Dealing with Diabetes and the Eye (Screening Process)
Are you a diabetic?
Do you know if you are a diabetic?
Do you regularly attend check-ups with your general practitioner?
Do you regularly attend check-ups with your optometrist?
If you have not answered “yes” to all of these questions, then you could unknowingly be persisting through life with diabetic retinopathy.
Optometrists and GPs are the gatekeepers for diabetic retinopathy. They cannot necessarily treat it, but they are the first ones to encounter it or diagnose it.
Diabetes and The Eyes
Due to the close correlation between Diabetes and eyesight problems, it is crucial that these issues are treated correspondingly. Our screening centres are the vehicle for this, as it forms a link between GP visits and the Fundus Camera. This correspondence is crucial, because leaving diabetes-related eyesight issues for very long could lead to the formation of Cataracts, Background Diabetic Retinopathy, Glaucoma or even total loss of sight in extreme circumstances.
Is this only for Diabetics?
Insulin-dependent diabetics are generally diagnosed at a younger age, meaning that this program is even more important for them, as these patients are being exposed to blood-glucose-level fluctuations from a very young age. That being said, those patients are usually much more aware of the eyesight-related problems which accompany Diabetes. On the other hand, non-insulin dependent patients often do not even know that they are diabetic, especially in pre-diabetic states. This can often mean that their eyesight is worsening unknowingly. For this reason, both diabetics and non-diabetics can benefit from our screening centres, as the latter is able to detect fluctuations early which could play a role in various diagnoses.
What We Do
Our screening centres aim to produce a systematic way of monitoring and making early diagnoses of diabetic retinopathy by introducing a crucial step into patients’ GP check-ups. This is to ensure that the patient’s vision is not worsening over time. Because of the way our program is set up, patients can be directed into all the necessary check-ups which enables a better control and detection of eyesight issues early, which then allows for a better prognosis.
Our program is unique to this country because it encompasses the following three essential aspects for this kind of monitoring and diagnosis:
1. The equipment:
The screening centre firstly utilises a Fundus Camera; a super specialised camera equipped with high-resolution flash photography. This allows for one of the only ways to observe arteries and veins in the body without being invasive. Through our program, patients can control and detect eyesight issues early, which then entails a better prognosis. The camera is based at our clinics, which is handled by a technician weekly. At the GP, the patient would book to have the photographs done with the clinic, where artificial intelligence will be utilised, meaning that the patient will not even be seeing a doctor. Instead, the technician and the GP will simply receive a report which will indicate whether or not this patient is referable to the specialist.
If it is non-referable, then all that will be needed is to continue to monitor that patient and continue to take photos with the usual GP visits. In this way, a series of photos can be generated to monitor the patient’s history.
On the other hand, if it is referable, then that indicates that immediate attention is necessary. This why this system makes it easier for ophthalmologists and GPs to detect and monitor eyesight issues. Because of the use of artificial intelligence and the Fundus Camera, it also significantly reduces the cost of monitoring diseases.
2. The Software
As mentioned earlier, this program involves a software to make a diagnosis in terms of whether or not the patient should be seen by an ophthalmologist. This software will utilise the images taken by the Fundus Camera to determine whether the patient is referable.
Due to the strong correlation between impaired vision and Diabetes, it is essential that every patient with Diabetes is seen by an eye specialist as well as a GP at least once each year.
3. The Medication
This is part of the treatment process, as opposed to the detection and monitoring process. If these bleeds are in the wrong place, such as your macula area, this will then affect the patient’s vision. The body can absorb this bleed at the back of the eye, however, medication such as Avastin can be used to assist the absorbing of the blood. The quicker the blood absorbs, the less damage that will be left behind.
4. The Centre
At no additional cost, at the same screening test point, the patient can also be checked for other common diseases that are leading causes of blindness, such as glaucoma, age-related macular degeneration and tumors of the eye.
Please note: it is important for the patient to indicate if they are booking just for a diabetic screening photograph when they speak to their GP.
What is Diabetic Retinopathy?
People with diabetes can have an eye disease called diabetic retinopathy or diabetic eye disease. This is when high blood sugar levels cause damage to blood vessels in the retina. These blood vessels can swell and leak. Or they can close, stopping blood from passing through. Sometimes abnormal new blood vessels grow on the retina. All of these changes can steal your vision. Diabetic retinopathy is one of the leading causes of blindness in people aged 20-64.
There are two main stages of diabetic eye disease, NPDR (non-proliferative diabetic retinopathy)is the early stage of diabetic eye disease and then the adanced stage is known as PDR (proliferative diabetic retinopathy). Learn more about these stages in our FAQ's pages.
Nonproliferative & proliferative Diabetic Retinopathy (NPDR & PDR)
NPDR (non-proliferative diabetic retinopathy):
NPDR (non-proliferative diabetic retinopathy) is the early stage of diabetic eye disease and many people with diabetes have it.
With NPDR, tiny blood vessels leak, making the retina swell. When the macula swells, it is called macular edema. This is the most common reason why people with diabetes lose their vision.
Also with NPDR, blood vessels in the retina can close off and this is called macular ischemia. When that occurs, blood cannot reach the macula. Sometimes tiny particles called exudates can form in the retina. These can affect your vision too. If you have NPDR, your vision will be blurry.
PDR (proliferative diabetic retinopathy):
PDR is the more advanced stage of diabetic eye disease. It happens when the retina starts growing new blood vessels. This is called neovascularization. These fragile new vessels often bleed into the vitreous. If they only bleed a little, you might see a few dark floaters. If they bleed a lot, it might block all vision.These new blood vessels can form scar tissue. Scar tissue can cause problems with the macula or lead to a detached retina. PDR is very serious, and can steal both your central and peripheral (side) vision.
Who is at risk of Diabetic Retinopathy?
It affects up to 80 percent of those who have had diabetes for 20 years or more. However, at least 90% of new cases could be reduced with proper treatment and monitoring of the eyes. The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy. This is why regular screening is crucial for a better prognosis.
How do I know that I have Diabetic Retinopathy?
You can have diabetic retinopathy and not know it, because it often has no symptoms in its early stages.
That is why it is important to screen for diabetic retinopathy, because leaving diabetes-related eyesight issues for very long could lead to the formation of Cataracts, Background Diabetic Retinopathy, Glaucoma or even total loss of sight in extreme circumstances.
As diabetic retinopathy gets worse, you will notice symptoms such as:
- seeing an increasing number of floaters,
- having blurry vision,
- having vision that changes sometimes from blurry to clear,
- seeing blank or dark areas in your field of vision,
- having poor night vision, and
- noticing colours appear faded or washed out losing vision.
Diabetic retinopathy symptoms usually affect both eyes.
How can diabetic retinopathy be detected?
Fundus photography captures considerably larger areas of the fundus and has the advantage of photo documentation for future reference, as well as availing the image to be examined by a specialist at another location or time. In this way, progression can be monitored. Our screening centres utilises a Fundus Camera; a super specialised camera equipped with high-resolution flash-photography. This allows for one of the only ways to observe arteries and veins in the body without being invasive. This is part of the screening process for diabetic retinopathy and is the most efficient way of managing eyesight problems for people with diabetes.
What is Fundoscopic (fundus camera) image analysis?
Using the images generated at the centre, Diabetic retinopathy can be diagnosed entirely. This is done through observing abnormalities on retinal images taken by fundoscopy.
Which other methods can be used for diabetic retinopathy diagnosis?
Fluorescein angiography is used to assess the extent of retinopathy that aids in treatment plan development. Optical coherence tomography (OCT) is used to determine the severity of edema and treatment response. Because fundoscopic images are the main sources for diagnosis of diabetic retinopathy, manually analysing those images can be time-consuming and unreliable, as the ability of detecting abnormalities varies by years of experience.
Software can be used to make a diagnosis in terms of whether or not the patient should be seen by an ophthalmologist. In this way, computer-aided diagnosis approaches to automate the process, which involves extracting information about the blood vessels and any abnormal patterns and analyzing them. This will determine whether or not a patient is referable.
What happens after diabetic retinopathy screening?
If the computer aided diagnosis indicates abnormality in your retina, you will be classified as referable and advised to book an appointment with an ophthalmologist. If it is non-referable, then all that will be needed is to continue to monitor that patient and continue to take photos with the usual GP visits. In this way, a series of photos can be generated to monitor the patient’s history.
What happens in the next appointment of a referable case (to an ophthalmologist)?
During the appointment with an eye specilaist early signs of eye disease will be detected such as:
- leaking blood vessels
- retinal swelling, such as macular edema,
- pale, fatty deposits on the retina (exudates) – signs of leaking blood vessels,
- damaged nerve tissue (neuropathy), and
- any changes in the blood vessels.
More information may be required to establish an accurate diagnosis. One or all of the following non-invasive tests may need to be performed:
- Fluorescein angiography or some other tests
If your disease is treatable we would prefer you treat it early to prevent progression of any further damage to your eye.
What are the treatment options for diabetic retinopathy?
There are three major treatments for diabetic retinopathy, which are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 95 percent chance of keeping their vision when they get treatment before the retina is severely damaged.
These three treatments are laser surgery, injection of corticosteroids or anti-VEGF agents into the eye, and surgery (for example vitrectomy).
Avoiding tobacco use and correction of associated hypertension are important therapeutic measures in the management of diabetic retinopathy.
Is diabetic retinopathy curable?
Although these treatments are very successful in slowing or stopping further vision loss, they do not cure diabetic retinopathy. The best way of preventing the onset and delaying the progression of diabetic retinopathy is to monitor it vigilantly and achieve optimal glycemic control. This is why regular screening at our centres are advised.
What is argon laser treatment?
Argon laser is used to prevent the leakage of fluid from blood vessels at the back of your eye or to prevent the development of abnormal blood vessels in the eye.
Note: You will not be able to drive home following treatment due to the eye drops used that will temporarily dilate your pupils and blur your vision. It is ideal to bring a relative/friend with you if possible.
The process of argon laser treatment:
- your eye will be dilated
- local anaesthetic drops will be put into your eye
- a lens will be placed on the eye to allow the Dr. to focus the laser on the retina
- you will then hear some clicks of the machine firing and see some bright flashes of light
- it is important to keep the eye as still as possible and open
- the process takes between 10-45 minutes
After the argon laser treatment
- due to the bright light & dilated eyes, your vision may be blurred for a few hours after
- you may experience brief discomfort or tenderness of the eyes
- a prescription may be given for further eye drops or cream
- you should avoid heavy lifting for 48 hours after laser treatment
Your vision after argon laser
- your vision may gradually improve over a few weeks or it may stay the same
- the treatment done just in one sitting may not always work due to persistent leakage and hence further treatments may be required
- the improvement is usually slow and may take weeks for you to notice.
- if the treatment has been used to prevent bleeding from abnormal blood vessels, you are unlikely to notice any change in your vision
- if you experience severe floaters and flashing lights or loss of vision please your eye specialist as soon as possible
What is vitrectomy?
Instead of laser surgery, some people require a vitrectomy to restore vision. It is performed when there is a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a saline solution.
Studies show that people who have a vitrectomy soon after a large haemorrhage are more likely to protect their vision than someone who waits to have the operation. Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a haemorrhage into the eye.
Vitrectomy is often done under local anaesthesia. Your surgeon will make a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye to remove the vitreous and insert the saline solution into the eye.
Patients may be able to return home soon after the vitrectomy, or may be asked to stay in the hospital overnight. After the operation, the eye will be red and sensitive, and patients usually need to wear an eyepatch for a few days to protect the eye. Medicated eye drops are also prescribed to protect against infection.