Diabetic Eye Diseases

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Do you know what causes the most blindness in U.S. adults? It is an eye problem caused by diabetes, called diabetic retinopathy. Your retina is the light-sensitive tissue at the back of your eye. You need a healthy retina to see clearly.

Diabetes can increase your risk of getting blind 25 times more of general population if left untreated. Hard to believe, but yet true.

Diabetic retinopathy happens when diabetes damages the tiny blood vessels inside your retina. You may not notice at first. Symptoms can include

  • Blurry or double vision
  • Rings, flashing lights or blank spots
  • Dark or floating spots
  • Pain or pressure in one or both of your eyes
  • Trouble seeing things out of the corners of your eyes

If you have diabetes, you should have a complete eye exam every year. Finding and treating problems early may save your vision. Treatment often includes laser treatment or surgery.




 

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Diabetic Eye Disease FAQ:

Diabetes is a very serious disease that can cause problems such as blindness, heart disease, kidney failure, and amputations. But by taking good care of yourself through diet, exercise, and special medications, you can control diabetes. And there is more good news. Diabetic eye disease, a complication of diabetes, can be treated before vision loss occurs.

All people with diabetes need to get a comprehensive dilated eye exam at least once a year.

1.What is diabetic eye disease?

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of this disease. All can cause severe vision loss or even blindness.
Diabetic eye disease includes:
  • Diabetic retinopathy: Damage to the blood vessels in the retina.
  • Cataract: Clouding of the lens of the eye.
  • Glaucoma: Increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.
2.What is the most common diabetic eye disease?

Diabetic retinopathy. This disease is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

3.What are its symptoms?

There are often no symptoms in the early stages of diabetic retinopathy. There is no pain and vision may not change until the disease becomes severe. Blurred vision may occur when the macula (the part of the retina that provides sharp, central vision) swells from the leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. Even in more advanced cases, the disease may progress a long way without symptoms. This symptomless progression is why regular eye examinations for people with diabetes are so important.

Diagram of the eye.

5.Who is most likely to get diabetic retinopathy?

Anyone with diabetes. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40-45 percent of those with diagnosed diabetes have some degree of diabetic retinopathy.

6.How is diabetic retinopathy detected?

If you have diabetes, you should have your eyes examined at least once a year. Your eyes should be dilated during the exam, which means eye drops are used to enlarge your pupils. This dilation allows the eye care professional to see more of the inside of your eyes to check for signs of the disease.

Diabetes facts: BewiseHealthwise

Diabetes facts 

The prevalence of diabetes has reached epidemic proportions.

WHO predicts that developing countries will bear the brunt of this epidemic in the 21st century. Currently, more than 70% of people with diabetes live in low- and middle income countries.

  • An estimated 285 million people, corresponding to 6.4% of the world's adult population, will live with diabetes in 2010. The number is expected to grow to 438 million by 2030, corresponding to 7.8% of the adult population.
  • While the global prevalence of diabetes is 6.4%, the prevalence varies from 10.2% in the Western Pacific to 3.8% in the African region. However, the African region is expected to experience the highest increase.
  • 70% of the current cases of diabetes occur in low- and middle income countries. With an estimated 50.8 million people living with diabetes, India has the world's largest diabetes population, followed by China with 43.2 million.
  • The largest age group currently affected by diabetes is between 40-59 years. By 2030 this “record” is expected to move to the 60-79 age group with some 196 million cases.
  • Diabetes is one of the major causes of premature illness and death worldwide. Non-communicable diseases including diabetes account for 60% of all deaths worldwide.

Lack of sufficient diagnosis and treatment

  • In developing countries, less than half of people with diabetes are diagnosed. Without timely diagnoses and adequate treatment, complications and morbidity from diabetes rise exponentially.
  • Type 2 diabetes can remain undetected for many years and the diagnosis is often made from associated complications or incidentally through an abnormal blood or urine glucose test.
  • Undiagnosed diabetes accounted for 85% of those with diabetes in studies from South Africa, 80% in Cameroon, 70% in Ghana and over 80% in Tanzania.
  • The number of deaths attributable to diabetes in 2010 shows a 5.5% increase over the estimates for the year 2007. This increase is largely due to a 29% increase in the number of deaths due to diabetes in the North America & Caribbean Region, a 12% increase in the South East Asia Region and an 11% increase in the Western Pacific Region.
  • Type 2 diabetes is responsible for 85-95% of all diabetes in high-income countries and may account for an even higher percentage in low- and middle-income countries.
  • 80% of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment. Yet, without effective prevention and control programmes, the incidence of diabetes is likely to continue rising globally.
  • Insulin is vital for the survival of people with type 1 diabetes and often ultimately required by people with type 2 diabetes. Even though insulin's indispensible nature is recognised by its inclusion in the WHO's Essential Medicines List, insulin is still not available on an uninterrupted basis in many parts of the developing world.

Diabetes costs – a burden for families and society

  • The financial burden borne by people with diabetes and their families as a result of their disease depends on their economic status and the social insurance policies of their countries. In the poorest countries, people with diabetes and their families bear almost the whole cost of the medical care they can afford.
  • In Latin America, families pay 40-60% of medical care expenditures from their own pockets. In Mozambique, diabetes care for one person requires 75% of the per capita income; in Mali it amounts to 61%; Vietnam is 51% and Zambia 21%.
  • Expressed in International Dollars (ID), which correct for differences in purchasing power, estimated global expenditures on diabetes will be at least ID 418 billion in 2010, and at least ID 561 billion in 2030. An estimated average of ID 878 per person will be spent on diabetes in 2010 globally.
  • Besides excess healthcare expenditure, diabetes also imposes large economic burdens in the form of lost productivity and foregone economic growth. The largest economic burden is the monetary value associated with disability and loss of life as a result of the disease itself and its related complications.
  • The World Health Organization (WHO) predicted net losses in national income from diabetes and cardiovascular disease of ID 557.7 billion in China, ID 303.2 billion in the Russian Federation, ID 336.6 billion in India, ID 49.2 billion in Brazil and ID 2.5 billion in Tanzania (2005 ID), between 2005 and 2015.
  • Unless addressed, the mortality and disease burden from diabetes and other NCDs will continue to increase. WHO projects that globally, deaths caused by these health problems will increase by 17% over the next decade, with the greatest increase in low- and middle-income countries, mainly in the African (27%) and Eastern Mediterranean (25%) regions.

Source: IDF, Diabetes Atlas, 4th edition


Understanding Proliferative Diabetic Retinopathy


Macular Function Test:BewiseHealthwise

Following Amsler Grid Test measures macular function of retina,most sensitive part of vision seeing appratus of eyes which are affected most frequently in advanced diabetes.Kindly follow instructions carefully for better results.
Instructions on using the Amsler grid
1. Wear your reading glasses and cover one eye.
2. Keep your eye focused on the center dot at all times.
3. While looking directly at the center dot be sure all the lines are straight and the squares are the     same size.
4. If any part of the grid appears distorted, blurred, or otherwise abnormal, please contact your     ophthalmologist's office right away.
5. Repeat this test with your other eye.







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Diabetes and the Eye


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Diabetes - Eye Complications


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Diabetic Eye Disease FAQ: Prevention & Treatment

1.Can diabetic retinopathy be treated?

Yes. Your eye care professional may suggest laser surgery in which a strong light beam is aimed onto the retina.

Laser surgery and appropriate followup care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost, which is why finding diabetic retinopathy early is the best way to prevent vision loss.

2.Can diabetic retinopathy be prevented?

Not totally, but your risk can be greatly reduced. The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

The study found that the group that tried to keep their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. This level of blood sugar control may not be best for everyone, including some older adults, children under 13, or people with heart disease. So ask your doctor if this program is right for you.

3.How common are the other diabetic eye diseases?

If you have diabetes, you are also at risk for other diabetic eye diseases, such as cataract and glaucoma. People with diabetes develop cataract at an earlier age than people without diabetes. Cataract can usually be treated by surgery.

A person with diabetes is nearly twice as likely to get glaucoma as other adults. And, as with diabetic retinopathy, the longer you have had diabetes, the greater your risk of getting glaucoma. Glaucoma may be treated with medications, laser surgery, or conventional surgery.

4.What research is being done?

Much research is being done to learn more about diabetic eye disease. For instance, the National Eye Institute is supporting a number of research studies in the laboratory and with patients to learn what causes diabetic retinopathy and how it can be better treated. This research should provide better ways to detect and treat diabetic eye disease and prevent blindness in more people with diabetes.

5.What can you do to protect your vision?

Finding and treating the disease early, before it causes vision loss or blindness, is the best way to control diabetic eye disease. So if you have diabetes, make sure you get a comprehensive dilated eye examination at least once a year.

Remember...


Diabetes is a disease that can cause very serious health problems. If you have diabetes:
  1. Know your ABCs: A1C (blood glucose), blood pressure (BP), and cholesterol numbers.
  2. Take your medicines as prescribed by your doctor.
  3. Monitor your blood sugar daily.
  4. Reach and stay at a healthy weight.
  5. Get regular physical activity.
  6. Quit smoking.

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What are the complications caused by diabetes?

A

Uncontrolled diabetes can give rise to many complications these are either acute or short tem; and chronic or long term. Acute problems are due to either low blood sugar causing hypoglycemia or high blood sugar causing hyperglycemia or diabetes keto-acidosis.  Chronic late complications associated with diabetes are high blood pressure and heart problems leading to heart attacks and heart failure; difficulty in vision and eye problems leading to blindness; kidney problems, leading to kidney failure; nerve damage primarily leading to problems of the foot but also to problems such as diarrhoea, constipation, nausea, vomiting etc. arising from damage to nerves in other parts of the body.


Q

What is diabetic retinopathy?


A

Damage to the retina, the innermost layer of the eye caused by prolonged and inadequate blood glucose control is called diabetic retinopathy. In this condition the small blood vessels in the eye are affected - the arteries supplying blood to the retina become narrow and leaky and the veins become enlarged and twisted causing fluid to leak into the retina causing swelling of the retina. Reduced oxygen supply to the retina stimulates formation of more new blood vessels, which are not stable, and bleed. Fibrous bands are formed which sometimes pull and tear the retina from the underlying attachment



Q

What are the common symptoms and causes of diabetic eye disease?


A

The early symptom of eye problem related to diabetes is blurred vision. High blood sugar changes the shape and flexibility of the lens of the eye distorting the ability to focus and causes blurred vision.

  • Another symptom is double vision - it means two objects are seen when only one exists. It occurs when the nerves controlling the eye muscle are damaged.
  • Cloudy vision - can occur because of cataract and swelling of the retina, it may occur over a period of months.
  • Floating spots in the visual field - The vitreous of the eye (transparent gel like substance that helps keep the shape of the eye) contains small transparent threads, which lose their transparency with age and may be seen as dark spots or lines.
  • Curtain like shadows in the eye - A retinal detachment or major bleeding in the retina may cause curtain like shadows in the front of the eye. Red irritated eyes may be due to infection in the eye and sudden pain in the eye may be due to raised pressure in the eye (glaucoma).


Q

How is diabetic retinopathy detected?


A

Your doctor will either advise or perform certain tests to check your eyes. These include:

  • Visual acuity (sharpness of vision) test - This eye chart test measures to see how well we can see small and large objects at various distances.
  • Ophthalmoscopy - Examination of the eye with a fundoscope after pupil dilation. The doctor puts some medicine in the eye to widen the pupil which is the central hole in the iris or curtain of the eye, so that he can look for signs of diabetic retinopathy more clearly. He looks for changes in shape, thickness and distribution of blood vessels in the eye, or, for presence of any leaking blood vessels; swelling of the retina in general and of the macula (a special portion used for sharp vision), in particular (macular oedema); exudates - pale, fatty deposits on the retina - sign of leaking blood vessels
  • Tonometry - A test that determines the fluid pressure in the eye to look for glaucoma


Q

How is diabetic retinopathy treated?


A

The best solution is to avoid retinopathy by proper diabetes control. Depending on the severity, grade and nature of the problem there are two treatments for diabetic retinopathy. They are both very effective in reducing vision loss.

  • Laser Surgery - Doctors perform laser surgery to burn off bleeding new blood vessel formation around the macula to save vision.
  • Vitrectomy - Vitreoretinal surgery is done to restore vision to the eye caused by a vitreous bleed or opacity.


Q

What complications take place in the eyes due to diabetes?


A

  • Corneal erosion - Cornea the central transparent portion in the front part of the eye can develop ulcer or erosion that may heal with difficulty and lead to corneal opacity and blindness requiring corneal transplant
  • Cataract - Partial or complete opacity of the lens of the eye initially causes blurred vision, and later blindness
  • Changing power of spectacles due to change in size of the lens caused by fluid accumulation
  • Bleeding in the vitreous, macular swelling, retinal hemorrhage, retinal exudates, retinal detachment - all causing blindness
  • Double vision due to nerve damage and paralysis of muscles that make the eyes move upwards, sideways and obliquely.
 

Q

How does one prevent further complications of the eye due to diabetes?


A

  • Ensure good control of blood sugar and blood pressure to avoid further progression of eye disease. Prevention is better than cure. Quit smoking if a smoker. Ensure regular and proper check up.
  • Children above 10 years and adults below 29 years should get their eyes tested within 3-5 years of diagnosis and then tested once a year.
  • Adults above 30 years should get their eyes tested at the time of diagnosis of diabetes and then once a year.
  • Pregnant women in pre diabetic state should get their eyes tested prior to becoming pregnant and then in the 1st trimester
  • Those already diagnosed with abnormal findings of the eyes need to be tested more frequently



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