Diabetes and the eye
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Diabetes can cause eye diseases. Dr. VIJAY SHANKAR looks at the problems and the cures.
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DIABETES MELLITUS occurs because of lack of insulin or due to the presence of factors that oppose the action of insulin.
The end result is an increase in the blood glucose concentration (hyperglycaemia). Occular problems in diabetes usually affect people who have long-standing and uncontrolled diabetes mellitus. The common complications are cataract and diabetic retinopathy.
Cataract usually occurs at about 60 years of age but in diabetics, ti could appear at a much younger age. Cataract is removed surgically by a technique called Phacoemulsification with intra-ocular lens implantation.
Diabetic retinopathy is essentially a disease process, which affects the blood vessels of the retina.
The longer the duration of diabetes, the greater the incidence of diabetic retinopathy. Blindness due to this is a major cause of irreversible blindness in old age.
The pathological changes in diabetes lead to lack of blood supply or ischemia of the retina and hypoxia (lack of oxygen) or retinal tissues. Long-standing hypoxia leads to formation of new blood vessels. These are fragile and bleed easily. Excessive bleeding in the eye leads to vitreous haemorrhage and loss of vision.
There are four stages in diabetic retinopathy: Background; pre-proliferative; proliferative and advanced.
A special photographic process is very helpful in detecting early effects of diabetic retinopathy. This is known as Fundus Flourescein Angiography (FFA). This involves injecting a dye through the arm into the bloodstream. As the dye is carried into the eye, photographs of the retina are taken showing areas of leakage or poor blood flow.
Laser photocoagulation is the mainstay in the management of diabetic retinopathy in stage two and three.
Laser is used to seal or obliterate abnormal leaky blood vessels. Laser treatment to the retina at the appropriate time prevents blindness in majority of patients.
Advanced diabetic eye disease comprising vitreous haemorrhage and tractional retinal detachment requires surgical intervention and endo-laser photocoagulation.
Hence the occular complications of diabtes can be prevented by control of diabetes by medication and diet; control of associated disorders like hypertension and anaemia; and regular eye check ups and immediate treatment of the problem.
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