Diabetes and Eye Health

Diabetic retinopathy is the leading cause of avoidable vision loss and blindness in working age Australians
People with diabetes are 25x more likely to experience vision loss than people without diabetes

Diabetic Retinopathy

Diabetes is a complex chronic health condition characterised by high blood glucose levels. Overtime diabetes can affect your eyes as a result of changes to blood vessels and blood supply. Every person with diabetes, which is approximately 1.2 million Australians, is at risk of a diabetic eye disease, and approximately 1/3 of this demographic show signs of diabetic retinopathy. A scary statistic considering 1/3 of Aussies with diabetes have never been for an eye test, and only 1/2 of people with diabetes have regular eye exams.

There are two different kinds of Diabetic Retinopathy, Non-Proliferative Diabetic Retinopathy (NPDR) and Proliferative Diabetic Retinopathy (PDR), the former may progress to the latter. It’s important to note that there are no early-stage symptoms and vision loss may not occur until the disease is advanced. NPDR occurs gradually when increased blood glucose levels cause damage to the small blood vessels in the retina. PDR occurs when decreased oxygen supply to the retina triggers the release of vascular endothelial growth factor (VEGF), which stimulates the growth of new blood vessels, a process known as neovascularisation. These new fragile blood vessels often leak and bleed which significantly affects vision. Because of this, scarring can occur which also alters vision, and as the scar tissue contracts the retina may detach leading to permanent blindness.

 

Symptoms of Diabetic Retinopathy

  • Balance issues
  • Blurred or distorted vision
  • Dim or patchy vision
  • Eye-strain
  • Frequent prescription changes
  • Flashes of light in periphery
  • Glare sensitivity
  • Headaches
  • Poor night-time vision
  • Sudden onset of haze, shadows, or floaters in vision

 

Signs of Diabetic Retinopathy (detectable by your optometrist)

  • Cotton wool spots (swollen areas of nerve fibre)
  • Exudates (protein or lipid deposits)
  • Microaneurysms or haemorrhage (small spots on blood)
  • Neovascularisation (growth of new blood vessels on the retina)
  • Oedema (retinal swelling)

 

Managing Risk Factors

It’s a good idea to take note of risk factors, because correct management can help to slow, stop, or sometimes reverse the progression of DR. Along with managing risk factors, and controlling your diabetes, regular eye exams are pertinent to eye health and reducing your risk of vision loss. Once diagnosed with DR, patients should have regular annual check-ups!

Weight and Exercise
Regular exercise helps insulin to work better, lowers blood pressure, and helps reduce weight, which are all important in reducing the risk of DR.
Blood Pressure
People with diabetes and high blood pressure are more likely to experience rapid progression of diabetic retinopathy.
Blood Lipids
Elevated blood lipids, including cholesterol, can increase risk of developing DR
Smoking
Smoking may increase the risk of developing DR and other diabetes related complications.

 

Treatment for Diabetic Retinopathy

The good news is diabetes management, early diagnosis and treatment of DR dramatically increase the likelihood of saving sight. So what are the treatment options?

Fenofibrate
Fenofibrate is a drug used to treat high blood lipid levels. It has been shown to decrease the risk of progression from NPDR to PDR in 30% of cases. The good news is this also works for people without high blood lipid levels.
Laser Treatment
Laser treatment, known as panretinal photocoagulation, is the most effective treatment for people with PDR, it has been shown to halve vision loss. The process of applying laser spots to the retina, over several sessions, reduces the oxygen demand of the peripheral parts of the retina. This can also decrease the production of VEGF, which causes blood vessel leakage and abnormal growth.
Intravitreal Injections
Intravitreal injections involve the injection of a medication into the eye, with the intent to stabilise or improve vision. The treatment varies but is usually an anti-inflammatory steroid, or an anti-VEGF. Injections needs to be conducted often, usually every month for several months, and potentially longer, for the best outcomes.
Vitrectomy
A vitrectomy involves the removal of the vitreous, the central gel cavity of the eye. This is then replaced with either fluid or a temporary gas bubble. This surgery may be required for several reasons; a vitreous haemorrhage, for PDR if laser or injection treatment has not been successful, or if fractional retinal detachments are complicating the PDR. The aim of the surgery is to remove the blood and scar tissue from the surface of the retina.

 

If you notice any new or worrying symptoms, or if you haven’t had an eye test for more than two years, visit us at Beckenham Optometrist as soon as possible. Early treatment saves sight!

 

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