How can diabetes affect eyes?
Diabetes can affect different parts of the eye. Diabetic Retinopathy is the most common manifestation of diabetic eye disease followed by Diabetic cataract (snowflake cataract). Recurrent eyelid infections called Stye or “Hordeolum” are also the early presenting signs of diabetes. Advanced diabetic eye disease may lead to intractable glaucoma (neovascular glaucoma) where in the eye pressure progressively increases to cause damage of optic nerve. Diabetic eye disease is now increasingly becoming a major cause of preventable blindness in India.
- What are the different types of eye problems that one can face?
Redness of eyes with swelling of eyelids is encountered in infection of oil secreting glands (meibomian) present in eyelids
Blurry vision and seeing multiple black spots in front of the eye are the early symptoms of Diabetic retinopathy. Distorted vision or” metamorphosia” is also a common complaint wherein a straight line may appear wavy; this is frequently encountered in type 2 diabetics. Type 1 Diabetics are prone for bleeding inside the eye called vitreous haemorrhage. If this is not treated promptly this can lead to detachment of retina.
Diabetic retinopathy is broadly classified into 2 types Non proliferative and Proliferative. The latter needs immediate attention and treatment.
Cloudy or foggy vision is a manifestation of cataract or clouding of the crystalline lens in the eye.
Glaucoma or eye pressure related vision loss is also seen in diabetics, is initially devoid of symptoms but can lead to progressive contraction of field of vision and irreversible blindness.
- When should one visit an eye doctor (ophthalmologist)?
If you were 30yrs and younger when your diabetes was detected, then eye exam by an ophthalmologist should be done within 5 yrs of the diagnoses. However if you are above 30 yrs when your diabetes is first detected then you need to be examined by an ophthalmologist within few months.
If you are a diabetic and become pregnant then schedule an eye exam in the first trimester.
If you have already experienced high risk Diabetic complications like diabetic kidney disease or diabetic foot leading to amputation then you need an eye exam immediately by an ophthalmologist.
If you have been examined by an ophthalmologist and found to have non proliferative diabetic retinopathy then yearly review as per the discretion of the ophthalmologist is required. If you have been diagnosed with proliferative retinopathy then monthly review and treatment as per the ophthalmologist advice is necessary to prevent vision loss.
- How are diabetic eye problems treated?
Diabetic retinopathy once diagnosed is then graded and assessed by the Retina specialist and treated. Initially you need to undergo a retinal scan called SD OCT to asses the extent of diabetic macular edema followed by an Angiogram to grade the severity of your diabetic eye disease.
There are different types of treatment modalities for diabetic eye disease which include:
- Laser photo coagulation of retina
- Intravitreal injections ( injections given in the eye)
- Intravitreal implants( drug eluting capsule implanted in eye)
- Surgery ( vitrectomy) for non clearing bleed inside the eye and retinal detachment
- Pattern scan and navigated laser treatment of diabetic maculopathy.
- Micro incision cataract surgery for diabetic cataract
- Eye drops to control your elevated eye pressures
- Cryotherapy for advanced diabetic eye disease.
The treatment strategy would be discussed by your retina specialist based on the severity and grade of your diabetic eye disease. All the above treatments are done as day care procedures and don’t require admission.
- What can one do to prevent damage to eyes?
Optimal control of your blood sugar levels is known to prevent progression of diabetic retinopathy . HbA1C levels which is indicative of 3 month glycemic control should be below 7.
You should also be aware that hypertension (High BP), anemia (low hemoglobin ) and kidney disease can worsen diabetic retinopathy and should consult your physician regularly.
The old adage “Prevention is always better than cure” is very true for diabetic retinopathy. Hence regular exercise, diet ( as prescribed by nutritionist) and periodic eye check up by an ophthalmologist can help you preserve your vision.
Dr Name: Jinadas & Atheeshwardas
Credentials: MD & DO DNB FRCS(Glasgow) FMRF(Sankara Nethralaya)