There are millions of patients throughout the world who suffer from type 2 diabetes, which is the type that has an onset in adulthood and is often associated with a poor diet rich in sugars and saturated fats. The incidence of diabetes is increasing in emerging countries such as India where lifestyle with a more sedentary life is increasing the risk of metabolic diseases including diabetes. Most of us are unaware of this condition, and we do not know much about the implications for the eyes.
The eyes are so important and we take them for granted. With them we can see, we can show emotion, people can look into our souls, they can read us and see how we are feeling. But if we have sick eyes with diabetes, we cannot see so well, and this too is reflected in the way we gaze or absence of gaze if we have lost our vision. Diabetes hampers the tiny blood vessels in the eyes and can affect the eyes severely. However, ophthalmologists can help by looking into your eye, which is a window to look at these blood vessels on the retina, and gauge the severity of diabetes, just by looking the eye. The retina is the part of the back of the eye much like the film of a camera, where light is focused, and the image of what we are seeing is formed and then messages sent to the brain to appreciate this as vision. The retina is primarily damaged in diabetes, and those who have this damage have diabetic retinopathy.
Diabetic retinopathy can lead to leakage of blood vessels with oedema of the retina particularly in the macula which is the most sensitive part of the retina at the back. It is responsible for fine detailed vision and colour vision. Initially, patients may be unaware that their eyes are affected by diabetes, as there may be just a few small dots or blot haemorrhages and soft exudates which essentially are little red spots or whitish spots seen at the back of the eye.
However, once there is macular oedema, this is more difficult to treat but not impossible and must be detected early. Treatment should be started as soon as possible. Usually, macular oedema is detected by the patient complaining of some blurring of vision, however by having eye tests the early signs of diabetes can be picked up and macular oedema can either be avoided or picked up earlier and treated earlier.
A dilated fundus eye examination is required at an ophthalmology consultation. At Clinica London, Mr Jaheed Khan and Professor Michel Michaelides are two surgeons looking after patients with diabetes. They carry out a consultation in which tests are done on the eye consisting of the scanning laser ophthalmoscopy, autofluorescence and OCT, as well as visual acuities, autorefraction and intraocular pressure management. They assess the lens for cataract as cataract is more common in diabetes and they examine the retina or fundus as it is called in detail. They can then advise whether you have diabetes, how bad it is and what treatment may be required.
However, if you have diabetes, the most important thing is not only regular dilated eye examination before vision is lost, but good control of your diabetes with a good diet and tablets if required. A few patients may require insulin. Whatever the treatment, it must keep the glucose levels as stable as possible plus thus help to avoid diabetic retinopathy, including diabetic maculopathy.