Don’t Let Diabetes Takes Away Your Vision!

Diabetes mellitus is one of the major health problems affecting the developed regions. It affects the integrity of blood vessels and cause damages in multiple organs. But actually one of the organs that can be severely impaired by diabetes is the eye. There is even a term called diabetic eye disease to describe a group of ocular pathologies that are caused by diabetes and all diabetic eye diseases can lead to severe vision loss or even blindness.

These diseases include cataract, glaucoma, diabetic macular oedema and diabetic retinopathy, while diabetic retinopathy is the most common cause of hampered vision as well as being a leading cause of blindness among working-age adults worldwide. What is the definition of diabetic retinopathy? What are its signs and symptoms? What are the possible treatments of diabetic retinopathy and how can we prevent from having the disease? Now let’s take a better look into diabetic retinopathy.

How do Diabetes Cause Diabetic Retinopathy?

In diabetic patients, their blood sugar level is higher than normal level. The elevated blood sugar level will damage the capillary blood vessels, which are rich in the retina. The compromised blood vessels will leak fluid and blood, or being blocked that cannot transport oxygen and nutrients to the retinal cells. If leakage happens close to the macula, the macula will swell, namely macular oedema and the vision will be distorted. In the late stage, abnormal blood vessels grow in the retina and these malformed vessels and prone to bleed. The scar tissues formed after bleeding can contract and pull the retina out of its place – this is the blind-causing retinal detachment. The abnormal vessels can also grow at the iris and cause glaucoma which can also cause blindness.

Probability of Having Diabetic Retinopathy and Its Risk Factors

The majority of diabetic patients in developed regions are type II diabetes. In general, the prevalence of diabetic retinopathy in diabetic patients of all ages are around 35%. The chance of having diabetic retinopathy correlates with the diabetes duration. According to the literature, more than 20% patients will have diabetic retinopathy after having type II diabetes for more than 10 years. Meanwhile, the probability increases to 40% after being diabetic for 14 years and reaches to 60% when patients have been type II diabetic for more than 16 years. Other risk factors of diabetic retinopathy include elevated blood sugar level, blood pressure and blood cholesterol level.

Signs and Symptoms of Diabetic Retinopathy

It is both a blessing and a curse that early diabetic retinopathy is generally asymptomatic. As patients themselves are unaware of their retinopathy, it can lead to disease progression and patients may experience floaters, blurry vision and vision distortion. In late stage, sudden severe vision loss can take place and it can be permanent. Other signs of diabetic retinopathy include blood and fluid leakage, conformation changes of retinal blood vessels, retinal nerve fibre infarction, macular oedema, growth of abnormal retinal vessels and retinal scarring.

Below are pictures demonstrating some visual symptoms experienced by moderate and late stage diabetic retinopathy:

Visual symptom for moderate diabetic retinopathy.
Image retrieved from
https://www.aao.org/eye-health/diseases/non-proliferative-diabetic-retinopathy-vision-simu-2


Visual symptom for late stage diabetic retinopathy.
Image retrieved from
https://www.aao.org/eye-health/diseases/proliferative-diabetic-retinopathy-vision-simulato


Comparison of the same scene viewed by a normal person (left) and by a patient with late stage diabetic retinopathy.
Images retrieved from https://nei.nih.gov/health/diabetic/retinopathy

How Fast is the Disease Progress?

The progression rate of diabetic retinopathy depends on its current stage and any proper disease management. The late stage of the disease is defined by the growth of abnormal retinal vessels which can cause sudden massive bleeding and can lead to blindness. For mild diabetic retinopathy, 5% of them will progress into late stage in 1 year without proper follow up. But for patients having moderate retinopathy without treatment, 27% of them will progress into late stage within 1 year. For severe diabetic retinopathy, 50% of them will progress into late stage in a year.

How can Diabetic Retinopathy be Treated?
Control blood sugar level and blood pressure

To delay the onset as well as control the progression of diabetic retinopathy, the best way is to control the blood sugar level and blood pressure. Patients should keep their HbA1c level, which is one of the parameter showing blood sugar level, in the range of 6-7% to control diabetic retinopathy. Reducing HbA1c level by 1% lowers retinopathy risk by around 30%. Concurrent hypertension together with diabetes increases diabetic retinopathy risk by 10%.

Laser and medications

Besides controlling diabetes and blood pressure, treatments can also be done to reduce the severity of signs and symptoms, based on different stages of the disease. For mild diabetic retinopathy, the vision usually remains unaffected and no additional ocular treatment is necessary. For moderate cases that vision is blurred and distorted by macular oedema, laser surgery may be used to seal off the leaking blood vessel and improves the vision. For late stage which abnormal vessels start to grow, medicines that inhibit the growth of abnormal vessels, named anti-VEGF, can be injected inside the eyeball and improve the vision by 1-2 lines on average. But the treatment may need to repeat from monthly to every few months. Some cases may also need to apply laser to burn over the whole retina except sparing the central part, sacrificing the peripheral vision and cut down the oxygen need of the retina to preserve the central vision.

How Often Should I Check My Eyes?

For general diabetic patients and patients having mild diabetic retinopathy, they should receive a comprehensive eye examination, which means including pupil dilation, at optometrists or eye doctors at least every year. For moderate diabetic retinopathy patients, they should review their conditions every 6 months. For severe cases, they have to attend comprehensive eye examinations every 2-3 months to promptly manage any changes.

Same as diabetes, diabetic retinopathy cannot be cured completely. However, the disease is manageable and preventable. More than 90% of blindness cases from diabetic retinopathy can be avoided by early diagnosis and treatment. Besides attending follow ups at your general physician, diabetic patients should also remember to make regular appointments at your optometrist for comprehensive eye examination.

By Jeff Tang, Registered (Part I) Optometrist


Eyecare information by Swisscoat Vision Centre

Address : 23/F Whole Floor, One Midtown, 11 Hoi Shing Rd, Tsuen Wan, N.T., HK

Appointment :+852 2751 8491

Website : www.swisscoat.com


Reference:

  1. Bhavsar A. (2017). Diabetic Retinopathy. Medscape. Retrieved from http://emedicine.medscape.com/article/1225122-overview#a1
  2. Diabetic Retinopathy. American Optometric Association. Retrieved from https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy?sso=y.
  3. Facts About Diabetic Eye Disease. (2015). The National Eye Institute . Retrieved from https://nei.nih.gov/health/diabetic/retinopathy.
  4. Yau JWY, Rogers SL, Kawasaki R, et al. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. 2012;35(3):556-564. doi:10.2337/dc11-1909.
We use cookies to personalise content and ads, to provide social media features and to analyse our traffic. We also share information about your use of our site with our social media, advertising and analytics partners.
Cookies settings
Accept
Privacy & Cookie policy
Privacy & Cookies policy
Cookie name Active

Privacy Policy

What information do we collect?

We collect information from you when you register on our site or place an order. When ordering or registering on our site, as appropriate, you may be asked to enter your: name, e-mail address or mailing address.

What do we use your information for?

Any of the information we collect from you may be used in one of the following ways: To personalize your experience (your information helps us to better respond to your individual needs) To improve our website (we continually strive to improve our website offerings based on the information and feedback we receive from you) To improve customer service (your information helps us to more effectively respond to your customer service requests and support needs) To process transactions Your information, whether public or private, will not be sold, exchanged, transferred, or given to any other company for any reason whatsoever, without your consent, other than for the express purpose of delivering the purchased product or service requested. To administer a contest, promotion, survey or other site feature To send periodic emails The email address you provide for order processing, will only be used to send you information and updates pertaining to your order.

How do we protect your information?

We implement a variety of security measures to maintain the safety of your personal information when you place an order or enter, submit, or access your personal information. We offer the use of a secure server. All supplied sensitive/credit information is transmitted via Secure Socket Layer (SSL) technology and then encrypted into our Payment gateway providers database only to be accessible by those authorized with special access rights to such systems, and are required to?keep the information confidential. After a transaction, your private information (credit cards, social security numbers, financials, etc.) will not be kept on file for more than 60 days.

Do we use cookies?

Yes (Cookies are small files that a site or its service provider transfers to your computers hard drive through your Web browser (if you allow) that enables the sites or service providers systems to recognize your browser and capture and remember certain information We use cookies to help us remember and process the items in your shopping cart, understand and save your preferences for future visits, keep track of advertisements and compile aggregate data about site traffic and site interaction so that we can offer better site experiences and tools in the future. We may contract with third-party service providers to assist us in better understanding our site visitors. These service providers are not permitted to use the information collected on our behalf except to help us conduct and improve our business. If you prefer, you can choose to have your computer warn you each time a cookie is being sent, or you can choose to turn off all cookies via your browser settings. Like most websites, if you turn your cookies off, some of our services may not function properly. However, you can still place orders by contacting customer service. Google Analytics We use Google Analytics on our sites for anonymous reporting of site usage and for advertising on the site. If you would like to opt-out of Google Analytics monitoring your behaviour on our sites please use this link (https://tools.google.com/dlpage/gaoptout/)

Do we disclose any information to outside parties?

We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information. This does not include trusted third parties who assist us in operating our website, conducting our business, or servicing you, so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, enforce our site policies, or protect ours or others rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.

Registration

The minimum information we need to register you is your name, email address and a password. We will ask you more questions for different services, including sales promotions. Unless we say otherwise, you have to answer all the registration questions. We may also ask some other, voluntary questions during registration for certain services (for example, professional networks) so we can gain a clearer understanding of who you are. This also allows us to personalise services for you. To assist us in our marketing, in addition to the data that you provide to us if you register, we may also obtain data from trusted third parties to help us understand what you might be interested in. This ‘profiling’ information is produced from a variety of sources, including publicly available data (such as the electoral roll) or from sources such as surveys and polls where you have given your permission for your data to be shared. You can choose not to have such data shared with the Guardian from these sources by logging into your account and changing the settings in the privacy section. After you have registered, and with your permission, we may send you emails we think may interest you. Newsletters may be personalised based on what you have been reading on theguardian.com. At any time you can decide not to receive these emails and will be able to ‘unsubscribe’. Logging in using social networking credentials If you log-in to our sites using a Facebook log-in, you are granting permission to Facebook to share your user details with us. This will include your name, email address, date of birth and location which will then be used to form a Guardian identity. You can also use your picture from Facebook as part of your profile. This will also allow us and Facebook to share your, networks, user ID and any other information you choose to share according to your Facebook account settings. If you remove the Guardian app from your Facebook settings, we will no longer have access to this information. If you log-in to our sites using a Google log-in, you grant permission to Google to share your user details with us. This will include your name, email address, date of birth, sex and location which we will then use to form a Guardian identity. You may use your picture from Google as part of your profile. This also allows us to share your networks, user ID and any other information you choose to share according to your Google account settings. If you remove the Guardian from your Google settings, we will no longer have access to this information. If you log-in to our sites using a twitter log-in, we receive your avatar (the small picture that appears next to your tweets) and twitter username.

Children’s Online Privacy Protection Act Compliance

We are in compliance with the requirements of COPPA (Childrens Online Privacy Protection Act), we do not collect any information from anyone under 13 years of age. Our website, products and services are all directed to people who are at least 13 years old or older.

Updating your personal information

We offer a ‘My details’ page (also known as Dashboard), where you can update your personal information at any time, and change your marketing preferences. You can get to this page from most pages on the site – simply click on the ‘My details’ link at the top of the screen when you are signed in.

Online Privacy Policy Only

This online privacy policy applies only to information collected through our website and not to information collected offline.

Your Consent

By using our site, you consent to our privacy policy.

Changes to our Privacy Policy

If we decide to change our privacy policy, we will post those changes on this page.
Save settings
Cookies settings