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DIABETES AND RETINA THERAPY

Comprehensive Eye Care & Surgeries

Diabetes And Eye

Diabetes,madhu meh,blood sugar disease… is a condition where in the sugar levels in the blood are above the normal average level. Diabetes leads to microangiopathy which means that it affects the finest branch of a blood vessel.Since we have a blood supply across our body,it is but obvious that Diabetes affects ALL the parts of the body.

BUT the good news is that if the blood sugar levels remain well controlled,a person may be spared of the ill effects of increased blood sugar levels in the body.

Almost every part of the eye is affected by Diabetes.Frequent styes,early development and rapid progress of cataract,iridocylitis,rapid progression of glaucoma,other forms of uveitis,retinopathy,Squints because of Cranial nerve palsies (secondary to strokes),Cellulitis,Blood vessel blocks etc can develop because of uncontrolled Diabetes.

DIABETES AND CATARACT

Cataract is almost 5 times more common in patients with cataract.It is also likely to come in earlier or at a younger age.Cataract also progresses more rapidly in diabetics.It may be as rapid as a few days.Since sugar levels are higher in diabetics,glucose is converted to sorbitol that causes faster clouding of the lens.

Uncontrolled diabetics,type -I or insulin dependant diabetics,long standing diabetics should consider a cataract surgery earlier because of chances of other diabetic complications in the eye,the rapid development of the cataract and their impending complications. Diabetics are likely to have other systemic complications like nephropathy,neuropathy,peripheral vascular disease,heart disease,etc.These co morbidities bring with them multiple medications and other treatments apart from disabilities.It is best to get a cataract surgery done while still systemically fit because the surgery itself is rapid,and recovery quick and without complications.this gives better visual results and better patient satisfaction.

It is also to be noted that in those patients with well controlled diabetes,everything may behave as good as a person with no disease.But of course there are no guarantees.The transition from having a normal vision to one that’s been affected in some way is random.It could be slow without symptoms or rapid and visually disturbing.

DIABETIC RETINOPATHY

Diabetic retinopathy is when the retina is affected because of inadequate control of Diabetes.Diabetic retinopathy is complex and the progression depends upon how well the blood sugar control is maintained.The entire retina may be affected ut the most common and important is the macula.Macula is the part of the eye where you have your sharpest vision.Hence affection of the macula will immediately cause a drop in vision.

Diabetic macular odema is common and can be recurrent inspite of managing is by various methods.The most effective being a good and sustained sugar control.As the disease progresses more parts of the eye are affected and the more difficult it becomes to treat and reverse the damage.

The affection of the blood vessels by diabetes causes the cells to starve.The associated inflammation of the cells and the loss of integrity of the blood vessel walls leads to release of angiogenesis (new vessel formation) factors.This leads to development of abnormal new blood vessels that are unstable and weak and fragile.This leads to leakage of proteins and bleeds. The next stage involves the formation of fibrosis and shrinkage leading to pulls on the retina at various places leading to detachment of the retina.

In all Diabetic retinopathy can be rapidly progressive and blinding.

Diabetic retinopathy can be managed in various ways

  1. Lasers: multiple sittings and different protocols are followed
  2. Medications: usually eye drops.Some anti oxidant tablets may be given to slow progression and reduce the damage.Though the results haven’t been proven
  3. Injections: Intra vitreal Anti VEGF Injections have been used with a lot of success in the various stages.it may require from one to a life time of injections depending upon the stage and the response the eye shows to treatment.

VASCULAR OCCLUSIONS

Venous and arterial occlusion of the retinal blood vessels is quite common in diabetics.Vascular occlusions also occur in other conditions like a co existing glaucoma,Hypertensive,Heart disease,etc.Vision may be affected depending upon which vessel and what area has been affected.

Most commonly there is a swelling at the macula (macular odema) that causes a dropped vision.

Treatment could be injections of Anti VeGFs.

PREVENTION OF DIABETIC EYE

1.The single most important way of preventing ocular complications in the eye is well controlled Blood sugar levels

  1. Exercise: It’s a know fact that insulin levels are likely to improve with exercise.The burning down of sugar also is better with exercise.The release of endorphins makes you feel better about yourself and hence makes you take care of your health better
  2. Diet:A balanced diet well adjusted to the persons metabolism and requirement so as to keep the sugar levels balanced through the day.
  3. Visit your ophthalmologist: A very important aspect that shouldn’t be taken lightly.Once a diabetic,a complete comprehensive eye check is very important.Thereafter as advised by your eye doctor.

FAQ’s

Q:How many years of having Diabetes does the eye get affected?

A: Usually 6-8 years after diagnosis.But it varies from person to person depending upon the control,years of diabetes before actual diagnosis and other comorbidities.It may be as early as the first year.

Q:Are the eyes affected even at the time of diagnosis?

A: Yes they could be.

Q:What are the symptoms of developing a cataract in diabetes?

A: The symptoms are the same as a developing cataract in any normal person.Dimness of vision,blurring,fading of colours,glare,light sensitivity,etc.

Q:How soon will the cataract have to be operated?

A: This depends upon a lot of parameters and the decision will have to be taken after weighing them.Please read the cataract section here .A discussion with your ophthalmologist and physician will help.

Q:What precautions should be taken while deciding Cataract surgery?

A: This depends upon a lot of parameters and the decision will have to be taken after weighing them.Please read the cataract section here. A discussion with your ophthalmologist and physician will help.

Q:Which Lens should be put in the eye?

A: Any hard lens or a acrylic foldable IOL is fine. Monofocal and astigmatism correcting IOLs are also ok.The decision for a Multifocal IOL will depend upon the status of your retina and will be decided by your ophthalmologist.So talk about your queries with your eye doctor.

Q:What precautions should I take after cataract surgery?

A: Strict adheerance to instructions by the eye surgeon.Instill drops without fail.Keep sugars under control and follow up regularly.In case of any symptoms that cause blurring redness pain and watering arise,please see the eye surgeion immediately.

Q: Will the follow up after cataract surgery be different?

A: No.It usually is the same as any other cataract surgery,unless the eye doctor finds it otherwise.

Q:If Diabetes remains uncontrolled how do we undergo cataract surgery?

A: No Diabetes can remain uncontrolled.If the required control isn’t acquired by the regular oral medication,the physician might consider switching you over to injectible medicine,namely Insulin.This can be moved back to oral medication later on.

Q:Is it true that persons with Diabetes cannot be operated?

A: No.Diabetics can be safely operated.But the blood sugar levels have to be controlled.

Q:Can vision improve after a cataract surgery in a Diabetic patient?

A:Yes of course.The visual prognosis will be explained to you by your eye surgeon if she finds any other changes in the eye that will affect vision.

Q:Can I undergo a cataract surgery if I also have Nephropathy(kidney disease)?

A: Yes you can.

Q:How can we schedule a surgery if a patient is on Dialysis?

A: A consultation with your nephrologist is required.An appointment for surgery can be scheduled in between two dialysis sessions.

Q: Can we do a cataract surgery on the day of Dialysis?

A: No.You cannot.

Q: Can people on Insulin be operated?

A: Yes.Of course.

Q:Can a person be put on insulin to control diabetes prior to a cataract surgery?

A: Yes.An uncontrolled diabetic may be switched over to Insulin for a short duration before and after surgery.

Q:What should be the ideal Blood sugar level before a cataract surgery?

A:There are no standard rules/guidelines. Generally fasting blood sugar could be from a 100-180mgdl.It varies from person to person and the state of control of diabetes.Your physician will decide when it will be ok to undergo a cataract surgery if your sugar levels have been persistingly on the higher side.

Q: What should be the Hb1Ac at the time of surgery?

A:Again there are no standard guidelines.But a Hb1Ac of between 8-10% should be reasonable.<8.5 is preferred.

Q:What are the symptoms that I should be aware of now that I have diabetes?

A: A few common symptoms are mentioned below.You may have none or any of the following in either or both eyes.

  • Blurring of vision
  • Distorsion of vision
  • Floating objects in front of the eye
  • Inability to focus or see clearly with existing glasses
  • Pain or discomfort in the eye
  • Central loss of vision while seeing any object
  • Crowding or blowing up of a image
  • Partial loss of vision
  • Sensitivity to light
Q:Is it possible to keep a watch on progression/improvement of vision while at home?

A: Yes.An easy home test would be the use of an amslers grid.Its nothing but a chequered box with a central dot.All you have to do is see with one eye (the other remains closed) at the Amslers grid at your reading distance (while wearing your reading glasses.)Look at the central dot.While focusing on the central dot,see if you can notice any distorsion/blurring/loss/patchy loss of the lines on the grid.Any change from previous may be cause for concern.Your seeing better could be a sign of improvement.

Q: Can I monitor my vision with the Amsler’s grid and not follow up with the doctor?

A: NO.Amsler’s grid is just a test for monitoring at home.It is not a substitute for a doctors scheduled visit.U may continue to use it until the time you see your doctor.

Q:What would require me to make an urgent unscheduled appointment with my eye doctor?

A: Following are few symptoms that would require an urgent appointment

  • Sudden drop or loss of vision
  • Sudden increase in the number of floaters
  • Pain
  • Headache/nausea/vomiting
  • Double vision
  • Photophobia/sensitivity to light
  • Swelling of the eyes
  • Redness
  • Discharge/stickiness of eyes
Q:What precautions should a diabetic take on the day of surgery?

A: Apart from following all the pre operative instructions given to you by your doctor,youmust consider the following.The instructions may vary depending upon the type of anaesthesia and the duration of your surgery.

  • Generally a cataract surgery under topical anaesthesia doesn’t require any change in your routine.
  • DO NOT SKIP a meal. Skipping a meal and continuing your diabetic medication will cause your blood sugar levels to dip (hypoglycemia) and may cause complications form a dropped sugar level.
  • Please carry ALL your reports with you,specially your most recent blood sugar tests.
  • Carry ALL your medications with you.
  • FASTING may be advised along with skipping your dose of diabetic medicine ,if the surgery is under sedation/general anaesthesia/is going to take long hours under a local anaesthesia.
Q: DO I need to repeat a blood sugar test before surgery?

A: There are no standard rules.If you are a diabetic,your Blood sugar reports are very important.If you are well controlled a report within a 1 week window period sould be ok .A Hb1Ac report would be more helpful.

Q: What should I expect on the day of an anti Vegf injection?

A: Its an OPD procedure. Its very quick and Its done in an Operation theater under sterile aseptic conditions.So you can expect the following:

  • A hospital stay of about 2 hours
  • Its done under topical aneasthesia and there is mild/no pain during the procedure.
  • A slight blurring of vision
  • You will be advised some topical drops and a follow up schedule by your eye doctor.
  • An eye patch may or may not be given.

Testimonials

Dr. Leena Doshi always takes time with me, she answers all my questions and never seems to be in a rush to move on the next patient. I had taken my mother in law for a cataract problem which was successfully treated. I always feel  completely satisfied each time after my appointment. There are no unanswered questions, doubts or confusion… Best Compliments.

Mrs. Sneh Chauhan

Patient

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