- What is diabetic retinopathy?
Diabetic retinopathy is an eye disease involving the retina. It occurs in a patient with diabetes mellitus. The disease is more severe when the blood glucose is poorly controlled. In Malaysia, diabetic retinopathy is the most common cause of visual loss among adults of working age.
- What are the causes and risk factors for diabetic retinopathy?
Diabetic retinopathy is caused by persistently raised blood glucose which is damaging to the delicate retinal blood vessels. Damaged retinal blood vessels cause swelling and bleeding within the retina resulting in blurring of vision. In some cases, the retina may develop scars and tractional retinal detachment both of which are potentially blinding conditions. Patients with all types of diabetes mellitus for example type I, type II, pregnancy induced diabetes and chronic kidney disease are at risk of developing diabetic retinopathy. The risk increases the longer a person has diabetes or if the diabetes is poorly controlled.
- How is the prevalence of the disease in Malaysia and globally?
The prevalence of diabetic retinopathy in Malaysian diabetic population is 36.8% while the global prevalence ranges from 6.8% to 44%. The prevalence of diabetic retinopathy in a newly diagnosed diabetic patient is 5% increasing to 50% for a patient with diabetes greater than 10 years in duration.
- What are the symptoms and complications?
Early diabetic retinopathy often has no symptoms. The symptoms of established diabetic retinopathy are;
- Blurring of vision
- Distortion of vision
- Floaters in vision (mobile dark shadows in the vision)
Patients with long-standing and poorly controlled diabetes are at risk of developing eye complications which are:
- early and rapid onset cataract
- retinal detachment and scarring
- bleeding in the eye (vitreous haemorrhage)
- Swelling of the macula leading to poor central vision
- How is diabetic retinopathy diagnosed?
Diabetic retinopathy is diagnosed by a combination of clinical examination of the retina using an ophthalmoscope, optical coherence tomography scan, or retinal fundus camera imaging.
- How can it be treated?
It is important to control the blood sugar level as poor diabetic control will worsen the eye disease. In addition, high blood pressure and high blood lipids should also be treated to reduce the severity of the eye disease.
Medical treatment of diabetic retinopathy is with argon laser photocoagulation and or intravitreal injection of antivascular endothelial growth factor (injection of medication directly into the eyeball)
Surgery is needed for the treatment of retinal detachment or persistent vitreous haemorrhage. Cataract surgery may be indicated for patients with coexisting cataracts.
- Is the disease reversible or irreversible?
The disease is reversible in the early stage if the blood sugar is tightly controlled, but severe complications are often not reversible.
- How can we prevent/slow down the progression of the disease?
It is important to maintain a healthy body weight, avoid active and passive smoking, take regular aerobic exercise and eat a healthy balanced diet consisting of fresh fruits and vegetables.
- What is your advice regarding the disease?
It is important to have the retina examined by a qualified eye care practitioner. The first eye screening for diabetic retinopathy should be done at the time of diagnosis for type II diabetic. Patients with type I diabetes should start having eye screening after 3 years of diagnosis. Women with known diabetes should have the retina examined before planned pregnancy. Women with pregnancy induced diabetes (gestational diabetes) should have the retina examined at the time of diagnosis.
Dr. Ong Chin Tuan, Consultant Ophthalmologist, Oculoplastic and Lacrimal Surgeon, Beacon Hospital Malaysia
Image source: http://www.premieridaho.com/diabetic-retinopathy