just the month of November. But I am going to take advantage of Diabetes Awareness Month to remind you that your eyes are important and can be significantly impacted by diabetes.
First and most important, keep your blood sugar levels under tight control. In the Diabetes Control and Complications Trial, people on standard diabetes treatment developed retinopathy four times as often as people who kept their blood sugar levels close to normal. In people who already have retinopathy, the condition progressed in the tight-control group only half as often.

Diabetic Retinopathy

These impressive results show that you have a lot of control over what happens to your eyes. Also, high blood sugar levels may make your vision temporarily blurry.

Second, keep blood pressure under control. High blood pressure can make eye problems worse.

Third, quit smoking.

Fourth, see your optometrist at least once a year for a dilated eye exam. Having your regular doctor look at your eyes is not enough.

Fifth, see your optometrist if:

your vision becomes blurry
you have trouble reading signs or books
you see double
one or both of your eyes hurt
your eyes get red and stay that way
you feel pressure in your eye
you see spots or floaters
straight lines do not look straight
you can’t see things to the side as you used to

Don’t procrastinate. If you have diabetes and haven’t had a dilated eye exam in the last 12 months, schedule an eye exam now.


Maintaining Clear Vision

Age-related eye diseases such as macular degeneration and cataracts commonly cause impaired vision and blindness in older adults. But lifestyle changes, including good nutrition, could help delay or prevent certain eye problems.
Besides adopting a healthy diet, you also can protect your eyes by avoiding intense ultraviolet (UV) light, quitting smoking and getting regular checkups that may help detect chronic diseases contributing to eye problems. Diabetes, for example, increases your risk for age-related eye diseases and may cause diabetic retinopathy.
Regular eye exams, too, are essential for maintaining eye health as you grow older. If eye problems and chronic diseases are detected early enough, appropriate treatment may prevent permanent vision loss.


Diabetic Retinopathy Continued

This is a continuation of my last blog post about diabetic retinopathy. I want to stress that diabetic retinopathy is the number 1 cause of new cases of blindness for adults 20-70 years old. The increasing number of people with diabetes means the number of people who will develop diabetic retinopathy will also increase. This is significant because severe vision loss can be prevented 90% of the time.

It is my job as an optometrist to identify and detect diabetic retinopathy. When I see diabetic retinopathy, I have to decide when to refer for further evaluation and/or treatment.


The most important thing you can do to prevent vision loss from diabetes is have a dilated eye examination every year.
If you notice changes in your vision or it seems blurry, call your eye doctor immediately. To read more about preventing eye complications from diabetes click here.


If I think treatment is indicated, I will refer you to a retinologist. A retinologist is an ophthalmologist, who treats conditions of the vitreous and retina, both effected by diabetic retinopathy. He or she will chose the best treatment option.

A laser may be used to stop blood vessels from leaking. It may also be used over a larger part of the retina to reduce the growth of abnormal blood vessels. Laser maintains sight, but the side effects can include, blind spots in the vision and reduced vision.

Corticosteroid injections into the eye provide a temporary treatment. To maintain control of the retinopathy, repeated injections are necessary every 6-8 weeks. The continued use of corticosteroids increases the risk of developing cataracts and glaucoma.

Another treatment is the injection of anti-vascular endothelial growth factor (anti-VEGF) to prevent the blood vessels from leaking. This treatment also needs to be repeated every 6-8 weeks.

The retinologist will often use a combination of the above treatments to yield the best results.

Researchers continue to look for therapies with long-term results and minimal side effects.