Prepared by Cheah Shi Mun

 

 

What is diabetic retinopathy

Diabetic retinopathy, also known as diabetic eye disease, is an eye condition that may affect people who have diabetes. Diabetic retinopathy is a serious vision-threatening consequence of diabetes, which causes progressive damage to the retina, the light-sensitive tissue lining at the back of the eye. If left undiagnosed and untreated, it can lead to blindness.

In Malaysia, the prevalence of diabetic retinopathy has been reported to range from 44.1% to 51.6%. Diabetic retinopathy is the most common cause of visual loss among working age adults with the rising prevalence of diabetes in Malaysia

 

Symptoms of diabetic retinopathy

It is possible to have diabetic retinopathy for a long time without noticing symptoms until substantial damage has occurred. Symptoms may occur in one or both eyes.

  • Blurred or double vision
  • Difficulty reading
  • The appearance of spots, commonly called “floaters” in your vision
  • A shadow across the field of vision
  • Eye pain or pressure
  • Difficulty with colour perception

How diabetes can affect the eyes

Diabetic retinopathy is caused by prolonged exposure to high sugar levels. Elevated sugar levels can weaken and damage the small blood vessels that nourish the retina, causing bleeding, exudates and even swelling of the retina. Overtime, it starves the retina of oxygen, and causes the abnormal growth of blood vessels, which can eventually lead to vision loss.

 

Who is at risk of diabetic retinopathy?

Anyone who has diabetes is at risk of diabetic retinopathy. Additional factors can increase the chance of developing diabetic retinopathy:

  • Disease duration (the longer the duration of having diabetes, the greater the risk of developing diabetic retinopathy)
  • Poor control of blood sugar levels overtime
  • High blood pressure
  • High cholesterol levels
  • Pregnancy

 

Preventing vision loss from diabetic retinopathy

Good management of diabetes by keeping blood sugar levels, blood pressure and cholesterol levels under control can reduce the risk of getting diabetic retinopathy, or prevent it getting worse. This can often be done by adopting healthy lifestyle changes, although some people will also need to take medication.

 

Healthy lifestyle

  • Eat a healthy, balanced diet, try to cut down on salt, fat and sugar
  • Lose weight of between 5-10% if overweight, aim for a BMI of 18.5-22.9
  • Exercise regularly, at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week; doing 10,000 steps a day can be a good way to reach this target
  • Stop smoking
  • Not exceeding the recommended alcohol limits. Men and women are advised not to regularly drink more than 14 alcohol units a week

 

Know your blood sugar, blood pressure and cholesterol levels

It can be easier to keep blood sugar levels, blood pressure and cholesterol levels under control if you monitor them regularly and know what level they are.

 

Treatments for diabetic retinopathy

Treatment for diabetic retinopathy is only necessary if screening detects significant problems. If the condition hasn’t reached this stage, the above advice on managing your diabetes is recommended. The main treatments for more advanced diabetic retinopathy are:

  • laser treatment
  • injections of medication into your eyes

 

Regular eye screening

“Diabetes doesn’t cause blindness; it only causes narrowing and leaking. People are the one who cause blindness.”

“In Seremban, I noticed that a lot of diabetics were coming from the Klinik Kesihatan (government health clinics) and private GPs when they were already going blind, and were not having their annual check-ups,” says Dr Kewaljit who is the clinical head of the Wilayah Persekutuan Kuala Lumpur & Putrajaya Diabetic Retinopathy screening programme. 

According to him, the problem is because “People only come to us when they have problems seeing, but the leaking or narrowing is happening before that – the vision is still normal then because the macula is not affected yet.” 

Failure to screen is a major reason why many diabetic patients present to the ophthalmologist with established visual loss that could have been prevented with timely intervention.

Therefore, it is important to have regular eye screening, Clinical Practice Guidelines Malaysia recommend for routine annual eye screening for all diabetic patients so that those at risk of visual loss may be identified and treated.  Early detection of retinopathy increases the chances of treatment being effective and stopping it getting worse.

References

  1. Guan Hoe T, Choi Sin Y, Zaini A. Prevalence Of Diabetic Retinopathy In The University Hospital Diabetic Population. Med J Malaysia. 1983;38(1):77-79.
  2. Shriwas SR, BRahman Isa A, Reddy SC, Mohammad M, W Mohammad WB, Mazlan M. Risk factors for Retinopathy in Diabetes Mellitus in Kelantan, Malaysia. Med J Malaysia. 1996;51(4):447-452.
  3. Tajunisah I, Ophth M, Nabilah H, Reddy SC. Prevalence and Risk Factors for Diabetic Retinopathy – A Study of 217 Patients from University of Malaya Medical Centre. Med J Malaysia. 2006;61(4):451-456.
  4. Malaysian Society of Ophthalmology (MSO). https://mso.org.my/index.cfm?&menuid=18. Accessed November 6, 2019.
  5. Sophie J. Bakri M, Audina Berrocal M, Antonio Capone, Jr. M, et al. Diabetic Retinopathy: Diabetic Retinopathy Is a Complication of Diabetes That Causes Damage to the Blood Vessels of the Retina – the Light-Sensitive Tissue That Lines the Back Part of the Eye, Allowing You to See Fine Detail.; 2016.
  6. Ministry of Health Malaysia. Clinical Practice Guidelines; Management of Type 2 Diabetes. 2015:73. doi:10.1007/s13398-014-0173-7.2.
  7. Diabetic retinopathy screening increases from 20% to 90% in KL | The Star Online. https://www.thestar.com.my/lifestyle/health/2016/09/04/diabetic-retinopathy-screening-increases-from-20-to-90-in-kl. Accessed November 6, 2019.
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