DIABETIC retinopathy can lead to permanent loss of vision if not managed well.
Diabetes is a serious problem amongst Malaysians - approximately 3.9 million people, according to the National Health and Morbidity Survey 2019.
It can result in many health complications - most commonly affecting the kidneys, leading to kidney failure. However, a slightly lesser-known complication, a condition called diabetic retinopathy, can impair vision and eventually, lead to blindness.
Pantai Hospital Ampang consultant ophthalmologist, Dr Sunita Padmanabhan says once there are signs of nephropathy (deterioration of kidney functions), it is highly likely there is onset of diabetic retinopathy in the patient as well.
Dr Sunita explains that this eye condition is caused by persistent high sugar levels that cause weakening of the blood vessels in the retina. These blood vessels then leak protein into the retinal layers causing visual problems.
"Symptoms are highly dependent on the severity of the condition. It is usually tricky to diagnose in the early stages as there are barely any symptoms," she says.
At times, patients may experience their vision becoming blurry, hazy or spotty.
NOT TO BE IGNORED
As the condition deteriorates, the walls of the blood vessels start to weaken and can leak fluid and blood into the retina. In certain cases, this can also lead to macular edema - which is build-up of fluid in the centre of the retina.
This will impair one's vision and will require treatment. In advanced stages, due to lack of sufficient oxygen - it prompts the body to sprout fragile and abnormal blood vessels. This can cause bleeding into the gel-like fluid in the eye (known as vitreous).
Over time, leaked blood in the vitreous can even result in the retina becoming detached from the eyeball.
The prolonged lack of oxygen can also cause a build-up of pressure. Eventually, this can damage the optic nerve which sends image signals to the brain, leading to glaucoma (blindness).
Dr Sunita recalls a patient who has been diabetic for several years but avoided going to the hospital for regular eye check-ups during the pandemic. He started experiencing blurring of vision for 3-4 months but assumed it was due to cataracts.
"One day, he woke up and realised all he could see was red out of his right eye."
The internal bleeding had begun. After a thorough check-up, it was discovered that the patient had kidney failure as well.
To date, there is no cure for diabetic retinopathy and there is no procedure that can replace a damaged retina.
Dr Sunita says the reason why doctors are so adamant that diabetic patients go for regular eye checks is because retinopathy has no obvious symptoms in the early stages. It can only be diagnosed with regular check-ups. The earlier it is detected, the better the outcome.
It is almost inevitable that diabetic patients will develop retinopathy. If there are no signs of it during their eye check, an annual eye appointment is necessary. If there are signs of it, check-ups need to be done every 3 - 6 months, depending on the severity of their condition.
Patients with macular edema will have an injection administered directly into the eye to help dry out the fluid and this can help restore vision.
Meanwhile, for patients with internal bleeding, laser treatment is needed to seal the leaking blood vessels.
Dr Sunita's patient had to undergo three rounds of laser treatment over a span of six months before his vision improved. Thankfully, he managed to recover some of his sight.
However, he started experiencing the same thing with his left eye and despite multiple laser treatment sessions, the bleeding would not stop. In the end, a surgical procedure, known as vitrectomy, had to be done where the blood was manually extracted.
While there is no cure, it is crucial for diabetic patients to control their sugar levels - they will have to keep track of this several times a day. On top of that, they should monitor their blood pressure and cholesterol levels and take any medication prescribed by doctors to help with this.
On the lifestyle front, they should eat a balanced diet and exercise regularly to ensure they are at a healthy weight. Those who smoke, should stop or cut down drastically as it can increase the risk of not just retinopathy, but other health complications related to diabetes.
In addition, they need to remain vigilant about eye health and schedule an appointment with their ophthalmologist immediately if there is any blurriness or haziness in their vision.
More importantly, diabetic patients must go for frequent eye check-ups. While retinopathy is difficult to prevent, the earlier the condition is detected, the better it can be managed to prevent symptoms from worsening.