Last Updated on January 8, 2024 by srivastava Ankita Srivastava
In the modern era, diabetes has reached epidemic proportions. Nevertheless, its impacts extend far beyond fluctuating blood sugar levels and insulin management. One of the lesser-known but serious consequences of diabetes is its impact on vision health. The relationship between diabetes and vision loss needs attention. In this interview, Dr Sheetal Savur discussed the ways in which diabetes impacts a person’s vision and how it can lead to vision loss. Dr Sheetal Savur is an experienced ophthalmologist and Professor and Head of the Department of Opthalmology at Yenepoya Medical College in Mangalore.
How do elevated blood sugar levels affect vision?
Dr Sheetal Savur: If a person has diabetes and their blood sugars remain elevated for a long time, there are certain changes that happen in the blood vessels. This especially is pertinent to us because of the layer, what we call as retina, which is the light-sensitive layer. It has blood vessels, and due to long-standing diabetes, it gets a little leaky. Since they get leaky, there’s a lot of collection of fluid inside the retina. This especially happens in the region of the macula that is responsible for the sharpest vision. So if fluid accumulates there, it tends to blur our vision. The changes depend on the stages of diabetic retinopathy. In the later stages, the light-sensitive retina tends to get detached. That’s when it is serious and you can’t do much at that stage.
Also before that, there’s a stage where there is bleeding inside the eyes because it gives rise to new vessels. Now, these new vessels are very fragile. They have no strength in them. So a sneeze, a cough, or lifting something heavy can rupture and give rise to bleeding inside the eye. These are the different changes that happen in the blood vessels and also in the retina that consequently affect vision.
What are some warning signs and symptoms experiencing which a person should seek immediate medical attention?
Dr Sheetal Savur: There’s one important thing that we need to understand about diabetes and diabetic retinopathy in particular. The diagnosis of diabetes is important. In a lot of cases, you wouldn’t know about the condition for a very long time unless it progresses and starts giving you symptoms. But we should not wait for that long. Therefore, the first thing to remember is to get yourself screened for diabetes regularly. If you have diabetes, go and get your eyes checked for retinopathy.
Now, if it is a little more advanced, then it will present to you as a blurring of vision, dark spots in front of the eyes, flashes in front of the eyes, or a full area of vision turning dark. But we don’t want to wait until these warning signs come for timely intervention and management of the condition.
How do medical professionals manage the eye problems associated with diabetes?
Dr Sheetal Savur: Whenever diabetes is diagnosed, the first thing that they need to do is to send the patient to an ophthalmologist. When a patient walks into an ophthalmology OPD, after a preliminary examination, where we check vision, et cetera, we dilate the pupils. It is done so that the retina becomes visible to us. The retina can tell us about the brain as well as the kidney health of a person. It can also tell us at what stage a person’s diabetic retinopathy is.
It is not only about diabetes. In some cases, some associated comorbidities like blood pressure, lipid levels, etc. can also worsen diabetic retinopathy. There are a couple of investigations. For example, there is an OCT scan which will tell us what kind of fluid accumulation is happening inside the retina. Another investigation that used to be done in the earlier days, is the Fundus Fluorescein Angiography, which tells us where and how much leakage is there in the retina so that those areas can be treated.
How can one prevent the impact of diabetes on the eyes?
Dr Sheetal Savur: No. See, you just have to get yourself diagnosed. Well, keep the sugars under control, because the most important risk factor for a diabetic to develop diabetic retinopathy is the duration of the diabetes. So if it’s present for more than ten years, 15 years, or 20 years, then because of the time factor, the changes are bound to come.
Second is the amount of blood sugar. That is, if the control is poor, if the sugar levels are very high, again, it could accelerate retinopathy. And as I said earlier, other things like hypertension, and hyperlipidemia, are the things that could worsen diabetic retinopathy. Actually, to sum you take care of all these conditions, you control your sugar lifestyle modification, control your BP. To a certain extent, we can reduce the effect of diabetic retinopathy, especially in the early stages. It might come down by itself without treatment.
What if diabetes has already caused some vision loss in some individuals? How can such people be helped?
Dr Sheetal Savur: There are three categories of management. We either treat it medically by giving lasers and intravitreal injections. And the other option is surgical, which generally happens in the advanced stages of diabetic retinopathy. However, we don’t want it to reach that stage. In the initial stages, when there’s an accumulation of fluid inside the retina, especially in the area of the macula where the vision is maximum, there are injections given inside the eye. Sometimes one injection helps if it is mild, but sometimes we need to keep repeating it a few times. Okay. So that is one modality of treatment.
Now, if there are those new vessels that are formed, which I told you could rupture and bleed. So if those vessels are formed, then we need to treat them with the help of a laser. So there are at least two to three sittings that might be required if it is quite severe. However, if a certain amount of damage has occurred, we can’t undo it. The only thing we can do is prevent further damage.
When surgical management is necessary, that means the damage is pretty severe. The retina has sort of come off from its underlying attachment. There’s fluid accumulated, there’s something pulling on it. So that’s not a very good sign. There’s a lot of haemorrhage inside the vitreous cavity. So that’s when we opt for surgical management and the prognosis for vision at this stage is not so great. So we may get good anatomical success, but functionally patient may not regain so much vision.
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