According to the Diabetes UK, there are over 4 million people living with the disease in the country and the cases have doubled in the last 15 years*. Based on figures from the Royal National Institute of Blind People (RNIB), nearly all Type 1 diabetes patients and almost two thirds of those with type 2 diabetes have some degree of retinopathy within 20 years of diagnosis**. However, a consistent management of diabetes, regular eye health screening, as well as accurate and timely treatment plan can make a lot of difference to the eyesight.
Here Moorfields Private Consultant Ophthalmic Surgeon, Mr Luke Nicholson addresses some of the common patient questions about diabetic eye changes and their management.
I’m diagnosed with diabetes. What should I do to
keep my eyes healthy?
The longer you have diabetes, the higher the chance of having eye problems. General advice: control your sugar and blood pressure, watch your weight, exercise, attend regular screening and receive prompt treatment if you need it.
Do different types of diabetes affect eyes differently?
Types 1 and types 2 diabetes both affect the eyes. The type 1 diabetes tends to have more retinopathy change and type 2 is more associated with maculopathy and retinopathy changes – the maculopathy changes mainly affecting the centre of the eye and the vision. Both of them affect the retina significantly.
In type 1 diabetes the duration of the disease is usually known, so retinal screening may start a few years after the diagnosis. With the type 2 diabetes, which is often diagnosed incidentally from a blood test done for a different reason, the screening starts immediately as it’s not known how long the patient has had the condition.
What eye conditions are people with diabetes at risk of?
Diabetes mostly cause changes to the fine blood vessels in the eyes, the microvasculature. The fine blood vessels in the retina can become leaky or occlude leading to diabetic retinopathy and diabetic maculopathy that can affect the vision.
Patients with diabetes tend to get cataract at an earlier age compared to the general population. Diabetes is a possible risk factor for glaucoma as well as for retinal vein occlusion and transient ischaemic events to the eye which can manifest as an acute vision loss or double vision.
Can controlling blood sugar stop these conditions from progressing?
Good control of the blood pressure and sugar level is key in diabetic eye health management, reducing the risk of eye complications. Once I had two patients who have had diabetes for 20 years. One had a very well documented and controlled sugar levels and minimal diabetes related changes in his eyes. Another patient had poor control of his diabetes and was not aware of his sugar or blood pressure levels, and had profound diabetic retinopathy damage. It’s a good example of how a patient with diabetes can help manage their eye health. Saying that, it can be difficult in some cases to maintain good blood sugar levels.
What treatment options are available for diabetic eye disease?
The two main problems that can happen with diabetes are maculopathy, or swelling and fluid leakage, and the growth of new blood vessels which we call proliferative diabetic retinopathy that is a result of significant closure of fine blood vessels in the retina.
For the proliferative disease, laser treatment is the 1st line of treatment which is invasive, may cause side effects, but it gives long term control of the growth of new blood vessels. We can also recommend laser in some selected cases of maculopathy. Advanced proliferative diabetic retinopathy can lead to detachment of the retina and this may require surgery by the vitreo-retinal surgeons.
Injections are a repeated treatment and are very effective in cases of maculopathy where the swelling is right in the centre of the eye. The number of injections required does vary between individuals.
Which consultant should I see for my diabetic eye problems?
Doctors who deal with diabetic eye conditions are retina consultants. If you’re assessed at the opticians and they think there are diabetes related changes in the retina, they will refer you to a retina consultant.
Retina doctors can treat multiple diabetic pathology in the same eye such as retinopathy, maculopathy and also a cataract; there is quite specialised planning needed for complex cases.
If you need a cataract surgery and you also have pre-existing diabetic changes in the eye, then you are more at risk of complications such as inflammation or swelling of the macula after cataract surgery.
This is ideally managed by a surgeon who sees cases relating to diabetic retinopathy and cataract, they can prime you for the right time to have surgery and the right treatment before and after the procedure to give you the best possible outcome.