Diabetic Eye Related Conditions
Diabetes affects approximately 1 in 25 patients in the developed world. The incidence of Diabetes in Ireland is increasing and it is expected that up to 6% of the population will become affected by 2015. In Ireland, Diabetic retinopathy accounts for 12% of all new cases of blindness each year and is the leading cause of blindness in patients between 20 and 65 years of age
How does diabetes affect the eye?
Diabetes can affect the eye in various ways. The most serious effects however are through problems in the retina. This problem is called diabetic retinopathy. Having diabetes does not mean that a person will have eye problems, but it is important that regular eye examinations are carried out to ensure that any potential problems are diagnosed early. Sight loss from diabetes can usually be prevented if retinopathy is diagnosed and treated early.
The prevalence of diabetic retinopathy increases with the age of the patient and the duration of diabetes. After 20 years of diabetes 99% of Insulin -dependent Diabetics and 60% of non-insulin dependent diabetics show some degree of retinopathy.
(Stage 1) Non-proliferative Diabetic Retinopathy (NPDR)
After a number of years of diabetes, blood vessels may show signs of being affected. They can bulge to form micro aneurysms, and leak either blood in the form of small haemorrhages or fluid in the form of hard exudates. The nerve fibre layer of the retina may become affected as infarcts.
If the central area of the retina becomes affected by diabetic retinopathy the condition is called a maculopathy. If this happens, the central vision may be affected. This condition is often slowly progressive with increasing loss of vision, but very seldom does this result in total vision loss.
(Stage 2) Proliferative Diabetic Retinopathy (PDR)
As the severity of the retinopathy increases, some retinal blood vessels may become blocked. The retina, in an attempt to heal itself, promotes the growth of new leaky blood vessels which start to grow on the surface of the retina. These blood vessels may leak fluid or blood which causes loss of vision. This visual loss may be sudden through a large bleed (vitreous haemorrhage) or more gradual through scarring (traction) and even retinal detachment.
Education and the Future
There are many good support networks to help educate and inform Diabetics about their illness so that they can take measures to improve their care. The Diabetes Federation of Ireland www.diabetesireland.ie is one.
New pharmacological treatments are being investigated at present to prevent and treat complications of retinopathy. At microscopic and cellular levels, diabetic blood vessel cells produce exciting factors (angiogenic factors) that result in new abnormal blood vessels forming. New injectable medicines that inhibit these factors have the potential to reduce vision loss in carefully selected patients. There is optimism in the ophthalmic community about the success of these new treatments. The future for prevention, early intervention and successful treatments is bright.
Screening and Treatment at the LaserVision Eye Clinic
Mr John Fenton FRCSI is a Consultant Ophthalmic Surgeon at the LaserVision Eye Clinic. Mr Fenton trained in retinal and diabetic surgery in New Orleans with Professor G. Peyman, an internationally recognized expert on diabetic laser eye surgery. The clinic has developed a Diabetic Diagnostic and Treatment programme which is available to all GPs, Optometrists, Health Care institutions and diabetic organizations to examine diabetics and direct future treatments. This new intelligent software application allows surgeons at remote locations to diagnose patients and direct referrals for laser treatment. The LaserVision Eye Clinic follows the Early Treatment of Diabetic Retinopathy Study (ETDRS) guidelines when managing diabetics with laser photocoagulation. This study sponsored by the US National Eye Institute has shown that early laser intervention when clinically significant macular oedema is present can reduce the risk of moderate visual loss by 50%.and severe visual loss for those with new blood vessels and haemorrhage (PDR) by 50%
If you are a General Practitioner or an Optometrist and would like further information on Screening for Diabetic Retinopathy and the mobile diabetic telescreening unit, telephone 01.6674778 or email firstname.lastname@example.org.
Comprehensive Consultant Eye Examination
This examination checks the health of the eye for glaucoma, cataracts, macular degeneration.and costs €100
It may be necessary to dilate (enlarge) the pupil with drops to examine the retina fully and this may blur your vision slightly for several hours so please bear this in mind if you intend to drive soon after the examination
Patients with Private Health insurance (VHI Quinn Healthcare Aviva ) may be entitled to a rebate for all or part of this fee from their insurance company depending on the level of cover, e.g. VHI healthcare plan B entitles you to a rebate of €51 per consultant visit Book an eye examination