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Diabetes
Diabetes

ABOUT DIABETES

Diabetes occurs when your body doesn't produce enough of the hormone "insulin" or because the insulin that is produced has a reduced effect. Insulin regulates the way your body uses the food you have eaten. If you have diabetes your body cannot cope in the usual way with sugar and other carbohydrates that you eat.

Nearly one person in 25 in the UK has diabetes mellitus.

Some children have diabetes but developing diabetes is much more common later in life. Diabetes can cause complications which affect different parts of your body, including your eye(s). The two main types of diabetes mellitus are known as Type 1 and Type 2 diabetes.

This page explains how diabetes may affect your eyes. It gives information on how eyes should be monitored, how eye conditions are treated and about help for when your sight changes.

Type 1 diabetes

This type of diabetes commonly occurs before the age of 30 and is the result of the body producing little or no insulin. Type 1 diabetes is primarily controlled by insulin injections so it is sometimes called insulin dependent diabetes.

Type 2 diabetes

This type of diabetes commonly occurs after the age of 40. In this type of diabetes the body does produce some insulin, but the amount is either not sufficient or the body is not able to make proper use of it. Type 2 diabetes is generally controlled by diet, exercise and/or tablets. Although some people in this group will use insulin injections it is sometimes referred to as non-insulin dependant diabetes.

South Asian communities and diabetes

People from India, Pakistan, Bangladesh and Sri Lanka (South Asian communities) have a four or five times greater risk of developing diabetes than someone from a European community. Around 20 to 25 per cent of South Asian adults aged 50 or over in the UK develop Type 2 diabetes.

At the moment the reasons why people from these communities are more at risk of Type 2 diabetes are not fully understood. There are thought to be a number of factors involved. As well as genetic make up these include diet, being overweight and not doing enough exercise.

If you are from a South Asian community it is important that you know about the risk of developing Type 2 diabetes, the sight loss it can cause, and the steps you can take to reduce the risk of losing your sight. Diabetes UK provides lots of information on their website.

Gestational diabetes mellitus (GDM)

GDM is a type of diabetes that sometimes arises during the second or third trimester of pregnancy. For most women this diabetes goes away after pregnancy but it increases the chances of developing of Type 1 or Type 2 diabetes in later life.

How your eye works

When we look at something, light passes through the front of the eye, and is focused by the cornea and lens onto the retina. The retina is a delicate tissue that is sensitive to light. It converts the light into electrical signals that travel along the optic nerve to your brain. The brain interprets these signals to "see" the world around us. The retina is supplied with blood by a delicate network of blood vessels. These blood vessels can be damaged by diabetes.

Light entering your eye is focused onto an area of the retina called the macula, which is about the size of a pinhead. This highly specialised part of the retina is vital, because it allows you to see fine detail for activities such as reading and writing, and to recognise colours. The rest of the retina gives you side vision (peripheral vision).

Your eye is filled with a clear jelly-like substance called the vitreous gel. Light passes through the gel to focus on the macula.

DIABETES IN THE EYE

Diabetes can affect your eye in a number of ways:

  • The most serious eye condition associated with diabetes involves the network of blood vessels supplying the retina. This condition is called diabetic retinopathy.
  • The unusual changes in blood sugar levels resulting from diabetes can affect the lens inside the eye, especially when diabetes is uncontrolled. This can result in blurring of vision which comes and goes over the day, depending on your blood sugar levels.
  • A longer term effect of diabetes is that the lens of your eye can go cloudy, This is called a cataract.

Not everyone who has diabetes develops an eye complication. Of those that do, many people have a very mild form of retinopathy which may never progress to a sight threatening condition.

Diabetic retinopathy

The most serious complication of diabetes for the eye is the development of diabetic retinopathy. Diabetes affects the tiny blood vessels of the eye and if they become blocked or leak then the retina and possibly your vision will be affected. The extent of these changes determines what type of diabetic retinopathy you have. Forty per cent of people with type 1 diabetes and twenty per cent with type 2 diabetes will develop some sort of diabetic retinopathy.

Background diabetic retinopathy

This is the most common type of diabetic retinopathy and many people who have had diabetes for some time will have this early type. The blood vessels in the retina are only very mildly affected, they may bulge slightly (microaneurysm) and may leak blood (haemorrhages) or fluid (exudates). As long as the macula is not affected, vision is normal and you will not be aware that anything is wrong. Your retinal screening test will keep a close check on these early changes and ensure that any signs of progression to more serious stages of retinopathy are detected early.

Maculopathy

Maculopathy means that your macula is affected by retinopathy. If this happens, your central vision will be affected and you may find it difficult to see detail such as recognising people's faces in the distance or seeing detail such as small print. Most maculopathy can be treated with laser with the aim of preserving as much vision as possible. The amount of central vision that is lost varies from person to person. However, the vision that allows you to get around at home and outside (peripheral vision) is not affected.

Proliferative diabetic retinopathy

If diabetic retinopathy progresses, it can cause the larger blood vessels in the retina to become blocked. These blockages can result in areas of the retina becoming starved of oxygen. This is called ischaemia. If this happens the eye is stimulated into growing new vessels, a process called neo-vascularisation. This is the proliferative stage of diabetic retinopathy, and is nature's way of trying to repair the damage by growing a new blood supply to the oxygen starved area of your retina.

Unfortunately, these new blood vessels are weak, and grow in the wrong place - on the surface of the retina and into the vitreous gel. As a result, these blood vessels can bleed very easily which may result in large haemorrhages over the surface of the retina or into the vitreous gel. These types of haemorrhages can totally obscure the vision in the affected eye as light is blocked by the bleed. With time the blood can be reabsorbed and vision can improve.

Extensive haemorrhages can lead to scar tissue forming which pulls and distorts the retina. This type of advanced diabetic eye disease can result in the retina becoming detached with the risk of serious sight loss.

SHOULD YOU REQUIRE ANY FURTHER ASSISTANCE, PLEASE CONTACT US ON 01159 244244 AND SPEAK TO ONE OF OUR QUALIFIED OPTOMETRISTS (we are registered with the GENERAL OPTICAL COUNCIL)