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Question:

From Oakland, California, USA:

I am an optometrist, and had a 40-something year old diabetic patient who came in for an eye exam a few weeks after a kidney transplant. After the surgery, they had a hard time controlling his blood sugar. For about two to three days, it was around 400 mg/dl [22.2 mmol/L].

His refraction was similar to previous exams. But, he came in three weeks later because his new glasses weren't working for him. I rechecked his refraction and it had shifted by -1.50 diopters (more myopic). He said his blood sugar was now down to normal, around 120 mg/dl [6.7 mmol/L]. Does the refractive shift commonly lag changes in blood sugar? If he stays under good control, about how long would it take for his refraction to return to normal?

Answer:

You pose excellent questions. I am giving a talk on this very topic before the Maine Optometric Association this Fall. It is my experience that refractive changes do not substantially lag blood glucose changes; typically, the effects are seen within one week. When glycemic control improves dramatically, there is typically a myopic shift (I have seen changes ranging from -0.50 to -4.00 diopters sphere) whereas worsening glycemic control tends to result in decreased myopia/increased hyperopia. In your patient's particular case, it is likely that corticosteroid use following transplantation worsened glycemic control and altered fluid balance (by multiple mechanisms) resulting in a hyperopic shift. I suspect his glycemic control was chronically sub-optimal, hence the relative refractive stability you indicate. I always recommend that eye doctors use glycosylated hemoglobin (A1c) as the benchmark for refractive stability; in my own practice, I usually prescribe when the A1c is below 7%. As an adjunct, it is wise to look at the patient's blood glucose log book.

PC

DTQ-20040802215207
Original posting 15 Aug 2004
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Last Updated: Tuesday April 06, 2010 15:09:58
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