DR. SIDDARTH SAIN Sharp Sight
Centre New Delhi
Diabetes is a metabolic disorder
which interferes with body's ability to use and store sugar. It usually affects
adults in their late forties or fifties. However, these days owing to lifestyle
changes even young people can get diabetes.
The classic symptoms of diabetes are increased thirst, frequent urination, weight loss, tiredness or blurred vision.
Uncontrolled diabetes can affect eyes, nerves and kidneys. Individuals with
diabetes are more likely to develop cataracts at a younger age and are twice as
likely to develop glaucoma as are non-diabetics. However, the primary vision
problem caused by diabetes is Diabetic Retinopathy which damages the blood vessels
of the retina.
1. DIABETIC RETINOPATHY
In uncontrolled diabetes, high
sugar in the blood can damage blood vessels of the eye. As damage progresses,
they begin to leak which results in accumulation of the fluid in the central
part of the retina. This deterioration of the blood vessels causes hindrance in
supply of oxygen and nutrients needed by retina to stay healthy.
Warning Symptoms
·
Blurred, double, or distorted vision or
difficulty in reading.
·
Floaters or spots in your vision.
·
Partial or total loss of vision or a shadow or
veil across your field of vision.
·
Pain, pressure, or constant redness of the eye.
All diabetics are at risk of
getting Diabetic Retinopathy. The risk multiplies the longer a person lives
with diabetes. It has been observed that about 80% of long standing diabetics
(15 years or more of diabetes) have some damage in the blood vessels of retina.
Diabetic retinopathy can occur at a young age in juvenile diabetics.
Diabetic retinopathy is a silent vision thief. In early stage, there is
hardly any symptom. Hence, a diabetic must strictly get his eye exam done every
year. If detected early, vision loss can be prevented. But, once the damage is
done, the effects are irreversible.
There are two main stages of
Diabetic Retinopathy:
The early stage is called Non Proliferative Diabetic
Retinopathy. In this stage there is damage to the retinal blood vessels,
which causes swelling of macula (central part of the retina). Known as Diabetic
Maculopathy, symptoms manifest as blurred vision.
The advanced stage is called Proliferative Diabetic Retinopathy.
This is the most serious stage of Diabetic Retinopathy. In this stage, there is
an overgrowth of new fragile blood vessels into the areas deprived of oxygen.
These new blood vessels can lead to various complications which could further
lead to a detached retina or glaucoma.
If it is not treated even by this stage, the patients are at risk of
going blind due to occurrence of vitreous hemorrhage and retinal detachment.
The ophthalmologist will do a
comprehensive eye investigation to detect Diabetic Retinopathy. The eye exam
includes visual acuity tests, eye pressure measurements and direct
visualization of the retina with an ophthalmoscope. Sometimes the
ophthalmologist may require more extensive imaging with technology like Fundus
Fluorescein Angiography (FFA) and Optical Coherence Tomography (OCT) to capture
the details of the damage caused by abnormal blood vessels & assess the
severity of the condition.
Treatment
a. Laser Photocoagulation: It is the most common line of action for
diabetic retinopathy treatment. But remember, this can only save the existing
sight level and cannot make it better. In laser treatment, the retina
specialist uses laser to destroy areas of retina deprived of oxygen which helps
to prevent growth of new blood vessels into these areas. It can be done in
multiple sessions. In most cases, this procedure causes the new blood vessels
to regress and the swelling to subside. It usually takes three to four months
to be fully effective.
b. Vitrectomy: Sometimes the new blood vessels bleed into the gel
like centre (vitreous) of the eye. This condition – Vitreous hemorrhage can
lead to a sudden loss of vision. If the vitreous hemorrhage is persistent then
a procedure called Vitrectomy is recommended. This is a microsurgical procedure
for diabetic retinopathy treatment which removes the blood and scar tissue from
the centre of the eye. Many patients have improved vision after vitrectomy.
c. Intravitreal Injections: Thesehelp patients with gross swelling
in the macula. It may require injections of vascular endothelial growth factor
(VEGF) inhibitor drug or steroid into the eye to reduce the growth of abnormal
blood vessels and leakage of fluid from them. These may also be used prior to
surgery to reduce the bleeding.
The choice of treatment depends
on the stage of the disease, the age of the patient and the recommendations of
the retina specialist.
Success Rate
Patients who have already lost
vision from the disease usually do not regain the original vision. However,
vision loss from complications such as bleeding into the eye or cataracts can
be regained after diabetic retinopathy treatment. There is evidence that proper
blood sugar control can delay and limit the progression and complications of
Diabetic Retinopathy for people with diabetes.
2. CATARACT
Cataract is the clouding of
the lens of the eye that leads to blurred vision. Although anyone can get
cataracts, theytend to develop at an earlier age in people with diabetes
and progress more rapidly than in non-diabetic people. The treatment of
cataracts is through surgical removal of the cloudy lens, which is removed and
replaced by a clear artificial lens in surgery thus helping you to see better.
3. GLAUCOMA
Glaucoma is caused by the build-up of fluid
pressure inside the eye. With age, disease, trauma and other factors, the
channels which drain the fluid from the eye get blocked. This results in
increased pressure inside the eye which damages the optic nerve. The optic
nerve transfers visual messages to the brain. When it gets damaged, it impairs
the visual ability of an individual leading to irreversible blindness. A person
with diabetes is nearly twice as likely to get glaucoma as compared to other individuals.
Treatment of glaucoma requires lowering the eye's
pressure by increasing the drainage of aqueous humor or decreasing the
production of the fluid by using eye drops in the affected eye. Surgical
management of glaucoma includes a procedure where an opening is made to create
a new drainage pathway for the fluid to leave the eye easily. Alternatively,
glaucoma management by lasers includes Trabeculoplasty in which a laser is used
to increase the drainage and reduce the pressure inside the eye. Diabetics can
prevent glaucoma by getting a yearly glaucoma screening from their eye doctor.
People with diabetes are also more at risk of a less common form of
glaucoma i.e. Neovascular glaucoma. In this form of glaucoma there is growth of
newblood vessels on the iris which block the
normal flow of the fluid out of the eye, raising the ocular pressure and
leading to glaucoma. Laser surgery is used to reduce the vessels.
MUST DO TIPS FOR DIABETICS
·
You must get a complete eye checkup done regularly
by an ophthalmologist
·
Keep strict control over your glucose and lipid
profile levels.
·
Maintain a healthy level of fitness with a
normal blood pressure
·
Quit smoking
·
When considering pregnancy, women with a history
of diabetes should have an eye exam prior to and during pregnancy
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