03 Nov From Head to Toe: Keeping An Eye On Your Health
Health professionals often consider vision problems and a wound on a foot as largely unrelated. However, for people diagnosed with Diabetes Type 1 or Diabetes Type 2 the link can be much more serious.
Diabetes Mellitus is a “chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves” (WHO, 2019). Diabetes can cause micro and macro vascular complications. The risk of these complications developing increases with time one has had Diabetes, poor blood glucose control and smoking. This damage can occur all over the body, but eyes and feet are particularly vulnerable due to them being peripheral or “end organs”, the delicate nature of blood vessels in the eye and the damage which may occur in feet to both nerves and blood vessels.
Diabetic Retinopathy is a microvascular complication of diabetes that can affect the blood vessels at the back of the eye at the retina. This serious condition can lead to blurred vision retinal detachment, vision loss and blindness if unmonitored and untreated.
Once diagnosed with diabetes patients should have annual eye examinations for screening, diagnosing and preventing eye complications. In addition, Ophthalmologist Dr David Robinson from Sydney Laser and Vision Centre recommends that anyone with diabetes who experiences any visual disturbance should present to an eye doctor as a matter of urgency.
Feet are at the extreme end of the body which makes them vulnerable to blood flow-related issues and potential nerve damage from diabetes. Those with diabetes are more likely to experience macrovascular complications such as atherosclerosis which is a condition where lipids, cholesterol, and other substances build up on the artery walls. This can restrict blood flow and result in clots (Shah, et al., 2015).
There are other changes which can occur to blood vessels in the lower limb such as Mönckeberg’s arteriosclerosis (hardening of the walls of the blood vessels) which is associated with an increased risk of hypertension. These blood vessel conditions can lead to reduced and less effective blood flow to the lower limb which can affect circulation and impact healing.
Nerve damage in the form of peripheral neuropathy is a microvascular complication of diabetes. This can result in a loss of sensation, usually starting in the toes, which can extend over time to the foot and up the lower limb. This loss of sensation means that those with diabetes may not feel when a rock gets into their shoes or other minor or major cuts or lacerations to the feet. Unknowingly wounds and ulcers can then occur. The combination of reduced blood flow and loss of peripheral sensation increases the risk of wound infection in the feet. Foot ulcers can then develop which can be slow to heal. Untreated foot ulcers can potentially lead to other complications such as gangrene which could result in amputation.
If you have any problems with your vision and you have diabetes, Podiatrist Zahava Robinson from Bondi Podiatry recommends that you “do not cut your own nails as there is a risk of causing wounds which you may not see, feel and/or maybe slow to heal.” It is therefore important that those with diabetes have regular assessments (at least annually) of their feet to assess skin integrity, blood flow and potential neuropathy.
A recent systematic review (Serban et al., 2021) found that the risk of Diabetic Retinopathy was significantly higher for those with a diabetic foot ulcer. There was a strong correlation between an increased frequency of Diabetic Retinopathy and Diabetic foot ulcers and risk of acceleration of both conditions. This review even stated that due to the significantly interlinked increased risk those with “Diabetic Foot Ulcers should be monitored by an Ophthalmologist, and those with Diabetic Retinopathy should be promptly referred to a specialised diabetic foot clinic”. According to Zahava Robinson “any experienced Podiatrist can assess your feet for prevention and management of Diabetic complications.”
As health professionals, we need to recognise the effect of diabetes across multiple organs and systems and work in tandem to improve health outcomes.
Serban, D., Papanas, N., Dascalu, A. M., Stana, D., Nicolae, V. A., Vancea, G., Badiu, C. D., Tanasescu, D., Tudor, C., Balasescu, S. A., & Pantea-Stoian, A. (2021). Diabetic Retinopathy in Patients With Diabetic Foot Ulcer: A Systematic Review. The International Journal of Lower Extremity Wounds, 20(2), 98–103. https://doi.org/10.1177/1534734620982237
Shah, P., Bajaj, S., Virk, H., Bikkina, M., & Shamoon, F. (2015). Rapid Progression
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World Health Organization. (2019). Diabetes. Retrieved 19 August 2019, from
Yau, J., Rogers, S., Kawasaki, R., Lamoureux, E., Kowalski, J., & Bek, T. et al.
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