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Almost a century ago, in October 1923, the Nobel Prize was awarded to Banting and Macleod for their discovery of insulin which has saved the lives of millions of people suffering from diabetes, one of the fastest growing chronic diseases worldwide. Insulin is a hormone that delivers glucose to the cells of the body. Diabetes is a disease in which the body either does not produce or use insulin effectively, resulting in damage to many parts of the body including the eyes. The eyes are particularly vulnerable to the impact that fluctuation in blood sugar levels has on blood vessels and nerves which causes a variety of diabetic eye diseases. DIABETIC RETINOPATHY The longer a person has diabetes, the more likely they are to develop diabetic retinopathy, but with control of blood sugar levels this risk reduces significantly. Diabetic retinopathy occurs as a result of damage to the small blood vessels of the retina. It is characterised by either the leaking of the blood vessels or the growth of abnormal new blood vessels on the surface of the retina. It usually progresses through four stages, from mild nonproliferative retinopathy to the severe proliferative stage. After a prolonged period of high blood sugar levels, the blood vessels weaken, bulge or leak into the retina, depriving it of oxygen and essential nutrients. As some of the damaged vessels become blocked or closed off, new blood vessels begin to grow. These fragile blood vessels can break, bleed or form clots. The resultant scar tissue can cause the retina to pull away and detach from the back of the eye, leading to severe vision problems which require immediate treatment. |
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DIABETIC MACULAR EDEMA This occurs when diabetes affects the macula, the area of the retina responsible for sharp central vision necessary for driving, reading and other similar activities. The build-up of leaking fluid into the macula leads to swelling and the gradual loss of central vision. Symptoms may include blurred or distorted vision. The earlier it is detected, the earlier it can be managed, and the progress of the vision loss slowed or even stopped. SWELLING OF THE LENS If blood sugar levels fluctuate rapidly from low to normal, the shape of the lens of the eye can be affected, causing blurred vision. Vision generally returns to normal once blood sugar levels stabilise. CATARACTS Cataracts are a common eye condition affecting many people worldwide. They can form earlier and progress more rapidly in people with diabetes due to the increase of sugar in the blood. GLAUCOMA The risk of developing glaucoma is doubled in people with diabetes. A rare form of glaucoma, neovascular glaucoma, is caused by high blood sugar levels which can damage the blood vessels of the retina and result in the creation of abnormal new ones. When the new vessels grow on the iris, the coloured part of the eye, the normal flow of fluid is disrupted, and eye pressure is raised. |
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MANAGEMENT OF DIABETIC EYE DISEASE The best way to manage or prevent diabetes-related eye problems is to monitor and control blood sugar levels, blood pressure and cholesterol levels, and to have regular eye examinations. If you have been diagnosed with diabetes, it is important to have regular eye examinations to evaluate the health of the eyes and detect changes. In a dilated eye examination, the optometrist will dilate the pupils so that the retina can be clearly observed. This allows for early identification of the signs of eye disease, sometimes even before symptoms of the condition have emerged or been experienced. Early detection leads to early treatment or management of the condition and a more positive long-term outcome. A healthy lifestyle, a nutritious diet which includes eye-healthy foods and regular exercise goes a long way towards minimising chronic diseases. Smoking can cause further damage to the blood vessels, including the ones in the eyes, so it is beneficial to general health as well as to eye health to stop smoking or at least cut back. Protect the eyes from the sun’s harmful ultraviolet rays by wearing sunglasses that block both UVA and UVB light. Exposure to these rays can speed up the progression of cataracts. Be aware of sudden changes to your eye health and vision. Seek medical intervention immediately if you experience blurred vision, sudden vision loss, eye pain, flashes of light or black spots in your vision. If you have already lost a certain amount of vision due to diabetes, have a discussion with your optometrist regarding resources for visual aids which can help you to cope with daily activities and maintain your independence. |
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