Diabetes – how keeping your sugar levels under control can save your sight.

Diabetes, especially Type 2 diabetes is one of the silent diseases which can go undetected for years. Unfortunately, diabetes is one of the major causes of blindness in the Western world so if your diabetes is undetected then this can lead to eye complications. Both type 1 and type 2 diabetes can cause eye disease.

 How does diabetes affect the eye? 

Diabetic changes in the eye start with leaky blood vessels. There are many blood vessels in the eye which feed the retina (where the receptor cells for sight are found) and carry away waste products. Diabetes cause these vessels to leak either red blood cells (haemorrhages) or white cells into the retina and other structures of the eye. This in turn either kills the receptor cells or causes mechanical damage to the eye and can lead to blindness. Diabetes has also been found to be a risk factor of Glaucoma which can also lead to blindness.

Is there any treatment? 

When I left university, 30 years ago, we were taught about heroic surgery. What this meant was the patient was going blind and anything you did was better than nothing. If the patient went blind due to the treatment then this was a risk worth taking as they were going to be blind in weeks in nothing was done. I still remember seeing blind diabetics in wheelchairs, legs amputated due to the disease affecting their peripheral nervous system and unable to use brail markings on the syringes to administer their own medication.

Fortunately, those days are, if not gone, are rare, in fact my last diabetic patient that was registered blind about 12 years ago. So what has changed? The first big change was the use of lasers. Lasers are used in diabetic retinopathy (eye disease) in two main ways:
1.    To seal off any leaking vessels and to seal areas of oedema (swelling due to liquid) in the retina to stop them spreading
2.    To kill off part of the peripheral retina so that the central retina is not damaged and therefore lead to blind registration.
Since then, it has been found that good control of you insulin levels makes a major difference to the likely hood of retinopathy.
Other treatments are now being used or considered after advancements in the treatment of other eye conditions. One of these is the use of anti VEGF’s which were developed to control wet macular degeneration and now are used in diabetic eye diseases.

What are the risk factors for diabetic eye disease?

1.    Having diabetes! If you control your diet so you reduce your risks of getting the disease then you are less likely to get the eye disease.
2.    It has been proved that the longer you have diabetes the more likely you are to get the eye complications so keep a watch on your diet and have a regular blood sugar check.
3.    Poor insulin control increases the risk.
4.    Not having regular eye checks. Optometrists and ophthalmologists are trained to pick up early signs of the disease so a regular annual eye check can nip the problems in the bud.

Signs and symptoms of diabetes

•    Increased thirst
•    Going to the loo (for a wee) all the time especially at night
•    Extreme tiredness
•    Weight loss
•    Blurred vision
•    Genital itching or regular episodes of thrush
•    Slow healing of wounds
These are more apparent in Type 1 diabetes but also apply to Type 2.