Diabetes Eye Awareness Month

By Eye Health Nepal Last updated Jun 2, 2021

What is Diabetes Eyes Awareness Month?

As the world, Diabetes Day is celebrated every 14 November worldwide, many organizations and institutes celebrate the entire November month as Diabetes Awareness Month. Therefore, Drishti Eye Care System is also celebrating November month as Diabetes Awareness Month.

What is diabetes and how does it affect your eyes?

Diabetes, as we know, is a condition where there is a rise in blood sugar levels due to various reasons.
When there is an uncontrolled level of blood sugar, it results in damage to various organs of the body like heart, kidney, brain, and eyes. “Diabetic retinopathy” is the term used to describe damage to the very sensitive part of our eyes, the retina (back of the eye).

The kind of damage that takes place due to uncontrolled blood sugar levels is primarily the weakening of the small blood vessels, over time leads to blockage, and eventually leads to hemorrhages on the retina. This kind of damages is mostly irreversible, Which can lead to affect our vision to various degrees.

What is the Global and National magnitude of diabetes-related health issues?

International diabetes federation has projected that by 2040, 642 million people will have diabetes worldwide. According to the WHO, and there is no exact data of patients with diabetes in Nepal. However, the 2016 Diabetes Profile has shown that 9.1 percent of the Nepali population are living with diabetes.

It includes 10.5 percent men and 7.9 percent women. Diabetic retinopathy is the leading cause of blindness among individuals aged between 25 and 74 years worldwide. It affects three out of four individuals who have had diabetes after 15 years. More than one-third of the population with diabetes are found to have some form of diabetic retinopathy.

What are the types to diabetes-related damages to the eye?

There are basically two kinds to damages that take place in the retina due either to uncontrolled diabetes or too long duration of diabetes. Firstly, there is a weakness in the walls of the blood vessels supplying the nutrients and oxygen to the retina. Over time, these weak points give in and there is hemorrhage (leakage of blood) into the retinal tissues. If these leakages are not controlled, the accumulation of fluid and blood into the retinal tissue results in swelling. This is when people start to feel their vision is not quite right.

Another mechanism of damage to the retina is again triggered by a decrease in oxygen supply due to damage to the blood vessels. In response to a decrease in oxygen, blood vessels multiply in number in an attempt to supply oxygen. However, these newly grown blood vessels are not strong enough for the job and they prematurely bleed into the retinal tissue, again resulting in loss of vision.

How aware are the patients (diabetics) about the need for regular eye check-ups?

Not much. People seem to be quite aware of diabetes causing damage to the kidneys. However, there seems to be a lack of awareness regarding the damage caused by uncontrolled diabetes to the eyes. Even not all the clinicians involved in treating people with diabetes are aware of diabetes-related damage to the eyes resulting in a lack of timely referral for an eye examination. Hence in developing countries like ours, there is a need for awareness campaigns targeted towards patients as well as treating physicians.

Are there any ways of preventing diabetes-related damage to the eyes?

Yes. Once you are diagnosed with diabetes, it is very to have a regular eye checkup that should include dilated Retina Checkup should be a part of your overall diabetes management preferably by a retina specialist every 6 months. To prevent diabetes-related damage to the eyes, mainly your diabetes has to be detected on time for which you need to have the regular health check of your body.

Many diabetic individuals believe that eye check-ups are necessary only if you have eye problems and which is not true. It is this lack of awareness, which has resulted in an increasing number of people with diabetes presenting to us with severe vision loss. Therefore, the referral of diabetes patients by physician or endocrinologist to the ophthalmologist (Retina Specialist) will play a key role to prevent diabetes-related eye damages.

What are the treatment options available to those who have already had diabetes-related damage to their retina?

There are mainly two modes of treatment. The good thing about this treatment is that they work but not so good thing about them is that it might have to be ongoing for a long time.

If there is swelling of the centre of the retina (macula), then the only treatment that might work is an injection of anti-VEGF agents (Inj. Avastin) into the eye. However, this mode of treatment is not straight forward. One might need several doses of this injection at monthly intervals depending on the extent of swelling. One dose of such injection costs around Nrs 7000. Hence, a massive financial burden to the family. Here, once again, I would like to stress on the fact that, if one has regular eye check-ups every 6 months, they might be saved from undergoing such intensive and costly treatment.
In the case of new blood vessel proliferation, treatment of choice is laser treatment. In this, the laser beam is applied to the periphery of the retina in order to save the most sensitive central part of the macula. Again this treatment does not necessarily improve vision and is mainly to preserve remaining vision
In many cases, there are mixed features of macular swelling as well as new blood vessel proliferation. In such cases, combination of treatment with laser as well as an injection into the eye is necessary.

How can we all work together to address this problem in the community?

The multi-disciplinary approach is what we need to control this problem. When I say the multidisciplinary approach, it means efforts from all the parties involved in the care of individuals with diabetes. The doctor, dietician, diabetes counsellor etc. should stress upon the importance of regular detail eye examination.

– Firstly, there should be guidelines and support from the government to implement nation-wide diabetic retinopathy screening program, which is still lacking.

– Secondly, these patients should be made aware of the eye-related complications that might arise in the future and how to prevent them.

– Thirdly, patients should also be proactive and listen to the advice given to them. They should keep in mind that management of diabetes is not just about blood sugar control but caring about their overall health including their eyes. Last but not the least, every eye hospitals should have a program to screen, monitor and manage diabetic-related eye diseases. It should be not only about treating the problem but about providing support and rehabilitation to those who have lost their vision due to diabetes-related eye complications as well.

Dr Samyukta Bista(Karki) MD, Ophthalmology(TU) M OPhth, Otago University, NewZealand, Medical Retina Specialist, Fellowship: Medical Retina(Tilganga Instititute of Ophthalmology) Currently working at Drishti Eye Care Center

Diabetes and Eye