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Diabetic Retinopathy: An Avoidable Blindness

July 15, 2012

Added By :
Dr Nezrean Radzana Hj Mohamed


Controlling Diabetes effects on eyes is one the most fundamental aspects in treament plans ot patients with high sugar levels. Dr Ahmad Fauzi Md. Sharif, Eye Specialist and Vitreo-retinal Surgeon, Diabetic Eye Specialist.givesa simple account of a routine conversation between a patient and a doctor. Please read more....

“But doctor, my sugar control is always good and my vision is normal”.

That is probably on of the more common statements made by most of my diabetic patients when I ask them if they have ever had their eyes examined.
They all know to watch out for sores and ulcers on their foot, numbness over their limbs and even to enquire about their kidney functions, but most will forget their eyes. This situation maybe compounded by those that manage their diabetes since it is relatively easier to look for sores and ulcers, and examined for numbness, and investigate for kidney function. But to examine the eyes in diabetics goes much further then just checking their vision. All of it (except for the detailed examination of the eyes), could in fact be done by the patients themselves.

Why is it so important for diabetics to have their eyes (not just vision!) examined regularly?

Imagine a diabetic with very poor vision. Will they be able to examine their foot for sores and ulcers? Can they determine how bad their numbness is? And for those that take insulin for their diabetic control, will they be able to administer the subcutaneous injections? The loss of their ability to self monitor and treat can by itself have a devastating psychological impact on these patients. However, vision alone in not an indicator of the severity of diabetic retinopathy.

Why is vision not a good indicator of severity of diabetic retinopathy?

There are patients that retain a good central vision despite having retinopathies, hence misleading them into thinking that their eyes are unaffected. This is due to the fact that diabetic retinopathy usually damages the peripheral areas of the retina first before encroaching centrally. By the time central vision is affected, it may be too late. That is why a regular complete eye examination with fully dilated pupils is necessary to determine the status of a diabetic retinopathy.

Why sugar control is not a good gauge for diabetic retinopathy?

It is a fact that the onset of diabetic retinopathy on the eyes has little to do with sugar control. It’s the duration of diabetes that is very important (but of course poorly controlled diabetes will aggravate the severity). The longer one is a diabetic the more likely they will have some form of diabetic retinopathy (Figure 1). About 20% of patients with type 2 diabetes (adult onset) have some form of retinopathy on diagnosis. Type 1 diabetics (juvenile onset) usually do not have diabetic retinopathy until after 5 years of diagnosis but unfortunately since they become diabetics at a much younger age; they are at a greater risk of developing the advance form of diabetic retinopathy (Figure 2).

Will diabetes lead to blindness?

Yes, diabetic retinopathy can lead to blindness if it is detected late. Once damage has occurred, it difficult to reverse. Diabetic retinopathy is the cause of blindness in 90% of type1 and 30% of type 2 legally blind patients. This is unfortunate, since they are preventable and treatable if detected early.

How frequent should I have my eyes examined?

It is recommended for a Type 1 diabetic to have a detailed eye examination after 5 years of diagnosis and for a Type 2 diabetic upon diagnosis. Following the initial examination, subsequent visits depends of the retinopathy status. On each visit a picture of the retina should be taken to record the diabetic retinopathy status.


 

Non Proliférative Diabetic Retinopathy





Advanced Proliferative Diabetic Retinopathy



 
Written by:
Dr Ahmad Fauzi Md. Sharif
Eye Specialist and Vitreo-retinal Surgeon,
Diabetic Eye Specialist.