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----- Original Message -----
From: "avinash shahi" <shahi88avin...@gmail.com>
To: "jnuvision" <jnuvis...@yahoogroups.com>; "accessindia"
<accessindia@accessindia.org.in>
Sent: Sunday, February 19, 2012 11:01 AM
Subject: [AI] When diabetes impacts the eye
http://www.thehindu.com/todays-paper/tp-features/tp-sundaymagazine/article2908785.ece
When diabetes impacts the eye
DR. MOHAN RAJAN
DR. KAVITHA and
Diabetes is one of the leading causes of blindness. DR. MOHAN RAJAN,
DR. KAVITHA and DR. SIDDHARTH RAVISHANKAR tell you how the eye gets
involved.
“Laughter is the best medicine, unless you're diabetic; then insulin
comes pretty high on the list.” Jasper Carott
Diabetes mellitus is a growing problem in India. With an estimated
50.8 million people living with diabetes, India has the largest
diabetic population. In a diabetic, the high glucose levels in the
blood can cause harm to most organs like the heart, arteries and
veins, the eyes, kidneys, brain and nerves.
Diabetes mellitus is one of the leading causes of blindness. Diabetic
eye disease primarily encompasses diabetic retinopathy and cataract,
which lead to either reversible or irreversible loss of vision.
The longer the duration of diabetes, the greater is the risk of
developing diabetic eye disease.
Progression is rapid in patients with uncontrolled blood sugar.
Similarly high blood pressure, increased blood lipid, renal disease,
pregnancy, anaemia and smoking also have an adverse effect in the
progression of diabetic retinopathy.
Diabetic retinopathy
The retina is the back portion of the eye. The retina along with optic
nerve connects the eye to the brain. The high blood sugar damages the
cells lining the walls of the arteries and the veins of the retina.
These small blood vessels may balloon in some places to form
micro-aneurysms that leak fluid, blood and fat into surrounding
tissues. The fluid accumulation leads to thickening of retina. When it
affects the central part of the retina known as the macula, there will
be a drop in vision.
The function of blood is to supply oxygen to the tissues. Since the
blood vessels of the retina are damaged, the oxygen supply to the
retina is deprived. New blood vessels start growing in an effort to
supply nutrients and oxygen to the tissues.
These new vessels grow on the surface of the retina and into the
vitreous, a jelly-like fluid inside the eye. Unfortunately these new
vessels are extremely fragile and leaky, leading to bleeding inside
the eye or vitreous haemorrhage.
Scar tissue also accompanies the growth of new vessels. In advanced
stages this scar tissue can contract pulling the retina along, leading
to detachment.
Cataract
The lens helps in focusing light rays to get clear vision. When this
lens gets opacified, it results in a cataract. In addition diabetic
patients develop earlier cataracts and may require surgery to replace
it with a new intra ocular lens.
Sometimes, in uncontrolled diabetes, high blood sugar causes swelling
of the lens. This results in temporary blurring of vision.
Once the blood sugar is brought under control and remains stable for
one week, vision will improve.
Treatment options
Timely treatment helps prevent further vision loss. Laser remains the
mainstay of treatment for diabetic retinopathy.
For fluid accumulation in macula, laser photocoagulation in focal or
grid pattern can be applied. For new vessel formation (proliferative
diabetic retinopathy), panretinal laser photocoagulation reduces the
oxygen demand for retina.
Hence the impulse to form new vessels is knocked off. Laser treatment
is often done to prevent complications related to diabetic retinopathy
but not to improve vision.
Steroids and anti-vascular endothelial growth factor (anti-VEGF) drugs
are being injected directly into the eye these days in patients with
certain types of macular thickening. This blocks vascular endothelial
growth factor, which plays a role in the growth of new vessels.
These injections help reduce blood vessel leakage and formation of
abnormal new vessels. If needed these injections are repeated at
intervals of 4-6 weeks.
For advanced diabetic eye disease, surgical intervention is
considered. Sutureless vitrectomy is the latest procedure in which
blood and scar tissue inside the eye is removed. Laser treatment is
often combined with surgery in such patients. Cataract needs surgical
removal.
Hence diabetic eye problems are treatable if diagnosed early. Diabetic
patients should undergo yearly examinations even if they have good
vision.
Last but not the least, lifestyle management helps reduce the risk of
developing type II diabetes. It can also slow or halt progression of
pre-diabetes to diabetes.
E-mail: rajan...@vsnl.com
When to consult an ophthalmologist?
Don't wait for symptoms. If you are diabetic, undergo a detailed eye
examination during diagnosis itself. A yearly follow up is mandatory.
If you have diabetic retinopathy further follow up is as per
ophthalmologist's advice.
Patients who undergo laser treatment should have follow up every three
months.
Diabetic patients who become pregnant are also at risk of developing
diabetic retinopathy. Seek an ophthalmologist's opinion in the first
trimester.
Diabetic retinopathy patients with hypertension or renal disease
should have regular ophthalmic check up every six months.
Symptoms
In early stages there will not be any blurring of vision.
If the patient develops fluid accumulation in the macula they will
find a drop in vision.
Sudden deterioration in vision in advanced stage can occur due to
bleeding inside the eye and retinal detachment.
Temporary change in refractive error sometimes occurs due to rapid
shift in blood sugar.
Glare and blurring of vision could be noticed due to cataract.
Preventive measures
Strict control of blood sugar is the mainstay. Your HbA1C levels
should be around six per cent.
A healthy lifestyle including diet control and regular exercise helps
avoid further complications.
Intensive control of blood pressure, renal function and serum lipid levels.
Blood haemoglobin should be within normal limits.
Avoid smoking.
--
"The best things and most beautiful things in the world Cannot be seen
or even touched. They must be felt within the heart." — Helen Keller
Avinash Shahi
M.A. Political Science
CPS JNU
New Delhi India
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