Dr Gareth Fernandes explains why a good relationship with your ophthalmologist will stand you in good stead.
We are often looking for a quick fix, when it comes to medical problems. We have become accustomed to near instantaneous results regarding ophthalmic treatments; vision is often excellent within a few hours of cataract or refractive eye surgery. Many diabetes patients would have had cataract surgery as they tend to get cataracts at a younger age than non-diabetes patients. However, many of the other ophthalmic problems, which are associated with diabetes patients, are chronic and persistent and require long-term treatment. For this reason – a good, steady long-standing relationship with your ophthalmologist is essential. This relationship would ideally go through a number of stages as discussed below.
Ideally, you should see an ophthalmologist (or optometrist) after five years of diagnosis of Type 1 diabetes and within a year of diagnosis of Type 2 diabetes. We, as medical practitioners, need to detect problems before your vision is affected.
Even if your vision is affected, the deterioration may be very slow, and can be compensated for by the other eye so that you don’t notice the decline. Though, you should not wait for your vision to deteriorate before coming to see us. The reason for this is, many of the effects of diabetes on the retina do not cause symptoms, and when diabetes does start to affect your vision – causing symptoms, some of the damage (to the retina) may already be irreversible. This means that even with ideal treatment, we may be able to improve your vision, however, we may not be able to restore it to normal.
Screening can be frustrating. You may see your ophthalmologist annually, only to be told that everything is okay. Many diabetes patients don’t need any treatment until five, 10 or even 20 years after diagnosis. After a few annual visits, it is easy to become blasé about the health of your eyes and lose motivation to continue your annual visits. You may only return when your vision is reduced and the damage is irreversible, and we may not be able restore your vision to normal again. Hence, why during this screening period it is so important to build a good and lasting relationship with your ophthalmologist.
Reduced vision in the diabetic population has many diverse causes. You may simply need glasses. As mentioned, conditions like cataracts can be easily and permanently cured with surgery, producing good results and a return of normal vision.
The most important and worrying cause of loss of vision in diabetes patients is from chronic damage to the small blood vessels in the retina (the membrane at the back of your eye which detects light and forms an image, much like the film of a camera).
One of the most common causes of retinal visual loss in diabetes patients is macula oedema. This is when the blood vessels of the retina become leaky, allowing too much fluid to seep out into the retina, causing the retinal tissues to swell. Macula oedema can be satisfactorily treated by monthly injections into the eye. The injections make the retina blood vessels less leaky, reducing the seepage of fluid into the retina. As the eye absorbs the excess fluid in the retina, the vision improves. Diabetic patients with macula oedema really need a solid, ongoing relationship with their ophthalmologist because it may take a few months for the fluid to be absorbed and little improvement may be seen initially, despite the monthly injections. But, if you persist with the treatment, you’ll usually be rewarded with improved vision. Once the fluid is gone, your vision is as good as we can get it. Your injections unfortunately do not end there; the injections will still be required to maintain your vision. We can usually increase the interval between injections at this point. The good news is that over the years you will require fewer and fewer injections to maintain control of the macula oedema.
The retina can also be affected by the formation of new blood vessels on the retina. These may bleed into the eye, causing reduced vision, or they may cause scar tissue to form on the retina. The scar tissue can cause permanent damage to the retina. Hopefully, if you have been seeing your ophthalmologist regularly, they would have been able to detect the new blood vessels before they form the scar tissue. We can laser the retina to stop the new vessels from progressing. This will prevent formation of scar tissue and allow you to maintain good vision.
All is not lost if scar tissue has damaged the retina. We then can remove the scar tissue surgically. This should prevent further deterioration in vision and can result in significant visual improvement.
Diabetic eye disease has multiple effective treatment options, and it is critical that patients have a good relationship with their ophthalmologist in order to benefit from these treatments. It is important to have a good understanding of your specific problem; the limitations and side effects of your treatment; and a realistic expectation what the treatment can do for you. This understanding is essential because the treatment is long-term and you need to persist with treatment to get the most benefit.