Diabetic Eye Disorder
People with diabetes have a unique disease called diabetic retinopathy that affects the retina, which is like the camera film of the eye. This is a disease of the small blood vessels supplying the retina. The vessels close prematurely, leak blood or fat or grow abnormally. These vascular changes are occurring within all the body’s organs in a diabetic patient and may lead to high blood pressure, numbness in the feet, kidney failure, strokes and heart attacks.
Fortunately, your ophthalmologist at Metwest Eye Centre can view these vessels directly and painlessly within the eye and can predict the health of the other organs. Once diabetes is diagnosed it is important for the eyes to be examined regularly for diabetic retinopathy. This is useful not only in preventing blindness, but also to help your doctors keep your general health at its best.
When to have your eyes examined?
At first diagnosis – this is important to determine your baseline health, as you may not know how long your sugars have been high.
Children with diabetes are usually examined at 10 years old, or 5 years after diagnosis (which ever is later).
Pregnant women should be seen in the first trimester.
How often to have an examination?
If all is well, we will need to see you every 12 to 18 months.
If there are changes occurring within the eye or if there is a deterioration of your general health, we may need to see you more often.
Symptoms of Diabetic Retinopathy
Most often there will be no symptoms that you would notice despite the diabetic changes slowly occurring at the back of your eye.
The warning signs may be:
- Black smudges in the vision
- Showers of floaters or “flies”
- Distorted or fluctuating blurry vision – If these occur, you should see us as soon as possible, be sure to let the Receptionist know it is urgent.
You will have your vision checked, as well as the pressure in your eye measured (see glaucoma).
The pupils will then be enlarged (dilated) with drops so our ophthalmologist can view the retina.
Warning – These drops will cause your vision to be blurry and bright, and this can last 4 hours or even longer. It is wise to come with a friend to assist you if your vision is severely affected, especially another driver if you normally visit us by car. A pair of sunglasses is also recommended if you find yourself affected by glare.
This is a test in which we inject a dye (Fluorescein) into your arm to find out if any of the blood vessels in the retina are leaking, and whereabouts they are. After injecting the dye the photographs of the retina are taken which help diagnose diabetic retinopathy and guide the doctor as to what treatment to use.
You do not need to fast before this test, though some people feel queasy during the injection. Your skin will tinged yellow by the dye, but this will only last 24 – 48 hours as you pass the dye from your urine (which will be bright yellow).
AntiVEGF Eye Injections or Laser Treatment
These provide the majority of treatment. Leaking blood vessels are usually treated with AntiVEGF injections. The antiVEGF reduces the permeability of these vessels.
The laser is used to treat the growth of new abnormal retinal vessels within the eye. Both treatments are well supported by evidence.
Of course, good control of blood sugars, cholesterol, weight and blood pressure are essential to slow the development of retinopathy and to help treat it once it has occurred. Cessation of smoking is highly recommended. Lipidil has been shown to slow the progression of more advanced diabetic retinopathy. It is usually prescribed by your general practitioner.
I have had diabetes for 15 years and had my eyes screened 3 times. Each time the doctor told me everything was OK. Do I still need to continue with screening?Yes. The likelihood of retinopathy increases with the duration of your diabetes. The need for therapy can almost always be identified early by examination by a Metwest Ophthalmologist. Waiting for vision to deteriorate before making an appointment can often mean the retinopathy is too advanced to achieve the best results.
80% of diabetic patients have some changes within their eyes by the time they have had the disease for 15 years.
I am a diabetic and the sole carer of my invalid husband. I really depend on my eyes for driving and reading his medications. What can I do to look after my vision?Good control of your sugars has been shown to delay the development of retinopathy. Your local doctor and dietitian can help you with this as well as giving attention to ceasing smoking, your weight, blood pressure, dietary fats and cholesterol. All these factors maintain your general health as well as your vision. Lipidl has also been shown to reduce the progression of more advanced retinopathy.
Regular eye review will detect retinopathy early and allow for timely treatment, thus minimising the risk of severe visual loss.
Can I have eye disease without any symptoms?Yes. Retinopathy may be present at the diagnosis of your diabetes, particularly in late-onset diabetes where the blood sugars gradually rise and it is difficult to pick the exact time when the diabetes started.
Are there any symptoms I should watch out for?If any of the following symptoms occur you should make an appointment with us immediately.
1. A shower of floaters – like a cloud of mosquitoes drifting in and out of your vision.
2. Distorted vision – the bending of a line of print on a page or the lines of a picket fence or wood panelling
3. Black smudges – noticeable when looking a plain background or printed page where the print goes missing in patches