Diabetes is well on its way to becoming an epidemic in India. A recent study concluded that India is one of the top three nations in the world to have the highest number of diabetes cases. With a countless number of side effects, diabetes is not only a silent killer but also one of the most lethal diseases. It can affect vital organs such as heart, kidney, and nerves. One such important organ it affects is the eye. This article will explain about effects of diabetes on eyes.
Diabetes is a slow killer and affects different organs along with eyes. The high amount of blood sugar in diabetic patients has an adverse effect on the lens as well as the retina of the eye. This not only leads to vision problems but can also cause blindness.
Here are some of the eye complications as a result of diabetes:
Diabetic Retinopathy refers to a condition where the blood vessels of the retina get damaged due to the high level of blood sugar. The damage can cause swelling in the retinal tissues and leakage of blood and fluids. Too much blood sugar can also change the curvature of the eye lens; thus affecting vision.
Diabetic Retinopathy can affect patients of both Type 1 & Type II diabetes. The most common symptom includes blurred vision along with blank spots, dark spots, and double vision. The patient may also experience pain or pressure in the eyes along with the inability to see things from the corner of eyes; resulting in a tunnel vision.
Diabetic Retinopathy can be diagnosed through a proper eye examination which includes:
- Visual Acuity Measurements to check how much central vision has been affected.
- Measurement of pressure within the eye.
- Evaluation of ocular structures as well as the retina.
Diabetic Retinopathy has two stages – Early & Advanced. In the early stage, the blood vessels of the retina form tiny bulges that leak blood and fluids. The tiny bulges also cause the nerve fibers to swell, hence making the blood vessels large and irregular. This stage is also known as Non Proliferative Diabetic Retinopathy (NDPR). In more severe cases with advanced diabetic retinopathy, the bulges lead to the growth of irregular or abnormal blood vessels. In some cases, this may lead to the retina detaching from the back of the eye.
Both stages may lead to complications such as vitreous hemorrhage where the excess fluid may fill up the vitreous cavity. This may also result in permanent or temporary blindness.
Patients can keep diabetic retinopathy in check with regular eye check-ups and be monitoring blood sugar levels. It is recommended to stick to the prescribed medication and diet, also avoiding alcohol and smoking helps.
In some cases, laser surgery may also be needed along with injecting medication to stop the leakage/inflammation. Surgical intervention may also be needed in case of retinal detachment or other serious complications.
Cataract is a result of the eye lens becoming opaque or foggy as a result of old age. However, diabetic patients tend to suffer from cataract at relatively early ages. The lens also has an enzyme to break down the glucose in the blood. However, since the enzyme cannot cope up with the high level of glucose, debris get collected resulting in cataract formation. The high amount of sugar in the blood can cause the lens to swell; thus making it opaque or unclear.
In almost all cases, the surgical procedure is required to remove the cataract. However, the blood sugar needs to be closely monitored before the surgery takes place. The procedure in itself is relatively risk-free and usually, involves a day’s hospital stay.
The doctor injects a local anaesthetic and the procedure takes about 30 minutes. In most cases, it is a keyhole operation where the cataract is pulled out using a small tube. Once the cataract is out, a new lens is put into place. Post operative eye drops and medication is prescribed. The doctor may advise one or two follow up check ups along with a visit to the optician for glasses.
Although the surgery is straightforward, patients with diabetes may have to deal with some risks and complications. A strict diet should be followed before the operation to regulate the amount of blood sugar. The patient’s blood pressure is also closely monitored. Other complications that may arise include:
- Macular Oedema, a condition that refers to collection of fluid in the central area of the retina leading to sight problems
- Higher risk of infection
- If retinopathy is present at the time of surgery, it may worsen and affect patient’s vision. It is recommended to start non-steroidal eye drops before the surgery in such a case.
Glaucoma is caused by pressure build up inside the eye leading to a damaged optic nerve. The optic nerve transmits the image to the brain and any damage to the nerve can affect vision.
The pressure referred to as intraocular pressure, is usually caused by irregular blood vessels and fluid build up, often caused by high blood sugar. If left untreated, it can gradually lead to permanent blindness.
Since the symptoms do not manifest themselves easily, it is recommended to have a complete eye exam every few years. Patients with diabetes, over 40 years or having a family history of the disease are exposed to a higher risk.
Immediate medical attention should be sought in case of the following symptoms:
- Eye pain
- Redness or hazy eyes
- Seeing halos in lights
- Blurred or Tunnel vision
Glaucoma can be diagnosed using the below:
- Dilating pupils using drops and checking the optic nerve
- Tonometry, a test to measure pressure inside the eye
- Visual field test to check for peripheral or tunnel vision
There are two main types of Glaucoma- Open Angle & Angle Closure. Open-angle glaucoma is a condition where the fluid drain channel also known as Trabecular meshwork is not affected, but even then the fluid does not drain properly. This is the more common type of glaucoma. Angle-closure glaucoma occurs when the fluid drainage is blocked due to the iris and cornea forming a narrow-angle. This type of glaucoma can also be caused due to far sightedness or cataracts.
Some infants also suffer from congenital glaucoma which can be corrected only by surgery. The main cause is an improper drainage system in the eye from birth.
Glaucoma can be treated using prescribed eye drops to relieve pressure by either increasing the outflow of eye fluid or reducing fluid formation. In some cases, laser surgery is done to stop fluid blockage and increase its flow.
Laser surgery involves the following procedures:
- Cyclophotocoagulation refers to treating the eye to reduce the fluid formation
- Trabeculoplasty refers to increasing the drainage area to allow increase in outflow
- Iridotomy, refers to increasing the fluid flow by making a small hole in the iris
Apart from the above, doctors may also suggest trabeculectomy where a new channel is created to increase the fluid drainage. However, this is a high-risk procedure and may lead to vision loss. It is recommended that you do not ignore any symptom related to Glaucoma as it is estimated that around 50% of Indian population is suffering from it. So along with some treatment as mentioned above, in some cases, the doctor may also implant a small tube to drain fluid. This may have increased chances of infection or bleeding.
All the above mentioned medical conditions are associated with patients suffering from diabetes. Hence, it is advisable to take proper care and follow instructions of your doctor.