An eye check is vital. Diabetes patients experiencing vision problem should immediately contact their ophthalmologist.
Without proper management, diabetes can lead to diabetic retinopathy, a leading cause of blindness among adults, writes Dr Asokumaran Thanaraj
A TWENTY-EIGHT-YEAR-OLD woman walks into my clinic, complaining of poor vision in both eyes which she claims happened over the past few weeks. After a thorough eye examination, she was diagnosed with having advanced diabetic eye disease with a loss of vision in both eyes, almost 90 per cent.
She works as a cook at the hawker stall owned by her fiance. She has to be accompanied by him every time she comes to the clinic as she has lost her navigating vision. In medical terms, she is legally blind.
After a long explanation regarding the prognosis and risks involved, she undergoes vitrectomy surgery and endolaser in one eye to repair the damage done by the disease. Post-operation, she gains slight vision which will enable her to navigate, with the other eye remaining at high risk even for surgery.
During follow-up she has one question which I can never answer: “Doctor, when can I see again?”
WHERE DID WE GO WRONG?
Diabetic retinopathy is the leading cause of blindness and visual disability in adults.
The World Health Organisation has estimated the global prevalence of diabetes to rise from 2.8 to 4.4 per cent from the year 2000 to 2030. It is a costly disease both for the affected individuals and health sector. Diabetic retinopathy leads the complication list of diabetes with a worldwide prevalence estimated at 6.8 to 44.4 per cent.
In Malaysia, the prevalence of diabetes among those aged 30 years and above has increased from 6.3 per cent (1986) to 14.9 per cent (2006).
It is recommended that all patients with Type I diabetes be screened for diabetic retinopathy from three to five years after initial diagnosis and for Type II diabetes, the recommendation for screening is immediately at the time of diagnosis.
We can go on giving these figures for public consumption. One can surf the net and find hundreds of pages of information available on this blinding disease.
But what difference does it make for the young woman who has already lost her vision? Is everyone still unaware of these facts and figures?
There are enough seminars, screenings and talks organised by the relevant authorities to tackle this problem.
The Health Ministry has even supplied Fundus cameras to selected primary care centres in this country to help screen patients and to be referred to tertiary centres for review and appropriate treatment.
The fact that this patient has been totally unaware of her problem tells us how silent this blinding disease can be. Most of the time, the damage done is so severe that a person can enter the eye clinic for the first time being legally blind without any prior knowledge about his deteriorating condition.
So how does one know if the eyes are affected with diabetic retinopathy?
The answer lies in only getting their eyes screened either by a trained primary care physician, family physician or by an ophthalmologist. Other clues are blurred vision or slow vision loss over time, floaters, shadows or missing areas of vision and trouble seeing at night.
Often, many patients with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye and that is why a regular check-up is needed once they are confirmed having diabetes or still at early stages of diabetic retinopathy.
THE SIGNS AND TREATMENT
The ophthalmologist can diagnose diabetic retinopathy by dilating your eyes and carefully examining the retina. He is usually fully equipped with other assessment tools to help him come to a conclusion about the stages of diabetic retinopathy the patient is suffering from.
In early stages of diabetic retinopathy (non proliferative), no treatment may be needed but the patient will need regular assessment. In cases where the non-proliferative stage has progressed, laser treatment is usually required.
If the condition has progressed to proliferative or advanced diabetic retinopathy stage, surgical treatment is usually initiated. A surgical procedure called vitrectomy is done to clear the blood within the eye which has bled from the abnormal vessels and also to repair a detached retina.
In certain cases, injection of drugs directly into the eye is done. This is to prevent development of any new vessels which are responsible for the bleeding.
At a time when the patient feels everything is solved, the doctors will have to keep their fingers crossed.
This is because diabetic eye disease does not only affects the retina, but it causes other complications like cataract and glaucoma.
Cataract probably is easily manageable but glaucoma or specifically known as neovascular glaucoma is one of the most dreaded complications of the disease.
A few months after the surgery, the patient came for follow up and I was happy to see her being able to navigate on her own without much help. She will need to undergo another surgery to remove the silicone oil placed inside the operated eye to stabilise the detached retina.
I was invited to go to their stall to taste their new cooking and probably a new recipe. It was amazing to see her standing and being able to cook while her fiance was busy serving the dish to the customers.
She is learning to use her sense of smell, touch and taste more to cook and never needed to ask me the same question — whether she will be able to see again.
The writer is consultant ophthalmologist at Columbia Asia Hospital-Puchong
IF you have diabetes and have not seen an ophthalmologist for the past one year, make an appointment now.
If you have any of these symptoms, it is even more important to do so:
• You cannot see well in dim light
• You have dark spots in your field of vision
• You are unable to focus and the vision is blurred and hazy
• You have double vision
• You see some spots floating in your field of vision
• You have pain in any one of the eyes which can be associated with headache
Read more: Diabetics, watch your eyes – Health – New Straits Times http://www.nst.com.my/life-times/health/diabetics-watch-your-eyes-1.173641#ixzz2Cm9zNIAA