Topic 3: Diabetes And Your Eyes
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Topic 3: Diabetes And Your Eyes

By November 25, 2022March 15th, 2023No Comments

Diabetes and Your Eyes

(prepared by consultant ophthalmologist Dr. Dhashani A/P Sivaratnam, MBBS (MAHE), MSurg Ophth (UKM))

  1. Can diabetes affect my eyes?

    Diabetic retinopathy is a complication of uncontrolled diabetes that affects the eyes. It primarily affects the retina, the inner layer of the eye, causing diabetic retinopathy. However, diabetic patients are at increased risk of other eye disorders as well, such as:

    • Cataracts
    • Glaucoma
    • Occlusion of the major vessels of the retina:
      Central retinal artery occlusion
      Central retinal vein occlusion
    • Disorders of the nerve responsible for eye movement:
      3rd cranial nerve palsy
      4th cranial nerve palsy
      6th cranial nerve palsy
    • Increased risk for abrasion of the surface of the eye (corneal abrasion)
    • Increased risk for corneal ulcers

  1. What are the risk factors for diabetes to affect my eyes?

    1. Poor control of blood sugar level
    2. Having diabetes for a long time
    3. High blood pressure
    4. High cholesterol
    5. Obesity
    6. Pregnancy
    7. Smokers
    8. Anaemia
    9. Kidney failure

  1. What are the symptoms of diabetic retinopathy?

    In the early stages of diabetic retinopathy, there are no symptoms at all. Therefore it is essential to be screened regularly.

    As diabetic retinopathy progresses into the more advanced stages, patients commonly have blurring of vision. Any pain or redness of the eye will not accompany this.

    In the final stages of diabetic retinopathy, there is complete blindness, in which the patient cannot discriminate between daytime and nighttime. In the final stages of diabetic retinopathy, surgery is required to preserve whatever vision is present and to prevent deterioration into a painful sightless eye.

    Therefore, it is best to be screened regularly and treated immediately before the disease progresses, as, in the early stages, the prognosis for improving and preserving vision is excellent.

    Other symptoms that may indicate complications of diabetic retinopathy include:

    1. Fluctuating vision – due to fluctuation in the blood sugar levels
    2. Floaters – due to bleeding from abnormal blood vessels in the eye
    3. Dark or empty areas of vision – may be associated with areas in which there is retinal detachmentIf you have any symptoms involving your eyes, please see an ophthalmologist immediately.

  1. How often should I be screened for diabetic retinopathy?

    Patients who have type 2 diabetes mellitus should be screened immediately on diagnosis of the disorder and then annually.

    • Patients with type 1 diabetes should be screened 5 years after the diagnosis and then annually
    • Pregnant women with diabetes – in the first trimester
    • Gestational Diabetes mellitus – no retinal screening required during pregnancy

  1. How is an eye examination performed by an Ophthalmologist?

    A complete retina examination requires seeing an ophthalmologist, who will first refract you to check if you need any spectacle corrections.

    • Next, the ophthalmologist with check your intra-ocular pressure at a slit-lamp to ensure you do not have glaucoma.
    • Finally, dilating eyedrops will be instilled to examine your retina. These eyedrops will blur vision, especially for near objects and glare lasting for 4-6 hours.
    • Once your pupils are fully dilated, the doctor will examine your retina at the slit-lamp and grade your level of retinopathy.
    • Finally, scans using optical coherence tomography (OCT), which will take a few minutes, will be performed to visualize the inner layers of the retina to confirm that there are no signs of the disease and the gradings done at the slit-lamp.

  1. What are the grades of Diabetic retinopathy?

    There are 4 grades:

    • Mild non-proliferative diabetic retinopathy
    • Moderate non-proliferative diabetic retinopathy
    • Severe non-proliferative diabetic retinopathy
    • Proliferative diabetic retinopathy

Diabetes Mellitus can also affect the macular area of the retina specifically, causing:

    • Diabetic macular oedema
    • Diabetic macular ischemia

  1. What is the treatment for diabetic retinopathy?

In mild and moderate non-proliferative diabetic retinopathy, the treatment prescribed is

    • Optimizing blood sugar control
    • Optimizing control of other medical conditions, i.e. blood pressure, cholesterol

In severe non-proliferative diabetic retinopathy, the patient will require a few doses of laser therapy over the retina, and this will be performed every 2 weeks.

In proliferative diabetic retinopathy, an advanced stage of diabetic retinopathy and at high risk for blindness, extensive laser for the retina is performed every 1-2 weeks.

If there is very advanced diabetic retinopathy, membranes have formed on the retina’s surface. In that case, the patient will require surgery to peel the membranes and reattach the retina. The prognosis for vision in these advanced stages is guarded and aimed primarily at preserving residual vision and avoiding further disease advancement.

– When diabetes mellitus causes macular oedema in the early stages is highly responsive to topical eyedrops. However, in later stages, the patient will require anti-vaso endothelial growth factor (VEGF) injections into the eye every month.

– Diabetic macular ischaemia is a dreaded complication of diabetes mellitus. There is no specific treatment; optimizing blood sugar control and medical conditions is prescribed to avoid disease advancement.

  1. How do I prevent diabetic retinopathy?

  1. Can diabetic retinopathy be reversed naturally?

    No, there are no natural or herbal remedies for diabetic retinopathy. Early screening and treatment prevent blindness.

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