WHAT IS IT

Diabetes mellitus is one of the leading causes of blindness in developed countries in the world, including Singapore. It is responsible for a spectrum of eye complications, of which the most serious is diabetic retinopathy.

In this condition, the high blood sugar levels in diabetes cause changes in the retina, the light-sensitive layer of nerve cells at the back of the eye, thus leading to visual loss.

 

There are three stages in diabetic retinopathy:

  • Non-proliferative retinopathy
    This is the early stage in which the small blood vessels in the retina are blocked or damaged, causing swelling and leakage of blood and fluid into the vitreous body of the eye. There are usually no symptoms at this stage.
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Moderate to severe diabetic changes

  • Maculopathy
    The macula is the pinhead-sized central area of the retina that lets us see details. When there is macular swelling (oedema), central vision is gradually affected, resulting in difficulty with tasks like reading and driving.
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Advanced diabetic eye changes with bleeding

  • Proliferative retinopathy
    This is the advanced stage where new blood vessels form on the retina and vision/optic nerve, These new vessels are abnormal and tend to rupture, causing bleeding within the eye.  In later stages, scarring develops, which in turn pulls on the retina, leading to retinal detachment and loss of vision.

SYMPTOMS OF DIABETIC RETINOPATHY

  • Blurred vision
  • Difficulty reading or seeing details
  • Seeing floaters/flashes
  • Sudden loss of vision in one or both eyes
  • Changes in vision throughout the day

MANAGEMENT OF DIABETIC RETINOPATHY

  • Screening
    The key to successful management of diabetic retinopathy lies in screening and early detection of the changes mentioned above to allow prompt treatment.ALL diabetic patients should have their eyes checked at least once a year by an eye doctor, irregardless of the duration of their diabetes or whether they have any visual symptoms.The examinations carried out are fundoscopy, retinal photography and sometimes retinal angiography.
  • Prevention
    It has been shown that good control of blood sugar levels and blood pressure can help to reduce the incidence of diabetic retinopathy. However, sometimes progression of retinal changes may still occur, despite the best of efforts.
  • Treatment
    There is no cure for diabetic retinopathy but surgical  and medical treatments are available that help reduce visual loss. These are:

    1. Laser surgery to seal leaky blood vessels, control macular oedema and stop the growth of new blood vessels. It can also be used to treat retinal detachment.
    2. Vitrectomy, in which the surgeon removes the bloody vitreous gel from the eye and replaces it with a clear solution. This enables light to pass through and restores vision.
    3. Injection of intraocular anti-VEGF medication (Lucentis, Eylea etc). These are the latest advances in medical treatment of diabetic eye disease and are now FDA approved for treatment of macular oedema in diabetes.