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Vitreoretinal Procedures

Diabetic Retinopathy

What is Diabetes?

This is a disease when the body cannot cope normally with sugar and other carbohydrates in the diet. About one person in thirteen is affected by diabetes mellitus in Malaysia.

There are two types of diabetes mellitus – one starts in childhood and is usually controlled by insulin injections; the other type often begins later in life and is usually controlled by dietary restrictions or oral medications. Both types affect the eyes in the same way.

Diabetic eye disease is one of the commonest causes of visual loss in adults of working age in Malaysia. There are more than 6,000 new patients found to have diabetic retinopathy each year in Malaysia.

If you have diabetes, this does not necessary mean that your sight will be affected, but there is a higher risk of early visual loss. If your diabetes is well controlled, you are less likely to have problems, or they may be less serious.

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How can diabetes affect the eye?

Your eye is like a camera. Light from the objects you look at passes through the lens at the front of your eye and is received at the back of your eye by the retina. The retina is made up of a delicate nervous tissue that is sensitive to light, rather like the film in a camera.

Diabetes can affect the eye in a number of ways. These usually involve the fine network of blood vessels in the retina – hence the term diabetic retinopathy.

In diabetes, the lining of the fine blood vessels is damaged and will cause leakage of blood and lipids into the surrounding tissue and causes the retina to swell – this is called edema and can interfere with normal vision.

Sometimes diabetes can cause the blood vessels in the retina to become blocked. The eye responds by creating new blood vessels, which grow in the retina. Unfortunately, these new vessels are weak. These blood vessels can bleed easily into the vitreous gel, the clear substance that fills the hollow part of the eye. This clouds vision and makes objects seem blurry.

These blood vessels if left untreated may also lead to scar tissue development. This scar tissue may contract, pull on the retinal surface, and cause a retinal detachment.

Without treatment, total loss of vision can happen in diabetic retinopathy.

What are the symptoms?

Diabetic retinopathy can be present and not affect vision at all until a more advanced condition occurs, such as edema or bleeding.

How do I know if I have retinopathy?

Regular eye examination by an eye doctor (Ophthalmologist) with dilation of the pupil is the only certain way to know if you have retinopathy.

Duration of diabetes and control are the most important factors determining the prevalence and severity of retinopathy.

About 30% of the diagnosed population has retinopathy and each year 1 % develop sight-threatening retinopathy.

Why regular eye tests are important?

Most sight loss from diabetic retinopathy can be prevented by routine follow-up and treatment, when needed.

With treatment, most sight-threatening diabetic problems can be prevented if identified early enough.

A juvenile-onset diabetic should have his first dilated retinal examination within the first five years after diagnosis. An adult-onset diabetic should have his first dilated retinal examination at the time of diagnosis, since it is often difficult to predict the actual time of onset of diabetes in this group of patients.

What is the treatment?

Most sight-threatening diabetic problems can be prevented by laser treatment if it is identified early enough. It is important to realize however that the laser treatment aims to maintain the sight you have – not to make it better in most cases.

All treatment is carried out in an outpatient clinic and you will not have to stay in the hospital. The laser treatment doesn't usually cause much discomfort. Most patients will need at least two, if not several more laser sessions.

If your eye condition becomes more severe, causing retinal detachment and scar tissue or if there is bleeding into the vitreous gel, it may be necessary to undergo vitreous surgery. This is highly specialised and you should discuss the various options with an ophthalmologist.