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Millions of South Africans struggle with diabetes.

Recent campaigns, surrounding World Diabetes Day, have educated diabetic patients about the importance of caring for their eyes. In fact, the effects of diabetes can affect your eyesight permanently. 


General information on diabetes

Diabetes is a disease in which a patient has high blood sugar (hyperglycaemia), either because their body doesn’t respond properly to insulin (type 2) or because their body doesn’t make enough insulin (type 1). 

Type 2 diabetes makes up more than 90% of diabetes cases, and often remains undiagnosed for several years.

People with high blood sugar may experience some of these symptoms:

• Frequent urination (polyuria) and increased thirst (polydipsia).

• Dry mouth.

• Blurry vision.

Risk factors for type 2 diabetes include:

• Having a first-degree relative with type 2 diabetes.

• Being overweight or obese.

• Being older than 45 years.

• Having a previous diagnosis of pre-diabetes.


How can diabetes affect your eyesight?

Diabetes is a leading cause of blindness in people between the ages of 20 and 74. In many cases, signs of diabetes are first identified during a routine eye exam.

What is proliferative diabetic retinopathy?

Diabetic retinopathy is a common complication of diabetes-related eye problems. In the early stages of diabetic retinopathy, you may not experience any symptoms. However, as the condition progresses, it will start to affect your eyesight. 

This complication tends to start as mild, non-proliferative diabetic retinopathy (NPDR). Without treatment, it then progresses to moderate or severe NPDR, and then to proliferative diabetic retinopathy (PDR). PDR is the most eyesight-threatening form of diabetic retinopathy.

Visual loss with diabetic retinopathy occurs due to the development of diabetic macular oedema, vitreous haemorrhage, or traction retinal detachment. With proliferative diabetic retinopathy (PDR), new blood vessels grow within the eye and can cause varying degrees of vision loss.

It is important to catch this condition at an early stage, so that you can begin treatment to prevent permanent damage to your eyesight.

What are the risk factors for diabetic retinopathy?

• Poor disease management.

• Duration of disease.

• Smoking.

• High blood pressure.

• High cholesterol.

• Pregnancy.


Other ocular complications of diabetes

Diabetic eye disease can affect all structures of the eye, and can impact your vision in various ways:

• Cataracts commonly cause visual impairment in diabetics. Furthermore, they develop earlier and progress more rapidly in diabetic patients.

• Diabetic patients may notice that they experience transient changes in their visual acuity, causing temporary near-sightedness or far-sightedness. 

• Colour vision changes may appear in patients with diabetes, and can precede the development of diabetic retinopathy. 

• Patients with diabetes may struggle to focus their eyes properly. This is known as accommodative dysfunction.

• The cornea of a person with diabetes is more susceptible to injury, and slower to heal after an injury.

• Diabetes increases the risk of contact lens-related eye infections. The risk is greater in patients using extended wear contact lenses. Daily contact lenses are believed to be a safer choice for many diabetic patients.

• Diabetic patients are at increased risk of vitreous degeneration and posterior vitreous detachment (PVD).

• Diabetes is a cause of ischaemic optic neuropathy, where the optic nerve becomes deprived of oxygen.

• There is also some evidence that diabetes is associated with elevated intraocular pressure (IOP) and glaucoma.

Diabetic eye disease - symptoms of undiagnosed or uncontrolled diabetes:

• Sudden loss of vision.

• Blurred vision.

• Fluctuating vision. 

• New-onset double vision (diplopia).

• Seeing spots or floaters.

• Eye infections occurring more frequently than usual.


What can I do to protect my eyes if I am diagnosed with diabetes?

Most importantly, diabetic patients must work closely with their doctors to manage their blood sugar. For some people, this can be controlled with diet and exercise alone. Other people may need medicines. 

Regular eye exams are essential for effective care, which can preserve vision and lower the risk of vision loss. 

Your eye exam will include:

• Measuring your refractive status.

• Fundoscopy and retinal screening, to examine the back of your eye for vascular changes, ischaemic optic neuropathy, and ocular signs of high blood pressure.

• Examination to determine if you have developed cataracts.

• Testing for elevated intraocular pressure.

• Colour-vision testing, if appropriate.


How often should I have a comprehensive eye exam if I have diabetes?

For diabetic patients without retinopathy, or with mild NPDR, we recommend an annual dilated eye examination. 

If you have moderate NPDR, we recommend re-examination every 6-9 months. 

For severe cases of NPDR, you should follow up every 3-4 months with your ophthalmologist. 


What else can I do to prevent diabetic eye problems?

High blood pressure (hypertension) is a common co-morbidity of diabetes. Tight blood pressure control (<150/85 mmHg) in diabetic patients with high blood pressure has been shown to delay the progression of diabetic retinopathy and deterioration of visual acuity. Some studies have also shown that raised blood pressure can contribute to the development of diabetic macular oedema.

High-cholesterol is another common comorbidity of diabetes. Lowering your cholesterol is also believed to reduce your risk of hard exudate formation and vision loss with diabetic retinopathy, or slow down progression if it has already occurred. 


What are the treatments for diabetic eye disease?

Most importantly, take your prescribed medications!

Other treatment options depend on the nature and severity of your diabetes-related ocular disease. In some cases, managing your blood sugar is all that will be needed. In other cases, an ophthalmologist may recommend laser photocoagulation and intraocular/intravitreous injections. 

The correct diabetic treatment protocol can preserve your eye vision, and it is important that you work with your doctors and optometrist to treat and monitor the ocular complications of diabetes.

Remember, the best way to prevent any eye problems is by early detection.

Book your appointment today with Leslie Sessel Optometrist. We have more than 30 years of experience in optometry! 

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