From Shalimar, Florida, USA:
My 15 year old son, diagnosed with type 1 diabetes at age two, has always had A1cs in the range of 5-6%, but he has been experiencing eye difficulties for about five months. It can happen at any time without regard to blood sugar level or body position. He has no headache or body weakness, or nausea, and there is no history of migraines in family. It usually happens when he walks from the bright outdoors into a building. He describes his temporary vision loss as a bright white light coming from the outside of his field of vision until there is a complete total loss of vision. The white light thens becomes black and vision returns in seconds. This happens in both eyes, at the same time, and only lasts for about four to five seconds. The frequency of the temporary loss of vision has been on the average of about once a day, every two to three days The ophthalmologist found no change in his eyes. Everything was normal, and he could find no reason for these occurrences. Do I need to take him to someone else for another look, or a different type of testing?
From the Editors: We received varying answers from different members of the Diabetes Team, and have posted them to show that this is a very unclear situation.
Comments from Dr. Charles Garcia:I am glad to hear that he was seen by his ophthalmologist and no problem was found. The only thing that I may suggest is that he get a second opinion from an ophthalmologist who specializes in the retina (a retina specialist), but I think he will say everything is normal as well.
The only comforting comment I can give you is that in the clinic in which I work, the "eye difficulty" your son is experiencing is a very common complaint among the patients with diabetes. Just as with your son, no abnormal eye finding is usually encountered. It is thought by the eye doctors here (myself included) that this phenomena is related to an effect that diabetes has on the overall ability of the retina to adapt quickly from light to dark or dark to light. This is dependent on a cascade of chemical reactions and pigment synthesis that may be slowed secondary to diabetes.
In the absence of any clinical abnormality, it is usually not prudent to undergo the cost involved in doing electro-diagnostic studies, which can test to some degree retinal sensitivity, that may still be inconclusive and still provide us with no treatment strategy other than glycemic control. I'm glad to hear your son's hemoglobin A1c stays below 6% since this is your best indicator of future complications. He and your family should be commended.
Additional comments from Dr. Stuart Brink:I don't think I have ever heard of such a complaint from any of the kids who come to see us. If one is sure that this is not blood glucose related (i.e., odd hypoglycemia) and can verify that multiple episodes occur without either extraordinarily high or low blood glucose levels, then I would search for some other possibility. I don't think it is very common and suspect migraine or vascular headaches rather than anything related to diabetes. I would suggest a pediatric neurologist be consulted if any of my own patients presented with such complaints, even with a normal eye exam.
Additional comments from Dr. Alan Schorr:I would suggest that she might seek the advice of a neuro-ophthalmologist. This sounds more in the brain tract area than pure retina. Visual fields and evoked potentials may be needed.
Additional comments from Dr. Donough O'Brien:The normal retina has two sets of cells: the 'rods' which dominate the dark adapted eye and which are more sensitive to blue than to red and the 'cones' which prevail in bright light and are more sensitive to red. This shift from a light adapted retina to a dark adapted retina is perfectly normal and is known as the Purkinje Shift (see The Purkinje rod-cone shift as a function of luminance and retinal eccentricity).
As with most natural phenomenon the rate at which it occurs in individuals is subject to the normal curve and is much more rapid in some than in others. Transient impairment of vision on moving from a very bright light into semi darkness (I get it in the medical school parking lot) is common and another more sophisticated example is when flowers change colour at dusk. It seems to be more pronounced when moving from light to dark than the other way around. I dont think that further studies are called for except perhaps that the phenomenon may be exaggerated in a 15 year old with diabetes who may already be anxious about his sight and has been taken to the eye clinic by a parent who is equally anxious. It might therefore be a good idea to talk this over briefly with the Medical Social Worker in the diabetes team just in case there are other anxieties to be relieved.
Original posting 20 Aug 2003
Posted to Other Illnesses
Last Updated: Tuesday April 06, 2010 15:09:46
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