Out of sight

05 May 2016
POSTED BY Y Magazine

Damage to the eyes can be a complication of diabetes needing specialist care. Take precautions, before you go out of sight.

There are an estimated 7,000 people living with diabetes in Oman and as many as 33 per cent of the population are pre-diabetic.

Diabetic retinopathy is a complication of diabetes. It’s caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).

Experts from Burjeel Hospital, which has a medical centre in Azaiba, Muscat, offer the following advice on the condition:

Who is at risk for diabetic retinopathy?

People with all types of diabetes (type 1, type 2 and gestational) are at risk of diabetic retinopathy. Risk increases the longer a person has diabetes. Women who develop or have diabetes during pregnancy may have rapid onset or worsening of diabetic retinopathy.

What are the other added risk factors for the development of diabetic retinopathy?

  • Duration of diabetes — the longer you have diabetes, the greater the risk of diabetic retinopathy
  • Poor control of blood sugar levels
  • High blood pressure
  • High cholesterol
  • Pregnancy
  • Tobacco use

What are the causes of visual loss in patients with diabetic retinopathy?

  • Diabetic macular edema (DME). A consequence of diabetic retinopathy, DME is swelling in an area of the retina called the macula.
  • A cataract is a clouding of the eye’s lens. Adults with diabetes are two to five times more likely than those without diabetes to develop cataract. Cataracts also tend to develop at an earlier age in people with diabetes.
  • Glaucoma covers a group of diseases that damage the eye’s optic nerve – the bundle of nerve fibres that connects the eye to the brain. In adults, diabetes nearly doubles the risk of glaucoma.
  • Macular ischemia – this is the loss of retinal cells due to lack of blood flow in the retina.
  • Vitreous hemorrhage – bleeding into the eye.
  • Retinal detachment – caused by contracting membranes on the surface of the retina.
  • Anterior ischemic optic neuropathy – damage to the optic nerve etc.

What are the symptoms of diabetic retinopathy and DME?

The early stages of diabetic retinopathy usually lack any symptoms. The disease often progresses unnoticed until it affects vision. Bleeding from abnormal retinal blood vessels can cause the appearance of “floating” spots. If DME occurs, it can cause blurred vision.

How are diabetic retinopathy and DME detected?

Diabetic retinopathy and DME are detected during a comprehensive eye exam that includes:

  • Visual acuity testing. An eye chart test that measures a person’s ability to see at various distances.
  • Tonometry. This test measures pressure inside the eye. 
  • Pupil Dilation. Drops placed on the eye’s surface dilate (widen) the pupil, allowing a doctor to examine the retina and optic nerve.
  • Optical coherence tomography (OCT). Like ultrasound but using light waves instead of sound waves to capture images of tissues inside the body.
  • Fundus fluorescein angiogram. Checks the blood flow in the retina, the areas of leakage and abnormal blood vessels on the retina.

A doctor can check the retina for:

  • Changes to blood vessels
  • Leaking blood vessels or warning signs of leaky blood vessels such as fatty deposits
  • Swelling of the macula
  • Changes in the lens
  • Damage to nerve tissue

How can people with diabetes protect their vision?

Vision lost to diabetic retinopathy can be irreversible. However, early detection and treatment can reduce the risk of blindness by 95 percent.

Controlling elevated blood pressure and cholesterol can reduce the risk of vision loss among people with diabetes.

How do you treat diabetic retinopathy and its complications?

The underlying cause of diabetic retinopathy is uncontrolled diabetes. Therefore, a strict control of diabetes is critically important.

The early stages of diabetic retinopathy with no added complications do not need treatment, and patients are advised to monitor strict blood sugar control, with an ophthalmologist.

If a patient develops diabetic macular edema, treatments can vary from the use of a focal retinal laser to intravitreal injections or a combination of both.

Later stages of diabetic retinopathy will probably need retinal lasers along with the treatment of associated problems.

Complications of diabetic retinopathy, such as cataract or neo vascular glaucoma, can be managed on a case-by-case basis.

To sum up, any irregularity in vision should be dealt with as soon as possible.

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