Diabetic retinopathy: A common cause for blindness in adults

SEPT 10, 2019
Diabetic retinopathy is the most common eye disease and is one of the main causes of blindness in adults.

Dr Manoharan Shunmugam, Ophthalmologist and Vitreoretinal surgeon from Pantai Hospital Kuala Lumpur  explained that it is caused by changes in the blood vessels of the retina.

“In some people, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina.

Symptoms
“Over time, diabetic retinopathy can get worse and cause vision loss. It usually affects both eyes but may be asymmetrical. Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:
  • Fragile, abnormal blood vessels can develop (this is called proliferative retinopathy) and leak blood into the retina. At first, there may only be a few specks of blood, or spots, “floating” in your vision.
 
  • Hemorrhage (bleeding) tends to happen more than once, often during sleep. Sometimes, without treatment, the spots clear. However, bleeding can recur and cause severely blurred vision. If left untreated, proliferative retinopathy can cause severe vision loss and even blindness.

Proliferative retinopathy if not treated on time can lead to serious conditions such as (tractional) retinal detachments whereby abnormal blood vessels start pulling the retina off resulting in permanent vision loss.

Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell and blurring of vision. This condition is called macular oedema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. Half of the people with proliferative retinopathy also have macular edema.

How do you detect diabetic retinopathy?
Diabetic retinopathy and macular edema are detected during a comprehensive eye check that includes:

Visual acuity test: the eye chart test measures how well you see at various distances

Tonometry: an instrument measures the pressure inside the eye. Numbing drops may be applied to the eye for this test.

Dilated eye examination
​Optical Coherence Tomography (OCT): this is a special scan of the retina which displays a cross-sectional view of the retina and can calculate exactly how swollen the retina is.

If your eye care doctor believes you need treatment for macular edema, he may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in the retina. The test allows the ophthalmologist to identify any leaking blood vessels and recommend treatment.

Blood sugar control slows onset of retinopathy
“The Diabetes Control and Complications Trial (DCCT) showed better control of blood sugar levels slows the onset and progression of retinopathy, expained Manoharan. 

People with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser.
​
Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help in overall health as well as help protect your vision. Maintaining good control of blood sugar levels will also mean you are more likely to have a heart attack, stroke or other diabetes-related complications.

EXPLORE FURTHER

Ethnic variations in glycaemic response to simple sugars and carbohydrates

​Impact on blood glucose levels in Caucasians versus Asians

One in 10 prediabetic individuals progress to diabetes within a year

​Limitations of finger prick testing for prediabetes diagnosis

Diabetes: Subtle signs you should not ignore

​Subtle signs include urinating often, thirsty, urinary tract infection, weight

Empowering children with type 1 diabetes mellitus

​​Is complete avoidance of sweets and sugar the solution?

​Can diabetes be reversed?

​Discover the power to reverse diabetes through nutrition and lifestyle

Maggot debridement therapy: Rescuing limbs from amputation

​An innovative modality for the treatment of chronic wounds