Diabetes and diabetic eye disease
Diabetes is a major public health problem all over the world. There is rapid increase in the number of diabetics. The reasons are as follows.
 

1. The hereditary nature of the disease
2. Sudden change of lifestyle and rapid urbanization
3. Excess amount of fat and refined sugar consumption through junk food
4. Sedentary lifestyle with decrease chance and motivation for exercise
5. Mental stress and pressure
6. Obesity

1. Irresistible thirst and dryness of mouth
2. Fatigue and loss of strength
3. Insatiable hunger
4. Sudden loss of weight
5. Delayed wound healing
6. Decrease in eye sight

1. Diabetic neuropathy: it is a highly morbid condition with pushes a person to death.

2. Diabetic retinopathy: it pushes a person to blindness.
3. Diabetic foot and amputation
4. Heart attack
5. Brain stroke causing death or paralysis

 
A  Diabetic patient:
 
1.Compared to non diabetic person has 25% chances of becoming blind.
2. Compared to a non diabetic person has 17% chances having kidney problems.
3. Compared to a diabetic person has 2 - 3% chance of paralysis.
4. Compared to a non diabetic person has 2% chance of brain stroke.

Diabetic retinopathy is a silent killer

1. the most common eyesight related disease faced by diabetic patients are retinopathy, cataract and glaucoma .Among these diabetic retinopathy is most prevalent t.80-90% of blindness related to diabetes are attributed to retinopathy.

2. Early diagnosis and treatment at the correct time can reduce chances of blindness considerably.

3. There are no symptoms in early stages of diabetic retinopathy. Therefore it is advisable that the diabetic patient should to go for an eye check up minimum once in a year by an ophthalmologist. If retinopathy is detected the patient should abide by the doctor's instructions and continue regular check up.

How does diabetes affect the eye?

Diabetic weakens the blood vessels of all the organs of the body. The delicate blood vessels of the retina, primarily affected the most. In the case of a diabetic patient the retinal veins and capillaries are affected and there is a gradual change is the structural layers of the retina which are unexpendable. This is called diabetic retinopathy which slowly leads to blindness.
Diabetic retinopathy advances slowly and it depends upon how long the person is suffering from diabetes. The causes and advancement of diabetic retinopathy depend upon:
1. High blood glucose in uncontrolled diabetes.
2. The length of time the person is suffering from diabetes.
3. High blood pressure.
4. Diabetic related kidney diseases.
5. Hyperlipidemia
6. Poor Eating habits- intake of excess fat or high calorie food.
5. Tobacco consumption in any form
6.Alcohol consumption
7. Pregnancy

Without getting into elaborate details we can classify the disease into two stages:


Non proliferative
this is the initial stage-hallmarked by hemorrhage in the retina or fluid or lipid builds up in the eye. It does not lead to formation of leaking new vessels


Proliferative
This is advanced stage-Formation of new ill formed vessels. Structurally these new vessels and weak and leaky and can lead to the profound and repeated haemorrhages and causes blindness.
Besides these, in either of the two stages CSME or build up of fluid and lipid substances in the retinal layers can take place. This is the major cause reason visual decline in diabetic retinopathy.



Diabetic retinopathy eye check up.
Every diabetic patient has a chance of having retinopathy.' Good vision is not equivalent to a healthy eye' because there are no early symptoms in Diabetic retinopathy .Detailed retinal examination in a pharmacologically dilated pupil need to be done for the diagnosis of. Thus regular examination and treatment can control the deterioration in the eyesight.
Full examination of the eye is not only checking the need for glasses. For proper diagnosis and determination of the stage of the disease, eye examination needs to be done under ophthalmoscopes and slit lamps. Depending on the disease it is assessed which patient needs optical coherence tomography, ultrasonography or fundus fluorescein angiography.


Fundus Fluorescein Angiography

In this technique the patient is injected with a dye (a colouring substance) in the vein present in the hand and the retina is photographed. Digitalized images are taken in an enlarged form. By this method the transformation of the thinnest arteries and veins can be determined. It helps in the detection of the stage of the disease and assessment of course of treatment .It also helps in understanding the result of previous treatment and their impact.

Optical Coherence Tomography.

Very useful and reliable technique by which the impact of diabetes on different layers of retina can be assessed .This machine also helps to assess the gradual improvement or deterioration of retina .It is non invasive and has no side effect in the body.

Treatment

Laser is the only effective treatment for retinopathy. Laser is a powerful and intense ray that works upon the retina and prevents the progression of diabetic retinopathy and prevents loss of eyesight.

Laser treatment

It is mostly done externally with the help of topical anaesthesia. Then the patient is seated in the slit lamp and specially designed lens are fitted to the eye from where the laser rays enter the eye ,which are then  absorbed by some specific retinal cells which results in the improvement of the structure of the retina and preventing the chance of haemorrhage and bleeding. A diabetic retinopathy patient may need to undergo multiple lasers in a lifetime according to the doctor's assessment for good vision.

Side effect of laser treatment

Excess tears, mild headache, double vision are temporary side effects of laser treatment but in case of severe pain of sudden loss of vision immediately contact the doctor.

Injection
 
In the recent years the invention of Intravitreal injection is revolutionary in the field of diabetic retinopathy treatment. Complex protein substances are injected in the eye which results in normalization of the retinal structures, prevents abnormal new vessel formation and chances of recurrent retinal bleeding and haemorrhage.
This injection has to be given with extreme caution, embracing proper guidelines. It needs to be administered every 4 weeks .Depending on the advancement of the disease the number of injection is determined by the doctors. Minimum 4 injections are needs to be administered.
There are no apparent such side effects of injection. Being an invasive procedure there is a chance of infection, thus the injection is administered with proper cautiousness and guidelines, so that no such complication arises.

 Vitrectomy operation

In certain cases there are internal haemorrhage in the eye which results in the loss of vision .In other cases the vitreous jelly inside the eye dries up causing traction on the retina which can result in tearing and detachment of the retina. This can severely affect the vision .Vitrectomy operation is done to remove the internal haemorrhage or to attach a detached retina .In this case the vitreous jelly is replaced by synthetic transparent substances which helps in visual restoration. This procedure is only done when other treatments are not possible or when other treatments have not yielded any fruitful results.

Points to remember:

1. Every diabetic patient has a probability of losing eyesight but it is possible to save 80-90% of them from severe vision loss.
2. Every diabetic patient should regularly get his/her retina examined.
3. Diabetic retinopathy is a silent eyesight killer. In the early stage does patients are asymptomatic.
4. Diabetic retinopathy requires lifelong treatment.
5. If diabetic retinopathy is diagnosed the patient should consult the doctor and get the eye examined as advised .This helps in prevention of severe vision loss and blindness.
6. Laser is an effective treatment, though it does not enhance the eyesight but prevents the advancement of the disease and keeps the vision stable.
7. Everyone above 40 years and people who are related to diabetic patients should get their blood tested for blood sugar.
8. Everyone above 40 years should get their full eye examination done by an ophthalmologist (checking for refractive errors is not sufficient).