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The Diabetic Eye 

Why are diabetics more at risk from visual loss?

What precautions should diabetics take to prevent visual loss?
Why do diabetics appear to have more frequent change of their glasses
How is the laser used to prevent diabetic eye complications
How painful is the laser application
What is the role of surgery  in diabetic visual loss?
 
  •  Why are diabetics more at risk from visual loss?
  • Diabetes affects the small blood vessels in the body. Inn the retina the blood vessels become abnormally permeable. As a result fluid and other constituents of the blood leak out from the blood vessels into the retina to form retinal haemorrhages, hard exudates, soft exudates and macular oedema. These together form the condition called "diabetic retinopathy" which is a potentially sight threatening condition. Later on blood might  stop circulating in parts of retina   or fragile immature blood vessels may form in other areas . These increase the risk of bleeding inside the eye and consequently increase the risk of sever visual loss.

    Diabetic eyes also have a higher risk of developing glaucoma and iritis  which area all potentially sight threatening conditions.

  • What precautions should diabetics take to prevent visual loss?
  • Diabetic retinopathy is the consequence of long term raised blood sugar which is modified by genetic or acquired systemic factors. The tight control of blood sugar is the single important factor for the prevention of this condition. Control of blood pressure, anaemia and control of smoking also aid the prevention of diabetic eye lesions.
     
  • Why do diabetics appear to have more frequent change of their glasses?

  • When the blood sugar level in the diabetic person fluctuates, so does the power of his glasses. These changes are temporary and should stabilise with the control of blood sugar. It is unwise to change the glasses during these  blood sugar fluctuations.
     

  • How is the laser used to prevent diabetic eye complications ?

  • Lasers are used to create accurately placed microscopic burns in the retina .This treatment is  called photocoagulation In early visual loss due to leakage of blood vessels called the maculopathy the focal leakage is checked to some extent by laser burns. In th more severe type of diabetic retinopathy called the "proliferative diabetic retinopathy" many spots of tiny laser burns are given all over the perepheral retina. By ablating the perepheral retina the aim is to keep the central retina , the macula ,clear of the disease process.
     

  • How painful is the laser application?

  • The laser burns in photocoagulation are so microscopic that they cause very little pain, at most a discompfort or ache. It is an outpatient procedure and does not require hospitalisation
     

  • What is the role of surgery  in diabetic visual loss?

  • Diabetics often develop cataract which progress rapidly. In the absence of diabetic retinopathy the cataract is managed in the same way as in other cataracts.However, for visual loss due to internal haemorrhage called vitreous haemorrhage, which does not resolve itself over a 3 to 4 months period of time, vitreoretinal surgery is indicated to remove the clotted blood from inside the eye. This is often combined with endophotocoagulation. However, such cases might develop re bleed or might have poor visual recovery due to other concomitant intraocular damage such as an advanced proliferative diabetic retinopathy.

    The single most important preventive factor in diabetic eye disease is to maintain the blood sugar in the acceptable limits. Periodic routine eye checkup and laser photocoagulation in selected cases are also preventive excercises.


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