‘Eye’ Can’t See Diabetes

05 April 2019

The leading cause of blindness among working age people in developed countries is diabetic retinopathy. These statistics may not reflect that of the Asian population, however, according to the National Health and Morbidity Survey 2011 the rate of diabetes in Malaysia is increasing at an alarming rate. This study also revealed that one out of five people above the age of 30 suffer from diabetes. The National Eye Registry in 2007 found that, 55% of people with diabetes never have their eyes screened and 20% of diabetics have sight-threatening retinopathy. Therefore in order to prevent the rate of blindness from diabetic retinopathy from increasing, eye screening has been emphasised all around the world as a measure to halt this problem.

What is Diabetic Retinopathy?

Retinopathy is a disorder of the blood vessels of the retina due to diabetes. It is one of the complications that may arise from diabetes. Diabetic retinopathy is caused by progressive damage to the fine blood vessels supplying oxygen to the light-sensitive tissue at the back of the eye, which is the retina.

The high levels of sugar in the blood over a long period of time lead to structural changes in, the small blood vessels that usually supply oxygen to the retina causing them to get blocked or leaky.

Are You At Risk?

According to Dr Tara George, Consultant Ophthalmologist at Sunway Medical Centre, most people who have had diabetes for 10 or more years will usually have some amount of retinopathy in the eye despite having no symptoms. However in cases of very poorly controlled diabetes, damage to the eye can happen as early as one to two years. “It is actually very easy for the ophthalmologist to detect changes inside the eye as our eye is a reflection of what’s happening in the rest of our body when it comes to diabetes”, said Dr Tara.

One must be aware that, retinopathy in the early stages has no symptoms. This explains why it is important to be aware of this condition and go for regular eye screening to prevent visual loss. If changes are detected early by examination, early interventions can be done. On the other hand, if the damage is left untreated, it will lead to visual loss and blindness.

Can It Be Treated?

Causes of visual loss are swelling of the centre of the retina (macula edema) or bleeding into the cavity of the eye. There are different interventions for these conditions. Swelling in the centre of the retina is treated by medication that is injected into the eye. If there is bleeding in the retina, the standard intervention is laser treatment. Sometimes, surgery is required to remove the blood.

These treatments usually stabilises vision and prevents further visual loss but rarely restores vision back to normal. “This is why it is so important for patients to present themselves at early stages to maintain their vision. Since our retina is nerve tissue, once it is damaged, it cannot regenerate to its original state. In other words, the damage is irreversible”, explained Dr Tara.

Unfortunately, symptoms usually only appear when the centre of the retina is affected. By then, the patient will usually see blurriness or black spots floating around when they read. Some lines may also appear wavy or crooked. It is still not too late for intervention at this stage. With early treatment, symptoms can be improved.

Control of diabetes, hypertension and cholesterol levels also plays a very important role in halting the progression of diabetic retinopathy. Therefore good control of diabetes and other risk factors from the start in terms of lifestyle modification, diet and medication can help prevent or delay this complication of diabetes.

Screening is Prevention

Diabetic retinopathy screening involves much more than just reading the vision chart or checking for glasses. The correct screening test involves examining the back of the eye, which is the retina. There are two ways in carrying out this test: An eye doctor will dilate the pupils and look into the back of the eye to examine the retina. Another method that has gained popularity recently involves using a special camera called the fundus camera that can take photos of the retina. These images will then be graded by certified personnel, usually the Ophthalmologist or a Physician trained in grading these photos.

With yearly screenings, any retinopathy can be easily detected. Apart from regular examination, prevention also comes in the form of good control of diabetes. Many people who have diabetes for 15 to 20 years with good control of the disease still maintain a good vision. “New studies have also shown that if diabetes is well-controlled from the time of diagnosis, a diabetic can delay the progression of the complications for up to 20 years,” said Dr Tara.

“In the past, diabetic retinopathy was more commonly seen in the older age group. Now, with patients being diagnosed with diabetes at a younger age, we see diabetic retinopathy occurring more and more in the working age population”, Dr Tara elaborated. Thus, awareness of the complications of diabetes and the importance of screening cannot be emphasised enough.

Annual screening of the retina is recommended for people with diabetes. Once diabetic retinopathy has been detected, screening schedule can be as frequent as every two to nine months.

Therefore good control of diabetes from the start in terms of lifestyle, diet, medication and also blood pressure and cholesterol can help prevent or delay the complications of diabetes.

At Sunway Medical Centre’s Eye Centre, we offer a comprehensive range of services focusing on screening, diagnosis and treatment of eye conditions for both adults and children. Apart from the usual eye examinations, the Eye Centre also performs ocular imaging with the fundus camera in diagnosis of Diabetic Retinopathy.

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