Preventing vision loss from diabetes
BEING diabetic increases the risk of a person developing eye conditions such as diabetic retinopathy, maculopathy, cataract and glaucoma.
Senior consultant ophthalmologist and medical retina specialist at the Tun Hussein Onn National Eye Hospital (Thoneh) Dr V. Gayatri Devi says the risk of a diabetic individual developing retinopathy depends on the duration and control of their diabetes.
Concomitant uncontrolled blood pressure and cholesterol levels, as well as tobacco use are also important risk factors. Pregnant diabetic women must be monitored closely as pregnancy hormones can cause a spike in insulin resistance, making them vulnerable to accelerated diabetic retinopathy.
Screening for eye problems will not prevent diabetic eye disease, but it can help avoid vision loss by allowing for early detection and treatment. Dr Gayatri urges all Type 2 diabetics to undergo a dilated eye examination with an ophthalmologist upon diagnosis.
As retinopathy is rare in childhood, Type 1 diabetics should have their eyes checked annually from the age of 12.
For pregnant women, frequent eye checks may be recommended if early retinopathy is detected during pregnancy.
“Primary healthcare professionals play an important role to ensure that this is done,” Dr Gayatri said.
“In the early stages of diabetic retinopathy, the retinal blood vessels weaken due to too much sugar in the blood causing leakage of fluid and blood into the retina,” explained Dr Gayatri.
“The condition progresses from mild to severe as more and more blood vessels become compromised.”
Over time, the eye tries to grow new blood vessels to replace the damaged vessels. But the new vessels are fragile and can break and bleed easily. This bleeding may cause dark spots or floaters in a person’s line of vision or even block their vision.
They may experience a sudden loss of vision when the vessels bleed into the clear, jelly-like substance in the centre of the eye, a condition called vitreous haemorrhage that clears itself over time.
This bleeding can cause dark spots or floaters in the line of vision or even completely block vision in severe cases.
In advanced diabetic eye disease, this can progress into scar tissue formation and distortion of the retina architecture, causing a retinal detachment and severe vision loss.
Blood and fluid leaking from retinal blood vessels can cause fatty material or exudates to be deposited in the central retina, called the macula. This swelling of the macula is known as diabetic maculopathy and blurs vision.
Improved treatment options have improved visual outcomes for patients. These include laser treatment and injection in the eye to regress the growth of new retinal blood vessels and resolve diabetic maculopathy.
Dr V. Gayatri Devi sub-specialises in medical retina management and has been one of the leading medical retina experts in the Asean region for the last 15 years.
■ This article is brought to you by Tun Hussein Onn National Eye Hospital.