In early September 2021, Luis Riollano, 31, noticed everything looked cloudy. He had long worn glasses to see distances and wondered if his prescription had changed. But soon, his vision worsened so much that he could barely see shapes and movements. When he visited an eye doctor, he learned the unexpected cause of his sudden blindness.
“When I got diagnosed with advanced cataracts I was really really scared,” Riollano, 32, of Brooklyn, told TODAY. “Due to my age the doctor was telling me that he suspected that maybe diabetes was in play.”
Loss of vision leads to an unexpected diagnosis
Having worn glasses most of his life, Riollano could tell when it was time for a new prescription. About a year ago, things started looking blurry so he upgraded his glasses. He could see normally with glasses until last fall.
“Everything was cloudy and looking milky and blurry,” he explained. “I thought maybe I need a new prescription.”
By the end of the month, though, he couldn’t see anything. Sometimes he could see shadowy shapes and tell if someone moved. But his vision declined so much he couldn’t care for himself.
“I was already fully blind,” Riollano said.
He visited Dr. Tommaso Vagaggini at New York Eye and Ear Infirmary at Mount Sinai to understand what happened.
“The most interesting part was seeing someone who was very young, 31, who … was at a juncture where the vision in both eyes was not only at the point of legal blindness but also really past the point of functioning vision,” Vagaggini, an ophthalmology resident at New York Eye and Ear Infirmary at Mount Sinai, told TODAY. “The second thing that was interesting was getting a sense of what was causing it. We don’t usually see cataracts enlarging in patients.”
Riollano didn’t have a family history of cataracts or any genetic condition that would cause them.
“The other thing that came to my mind just looking at those cataracts on the exam is that these could be diabetes,” Vagaggini said. “By looking at his cataracts and seeing how hydrated they seemed and then the symptoms of fluid it just reminded me of a diabetic cataract.”
Before deciding how to address the cataracts, Vagaggini used a finger prick test on Riollano to learn his blood glucose levels. His sugar was 465 mg, far higher than normal blood sugar levels, which are 200 mg or lower, according to the Centers for Disease Control and Prevention.
“His glucose was through the roof, confirming our suspicion,” Vagaggini said. “That’s a point of being close to being dangerous to someone’s life.”
Riollano felt shocked. While his mom has Type 2 diabetes, he didn’t really notice any symptoms. He had he felt more thirsty and urinated more often but he thought he had a urinary tract infection. But he had been as active as usual.
“I was feeling guilty because I never went to the doctor because I never got sick,” Riollano said. “When my vision started going away then finding out it was cataracts then I had diabetes … it was very big.”
As Riollano's vision worsened he started experienced panic attacks. He lived on the third floor and often fell down the stairs and struggled to perform even daily tasks, such brushing his teeth.
“I couldn’t do anything and I’m by myself,” he said.
Riollano needed to get his blood sugar under control before surgery to remove the cataracts. From September to December he took insulin to lower his blood sugar. He also changed his diet. That helped and he was able scheduled surgery for one eye.
The challenges of cataract surgery
Doctors had hoped that the surgery would restore some of Riollano's sight. But they weren’t entirely sure what they would encounter. The cataracts were so large that they couldn’t see past them. It was possible that more than just the cataracts impacted his sight.
“Point number one was to try and get as much of the vision back with the caveat at the time that we didn’t know what else went on in the back of the eye,” Vagaggini said. “We had no view.”
When surgery started, doctors noticed that Riollano’s capsular bag, the thin membrane surrounding the lens, was so delicate from pressure of the cataract. Opening it to replace the lens presented a challenge.
“We saw the bag trying to split in half, which is always immensely concerning,” Vagaggini explained. “The whole surgery was managing that cataract under pressure and removing it while maintaining the rest of the anatomy of the front of the eye. And we managed to do it.”
The next complication came to selecting the correct lens. In cataract surgery, doctors remove the old lens and replace it with a new one.
“You have to calculate what kind of lens you’re going to put into the eye. You can have a technically perfect surgery, but if you put a lens inside the eye that is the wrong power that’s going to throw everything off,” Vagaggini said. “It is immensely challenging to calculate because of the lack of clarity to the back of the eye.”
They picked the correct lens and Riollano's vision in one eye was restored.
Recovering from the surgery
Having his diabetes managed and his vision treated has improved the quality of Riollano’s life. Though seeing out of one eye felt tough.
“It was weird. I felt like I had a curtain on the front of my other eye,” Riollano said. “Seeing out of one eye is way better than not being able to see at all. It was difficult because I lost my hand-to-eye coordination.”
About three weeks ago, he underwent surgery for the remaining cataract. While the complications were the same, the outcome was just as good.
“We’re very happy,” Vagaggini said. “Now he’s 20/20 in the other eye as well.”
Riollano also noticed he had more energy after his blood sugar was well controlled.
“I got used to feeling the symptoms of diabetes,” he said. “I noticed a big difference. I deal with more energy now.”
Since undergoing surgery on his other eye, it feels like “a brand new world.”
“I see actually way better than before,” he said. “Now I can see without glasses.”
While he’s grateful for his successful treatment, he hopes his story encourages others to regularly visit their doctors — even if they don’t feel sick.
“I didn’t know that I had diabetes,” he said. ‘You never know when it is going to be too late when you finally go to the doctor.”