Diabetes

What is Diabetic Eye Disease?

Diabetic eye disease ends up affecting most people with diabetes.  After 10 years of diabetes 80% of patients will have signs of diabetes that can be seen by an ophthalmologist.  There are 2 common types of diabetic eye disease:  diabetic retinopathy and diabetic macular oedema.  Diabetic eye disease is the most common cause of blindness in the working population and affects 8% of Australian men and 6.5% of Australian women1 - and these numbers are increasing.

What is Diabetic Retinopathy?

Diabetes affects the small blood vessels of the body.  The retina (the seeing layers at the back of the eye) are supplied with oxygen and nutrients by a rich network of small blood vessels.  These become damaged by high sugar levels in the blood and can become leaky or stop working altogether.  The early signs of diabetic retinopathy are patches of exudates (fats and other proteins that can leak out of the damaged blood vessels) and haemorrhages (blood spots) that can be seen by an ophthalmologist (eye doctor) or an optometrist (optician) when they examine the back of the eye.  As the condition progresses the small blood vessels stop working and the retina is no longer supplied with the blood that it needs.  This is called retinal ischaemia.  The area of the retina that is starved of oxygen releases powerful factors (angiogenic factors) that cause new vessels to grow within the jelly of the eye (the vitreous).  These vessels do not grow normally and tend to break, releasing blood into the normally clear vitreous jelly in the middle of the eye.  Left untreated this process leads to scar tissue and retinal detachment.  The end result can be untreatable blindness. 

 Diagram of Diabetic Retinopathy

Diagram of Diabetic Retinopathy

What is Diabetic Macular Oedema (DMO)?

High quality vision relies on a very specialised small part of the retina at the centre of the eye called the macula.  Diabetes can cause the fine blood vessels (capillaries) at the macula to leak.  The back of the eye becomes “boggy” and the fine layers of the eye needed for vision become disturbed and vision is reduced.  At the Moreton Eye Group we use sophisticated equipment Optical Coherence Tomography (OCT) to measure this. 

Moreton Eye Group uses the latest generation “spectral domain” OCT equipment to image your macula in great detail.  

How is Diabetic Eye Disease diagnosed?

Diabetic Eye Disease can be diagnosed by an ophthalmologist or an experienced optometrist examining the back of the eye.  It is important that the whole of the eye is carefully examined and this is best done by a fully trained and experienced practitioner - as it can be difficult to see into the periphery of the eye.  The evidence is clear that it is important to look at the whole retina carefully.  If the eye needs treating further investigations will probably be needed, such as the use of Optical Coherence Tomography or Fluorescein Angiography (a test using a special dye which can only be done in a specialist ophthalmology centre).

Is it important to have my eyes checked?

Yes!  The early signs of diabetic eye disease can only be seen by an experienced eye doctor (ophthalmic surgeon).  Some optometrists also have the necessary skill and experience to examine the retina fully and can refer patients to an eye doctor (opthalmic surgeon) if they find signs of diabetic eye disease.  Treatment to prevent blindness, if necessary, is best started before permanent damage is done.  Other countries such as the UK have a national annual screening programme for all diabetics which has reduced the numbers of people loosing sight to diabetes.  In Australia it is important that all diabetics (with or without signs or symptoms) make sure they see an eye doctor (ophthalmic surgeon) at least every year.  If they have more advance diabetic eye disease they will need to see an eye doctor more regularly.  At Moreton Eye Group we can arrange a suitable and safe review schedule for you.

How is Diabetic Eye Disease treated?

There have been very exciting advances in the management of diabetic eye disease in recent years.  The traditional use of laser photocoagulation of the retina (small burns on the retina with a special laser) is now used with or even (in certain cases) replaced by special new drugs call Anti Vascular Endothelial Growth Factor (Anti VEG-F).  These drugs need to get to work directly on the retina (back of the eye) and are injected into the eye using a tiny needle - but fortunately the process is painless.

Does diabetes cause cataract?

Most diabetics develop cataract earlier than people who do not have cataract.  Fortunately cataracts can be removed with an operation. Dr Hay-Smith and others at Moreton Eye Group are specially trained in removing cataracts from patients with diabetes.  Sometimes it is necessary to do some further special treatments before, during or after surgery to maximise the success of the operation.

Is there anything I can do to reduce the chance that my vision will be damaged by diabetic eye disease?

Yes!  Control of blood sugar, eating well and exercising are proven to help a lot.  The Diabetes Control and Complications Trial (DCCT) showed that tight diabetic control resulted in a massive 76% reduction of diabetic retinopathy (and a 60% reduction in neuropathy (nerves problems) and 54% reduction in nephropathy (kidney problems)).  The UK Prospective Diabetic Study (UK PDS) showed tight diabetic control a 25% reduction in microvascular disease (a cause of heart attack and stroke in addition to eye problems).  Combined with good blood pressure control in the UK PDS trial 1/3 fewer patients died from diabetes related conditions.  It is clear.  Look after yourself and avoid the worst problems of diabetes.