Diabetic Retinopathy

A diabetic is also at higher risk of getting cataracts.

by Dr. Y.L.M.

Can diabetes affect the eyes?

Unfortunately, the answer is yes. Most people who have diabetes mellitus that is well controlled have no major problems with their eyes. But if your diabetes has not been well controlled for a long period of time, then you can get something called diabetic retinopathy as one of the many complications of diabetes. You can also develop cataracts.

Diabetic retinopathy can occur in both types of diabetes – type 1 (the insulin dependent one that usually occurs from a young age) or type 2 (the insulin resistant one that can develop in later ages).

The longer you have had diabetes, the likelier you are to develop diabetic retinopathy. You are also more likely to develop it if you have high blood pressure, high cholesterol, are pregnant or if you smoke.

Diabetic retinopathy will affect both your eyes.

What is the retina?

The retina is the sensory tissue that lines the back of your eye. It has many layers and contains millions of photoreceptors (cones and rods) that capture the light rays that go through your eye and converts them into nerve impulses.

These impulses are then carried via the optic nerve to the back portion of your brain where the images you are seeing are translated into something that makes sense.

The macula is a very dense, cone-packed area within your retina which is responsible for central vision – which you use most of the time to focus on an object. In the very centre of your macula is the fovea.

Your cones are responsible for bright light and colour vision and your rods are responsible for dim light vision.

Your retina functions as a screen. If anything happens to occlude this screen – especially around your macula area – you are going to have trouble seeing.

What is diabetic retinopathy?

Diabetic retinopathy is a term given to the disease you get in your retina which is caused by diabetes. The reason you get diabetic retinopathy is uncontrolled sugar levels in your bloodstream. The excessive sugar level damages the fine blood vessels in your retina.

The weakened walls of your blood vessels begin to bulge. These are called microaneurysms. The miceoaneurysms may leak blood into your retina or burst.

There are four main types of diabetic retinopathy:

1. Background retinopathy – the early stage.

2. Maculopathy – your macula begins to be affected. This is more serious because your focused vision begins to be affected. The macula may also swell with blood and fluid.

3. Pre-proliferative – the period before new blood vessels start growing in your retina.

4. Proliferative – the most serious sort. Abnormal blood vessels grow in your retina. They may leak blood into the jelly substance that forms your eyeball – the vitreous. These new blood vessels run havoc around your eye, causing your retina to scar and detach from the back of your eye. They may even interfere with your optic nerve and the normal flow of fluid from your eye, causing pressure to build. You can go blind this way.

The most advanced and dangerous stage of diabetic retinopathy is the advanced proliferative stage, when new blood vessels rupture, causing further scar formation. The scar tissue can pull the retina away from its normal position at the back of the eye (right).

Now I am worried. Is blindness the only way to tell if I have diabetic retinopathy? Isn’t that too late for me?

No. When you have been diagnosed with diabetes mellitus, you should already be regularly seeing a doctor for stringent sugar control. Your doctor should be periodically examining your retina for any early signs. Most of the time, you may have diabetic retinopathy already and not know it.

People who have symptoms may have spots floating within their vision (bleeding occurring on your retina or vitreous), blurred vision in itself (when your macula is affected), poor night vision (when your rods are affected), dark streaks or a red film that blocks your vision, and actual loss of vision.

Once I get diabetic retinopathy, is there any hope for me? Or am I doomed to become blind?

Of course there is hope! The most important thing is to control your blood sugar levels so that the damage to your blood vessels can be halted.

Early diabetic retinopathy is not usually treated but monitored by your doctor.

Once you have proliferative diabetic retinopathy, you can get photocoagulation laser treatment to stop the leakage of blood and fluid into your eye. Rest assured, it is painless and rapid. Lasers can also shrink your abnormal new blood vessels.

There is also a procedure to remove blood from the centre of your vitreous. If your retina does detach, lasers can also seal it back to your eye.

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