Seeing the Effects of Obesity

January is National Glaucoma Awareness month, and although eye health is not often discussed in relation to weight, glaucoma and other ocular issues are, indeed, linked to obesity. Although only a small percentage of patients with glaucoma become blind, it is nonetheless the leading cause of blindness in the United States. Fortunately, effective treatment is available and can prevent progression in 90 percent of all cases, but this is heavily dependent on early diagnosis and care.

In addition to glaucoma, diabetic retinopathy is often associated with patients with obesity. Given that more than 90 percent of diabetics have obesity, it is not surprising that vision problems are a high risk for people with diabetes. In its early stages, diabetic retinopathy may not have any symptoms as tiny blood vessels in their eyes leak, causing the retina to swell.  Left untreated, it can cause the retina to grow new blood vessels, which can form scar tissue and affect vision. It can also lead to diabetic macular edema, neovascular glaucoma or retinal detachment.

There are other vision-related risks. In a 2019 study comparing the eye health in participants with obesity versus those of normal weight, uncorrected intraocular pressure (IOP) was significantly elevated in morbidly obese participants, even though they did not have other weight-related diseases. Participants in the obesity group also showed signs of retinopathy and vascular abnormalities, suggesting higher risk for glaucoma and other eye diseases independent of other comorbidities. A meta-analysis evaluating the association between obesity and IOP likewise found a positive relationship between these two variables, with some evidence that women are more likely to be affected.

The study also found significant thinning of the retinal nerve fiber layer (RNFL), which can create areas more prone to retinal detachment. This supports other findings that indicate, contrary to expectations, that patients with obesity waiting to undergo bariatric surgery showed decreased RNFL thickness, again independent of age, gender or other comorbidities. This is of concern because aging causes RNFL thinning and obesity appears to accelerate the process, which can be a risk factor for neurodegenerative diseases, including vision deterioration.

Weight loss can help reverse some of these effects, including diabetes, and offers the best, nonpharmacological intervention. The American Diabetes Association, The Obesity Society and other well-regarded health associations recommend high-intensity weight loss program for treating obesity in patients with type 2 diabetes. Medically-supervised weight management programs and products, such as Robard’s New Direction Advanced, meet the parameters of these guidelines with safe, healthy and effective outcomes. Meal replacements offer rapid weight loss with positive short-and-longer term outcomes that are comparable or better than other weight loss methods.

Vision problems can restrict freedom and create dependency on others, though many issues can be avoided through prevention or early detection. Providing focused recommendations, including realistic guidelines for weight loss and lifestyle change, can help ensure that patients will see a bright future.