Diabetes mellitus (DM) is one of the most common health conditions among individuals of different ethnicities and all age groups. It is characterized by high levels of glucose in the blood, due to the inability of the pancreas inability to produce insulin in adequate amounts. It affects many organ systems, including blood vessels, nerves, kidneys and the eyes. DM and its complications are rapidly becoming the world’s most significant cause of morbidity and mortality. The DM pandemic has expanded rapidly in developed and developing countries. It is expected that DM will reach epidemic proportions within the near future. DM affects more than 240 million people worldwide, and this number is expected to reach roughly 370 million by the year 2030.
Ocular complications associated with diabetes are progressive and rapidly becoming the world’s most significant cause of morbidity. However, they are preventable with early detection and timely treatment. Diabetic eye disease varies from mild, with no visual symptoms, to blindness. Conditions in the eye include diabetic retinopathy (DR), cataract, glaucoma, and diabetic macular edema (DME).
Diabetic Retinopathy (DR):In this condition, the excessive levels of glucose in the blood cause damage to the tiny blood vessels in the retina. They swell and block blood flow, denying the supply of oxygen and nutrients to the retina. This leads to the growth of abnormal vessels which leak blood, causing distorted vision. In later stages, it can cause blindness. Diabetic retinopathy, the most common microvascular complication of diabetes, is the principal cause of new blindness among our working population. And it is the major cause of blindness in adults 20-74 years of age in the US. In patients with Type 1 and Type 2 diabetes, with disease duration of over twenty years, the percentage of patients with diabetic retinopathy is 95% and 60%, respectively.
Cataract: It is characterized by clouding of the lens of the eye, requiring surgery to replace it with an intraocular lens. DR and macular edema, or swelling inside the eye, can become worse after surgery. Cataracts affect people who are non-diabetic as well, but diabetic patients are 2-5 times more at risk for cataract formation and it is more likely to happen at a younger age.
Glaucoma:Glaucoma is high pressure in the eye that causes damage to the optic nerve and leads to loss of vision. Neovascular glaucoma (NVG) is a severe and troublesome type of glaucoma where abnormal blood vessels grow on the surface of the iris (the colored part of the eye) and obstruct the flow of aqueous fluid causing an increased pressure (this is the fluid that maintains the shape of the eye). DR is one of the most common causes of NVG.
Diabetic Macular Edema (DME): The macula is the region in the retina that is responsible for sharp central vision, used for activities like reading and driving. Patients with DME suffer loss of vision due to the accumulation of fluid in the macula. Almost half the patients with DR later develop DME. DME is the most common cause of moderate to severe visual loss in diabetic patients.
Get your eye diseases treated before it’s too late!
The majority of patients with diabetic retinopathy don’t feel any symptoms at all until they start experiencing a loss of vision, either gradual or abrupt. Hemorrhages from the retinal blood vessels may cause the patient to see floating spots. New floaters are an emergency which should be checked by an eye doctor immediately. To identify whose eyes are at risk, and prevent diabetic retinopathy from causing permanent vision loss, diabetic patients should undergo a comprehensive dilated eye exam every year. This is so the eye doctor can detect the onset of diabetic eye disease at an early stage, before permanent damage has occurred, and treat accordingly.
The examination includes visual acuity test, refraction, pupil check, tonometry (checking the pressure in the eye), dilation (instilling eye drops to enlarge the pupils and have a good view of the entire retina), photographs, and optical coherence tomography (OCT-a laser measurement of the layers of the retina). These tests can be used to diagnose diabetic retinopathy (DR), cataract, glaucoma, and diabetic macular edema (DME).
Studies show that maintaining your blood-sugar level as close as possible to normal would slow down the onset or progress of diabetic retinopathy. It also reduces the risk of total loss of vision in patients who are already diagnosed with diabetes. The best things to do are eating a healthy diet, taking your diabetic medication regularly, exercising regularly, and undergoing yearly dilated eye exams with your eye doctor.