DIBETIC RETINOPATHY: PREVENTION IS BETTER THAN CURE

Diabetes is a disease characterized by persistent high blood sugar levels either due to decreased insulin production in the body as seen in young type 1 diabetics, or due to increased insulin resistance in the body preventing its proper action as seen in older type 2 diabetics. The incidence of diabetes is rising rapidly especially in the developing countries and India is expected to become the diabetic capital of the world by 2020 with the maximum number of patients in this country compared to any other country in the world. The situation is especially grim in North India especially the Punjab belt where the incidence of diabetes seems to be increasing with every passing day. Multiple factors have been suggested to play a role including genetic susceptibility, unhealthy dietary habits, sedentary life style, truncal obesity and lack of regular exercise.

Diabetes, once it develops, slowly damages various organs in the body including the Kidneys, the eyes, the heart, the blood vessels and the nerves. The most dangerous and worrisome factor about diabetes is that it dose not cause any symptoms in the early days of the disease and is not usually diagnosed till the damage has become very extensive in the body. Hence screening is must to pick up diabetes at an early stage before it has caused damage to any organ in the body. Based on my experience with thousands of diabetic patients, I recommend regular screening Fasting and Post- prandial blood sugar levels to be done for the following individuals with:

  • Family history of Diabetes in parents or siblings.
  • Unexplained weight loss.
  • Repeated skin infections like boils.
  • Extra-ordinary delay in wound healing.
  • Unexplained pain in the lower legs.
  • Excessive thirst, repeated urination and unusually increased appetite.

As I mentioned above, Eyes are one of the first organs in the body to be affected by diabetes even in its early days. In the eyes it can cause cataract, glaucoma and the most severe and blinding disease of them all: DIABETIC RETINOPATHY. All of you who suffer from this disease know that this disease dose not cause any visual loss in its early stages but can lead to total blindness when it becomes advanced. Hence it is important that diabetic retinopathy is picked up and treated at an early stage. The current standard of treatment includes retinal laser treatment, intravitreal anti-VEGF injections and vitreous surgery for very advanced disease, the result of which are also very limited if the damage has become extensive. Kindly remember that unlike some parts of the eye like the lens and the cornea which can be replaced or transplanted once they are damaged, Retina in spite of the present medical advances and continuous research, can not be artificially replaced or transplanted from other human donors. Hence what ever treatment we can offer at present is to repair your damaged retina to some extent and to prevent further damage because of the diabetes.

Hence the most important question for some of these diabetic patients is that: if the treatment for advanced diabetic retinopathy is very limited with moderate recovery, is it possible to prevent the diabetes from affecting your eyes (Retina) at all or preventing it from progressing from early to advanced stage so that it does not affect the vision at all. The answer is YES, we can. These are the recommendations based on various studies being done throughout the world.

Maintain your blood glucose levels as close to normal as possible. For this the diabetes need to picked up early by screening the susceptible population and by aggressive treatment of the disease. Regular exercise and dietary and dietary restrictions help to further control the blood sugar levels. It has been shown by simple controlling the blood sugar levels, you can prevent or postpone the damage occurring to the eyes, so that the damage that would have occurred with 5 years of uncontrolled diabetes.

Controlling associated diseases like Hypertension and anemia. Studies show that high BP levels are associated with faster progression of the disease in the eyes. Similarly patients with low blood Haemoglobin levels may have more advanced diabetic retinopathy compared to patients with normal HB levels and improving the HB levels may reverse some of the diabetic damage in the eyes.

Regular eye check up: This may be the most important factors in saving your eyes. It is recommended that type 2 diabetics (age> 35 years) should get their eyes checked as soon as they are diagnosed to have diabetics and on yearly basis thereafter. While type 1 diabetics (age

In my experience I have seen many patients presenting with sudden visual loss due to advanced diabetic retinopathy although they say that they had got their eyes checked just few months back by an eye doctor. The problem lies in the fact that not all eye doctors are trained in examining the retina of the retina of the patient and picking up the disease at an early stage. Hence it is very essential that you get your eyes (Retina) checked by a trained retina specialist after putting a drop of dilator drops in your eyes.

Always remember that timely laser treatment is very effective in restoring or preserving your vision when the damage is minimal or mild compared to when it is very advanced and hence the old phrase “prevention is better than cure”. The above points may held you in saving your eyes, preserving your vision, avoiding anxiety in the family and saving thousands of rupees required for treatment of advanced diabetic retinopathy.

M.S. OPHTHAL Retina specialist
Consultant, Medical retina and vitreo-retina surgery.
Sri Guru Harkrishan Sahib Charitable Eye Hospital,
(Eye Institute & Multi Speciality Hospital)
Sector 77, Sohana, MOHALI.
Website : http://www.sghshospitals.com

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