Diabetes and Eye Care

1. Diabetes and Eye Care

2. What is Diabetes? • Diabetes is a condition in which there is too much sugar (glucose) in the blood. Although sugar is needed to provide energy for the body, when in excess, it causes problem. • Persons with diabetes have excess sugar because they lack or have deficient supply of insulin.

3. Diabetes “Mild Disease” Serious consequences

4. Diabetes Mellitus A Serious Disease Leading cause of new cases of blindness 25 times more prone to eye problems 6 times higher risk for Paralysis (stroke) 2-3 times higher risk for heart attack 5 times more prone to Kidney failure 20 times more prone to lower limb amputation Nerve damage causes loss of sensation

5. Diabetes and Your Eyes • Why eye care is important when you have Diabetes • Diabetes is the third most important cause of new blindness in adults • Serious eye problems often develop without warning symptoms • Blurring of vision is often the only symptom when blood sugar is high • Consistent high blood sugar causes severe loss of vision

6. The Eye Lens Vitreous Aqueous humor (anterior chamber) Optic Nerve Retina Cornea Iris and pupil Choroid Sclera

7. How do we see ? • Retina -the inner lining of the eye ball is sensitive to light and continues as the optic nerve • The light, enters the eye through the cornea and pupil - the central hole in the iris (curtain of the eye); gets focused by the lens and falls on the retina, which changesit into nerve signals • The signals are transmitted through the optic nerve to the brain enabling us to see

8. How do we see ? • Without proper functioning of the retina, it is not possible to see • Retina has a rich supply of thin blood vessels • Macula is the dense area in the centre of the retina without blood capillaries and concentration of light sensitive cells. It is the centre of sharp and colourvision where the focused light falls. Damage to the macula causes loss of vision

9. Diabetes and Eye Problems • The eye is supplied with oxygen and other necessary nutrients through a network of capillaries (very small blood vessels). Unfortunately this blood supply can be damaged as a result of diabetes. • When enough capillaries are damaged, the blood supply to an area of the retina is impaired • This interruption of the circulation causes formation of new, smaller blood vessels • These new blood vessels are fragile and can easily break. When this happens blood leaks in to the eye spaces and results in to visual loss. Newly formed blood vessels

10. The cornea The iris; pupil and anterior chamber The lens The vitreous The retina The eye muscles Corneal erosion – ulcer in the cornea due to dryness Acute glaucoma Swelling and Cataract (lens becomes opaque) causing blurred vision and blindness Bleeding in vitreous Swelling, new blood vessels; bleeding; detachment Double vision Parts of the Eye How they are affected by Diabetes

11. Visual Disturbances in Diabetes • Blurred vision • Double vision • Cloudy vision • Floating spots in the visual field • Curtain like shadows in the eye • Red, irritated eyes • Painful pressure in the eye

12. Symptoms of Eye Disease • Blurred Vision - high blood sugar changes the shape and flexibility of the lens distorting the ability to focus and causes blurred vision. Frequent changes in eye glasses can occur both when diabetes is out of control and when it is brought under control. • Double Vision - means two objects are seen where only one exists. It occurs when the nerves controlling eye muscle are damaged due to high blood sugar.

13. Symptoms of Eye Disease • Cloudy vision- occurs because of developing cataract or swelling of the retina, it occurs over a period of months of uncontrolled diabetes. • Floating spots - the vitreous of the eye contains small transparent threads, which lose their transparency with age and may be seen as dark spots or lines. This occurs earlier in persons with diabetes.  

14. Symptoms of Eye Disease • Curtain like shadows in the eye - retinal detachment or major bleeding in the retina may cause curtain like shadows in the front of the eye. This occurs suddenly and causes blindness. • Red irritated eyes may be due to some infection in the eye. • Sudden pain in the eye may be due to glaucoma, which is due to increased pressure in the eye.

15. Symptoms of Eye Disease • You may also have serious eye problems without any symptoms • Insist on examining your eyes when you are diagnosed or as soon as possible • See your eye specialist regularly for examination as advised by your doctor

16. When to get your eyes Tested ? Children >10 years and Within 3-5 years of diagnosis and adults< 30 years thereafter once a year Adults > 30 years At the time of diagnosis and thereafter once a year

17. When to get your eyes Tested ? • Women with diabetes in child bearing age prior to or after becoming pregnant and then in the 1st trimester; after pregnancy as advised above.      • Those already diagnosed with abnormal findings need to be tested more frequently as advised by their doctor.

18. Common Test done to Check the Eyes • Visual acuity (sharpness of vision) test: The eye chart test measures how well we can see at various distances. • Ophthalmoscopy: Examination of the eye with a fundoscope an instrument through which the doctor looks into the eye. Sometimes the doctor may put eye drops to widen the pupil- central hole in the iris the curtain of the eye) so that he can look at the retina better for signs of diabetic retinopathy.

19. Common Test done to Check the Eyes • Tonometry: A test that determines the fluid pressure in the eye to check for glaucoma.

20. What can be found through Ophthalmoscopy ? • Retinal swelling, such as macular edema • New blood vessel formation or changes in the blood vessels • Leaking blood vessels or retinal bleeds • Pale, fatty deposits on the retina -sign of leaking blood vessels in the past • Damaged nerve tissue • Detachment of the retina

21. Normal Eye on Fundoscopy ? Retinal Blood Vessels Optic Disc Macula

22. Changes in Retina due to Diabetes ? Microaneurysm Bleeding

23. Changes in Retina due to Diabetes ? Newly formed blood vessels

24. How to Prevent Eye Problems • These changes cause no uncomfortable symptoms at first, but if allowed to continue over the years can result in serious loss of vision • Strict control of diabetes is most important to prevent these changes • Regular eye examinations are essential to detect and treat these changes at an early stage

25. What is the Treatment for Retinopathy • Good diabetes control is important to prevent further progression • Laser Surgery - Doctors pass laser rays to burn the leaking capillaries and also the non essential parts of the retina to reduce need for new blood vessels to form and reduce swelling in the macula • Vitrectomy – Vitreo- retinal surgery is done to remove clots from the vitreous over the retina; remove fibrous tissue and reattach the retina which has been torn apart to restore vision to the eye

26. Save Your Eye Sight Take Action • Consult your diabetes care team or eye doctor if you find any changes in your vision or any problems with your eye • Insist on your eye being examined as required • Take good care of your diabetes, achieve good blood sugar control. Take Insulin if advised It will save your eye sight and vision