How is your relationship with your ophthalmologist?

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.

MEET OUR EXPERT - Dr Gareth Fernandes

relationship ophthalmologist diabetes
Dr Gareth Fernandes is an ophthalmologist in private practice at Visiomed Eye Laser Centre in Northcliff, Johannesburg. He completed his ophthalmology training at Wits University in 2014. He performs a range of treatments for diabetes patients, including diabetic screening, intra-ocular injections, laser treatments and cataract surgery.

How is your relationship with your heart?

Our hearts serve us dutifully, sustaining us from our first to our very last breath. In view of this, the Heart and Stroke Foundation South Africa (HSFSA) have come up with six practical tips to treat your heart with the respect and care it deserves.

Get active!

A strong heart is a happy heart. Regular exercise provides profound long-term health benefits including benefits which protect your heart’s health, such as:

  • Improves ‘good’ cholesterol levels
  • Helps lower high blood pressure
  • Helps reduce and control body weight
  • Helps control blood sugar levels and reduces the risk of developing diabetes
  • Helps to manage stress and releases tension
  • Reduces the risk of heart disease and stroke

Aim for a minimum of 150 minutes of moderate activity a week, such as 30 minutes 5 days a week, or 75 minutes of vigorous activity per week, such as 20 minutes 4 times a week.


Know your numbers

All strong relationships are built on good communication. Blood pressure, cholesterol and blood glucose values shouldn’t be a secret than can ruin the relationship with your heart. If these hidden numbers are out in the open, a broken heart could be saved before it’s too late! So go for regular health checks to make sure you know what your numbers are.


Eat well

How we eat and it’s impact on our daily blood glucose control has an accumulating effect on our heart health. Which means that our daily choices which stretch over months and years have a far larger impact on our heart’s health than the odd chocolate. So, care for your heart by nourishing your body daily with a balanced, healthy diet. Eat more healthy foods such as fruits, vegetables, beans, low-fat dairy, whole grains, and healthy fats like olive oil and avocados. Watch your portion sizes to avoid over-eating and eat less food with excess sugar, salt and bad fats such as take-aways, sugary drinks, cakes and pies. For individualised dietary advice and support, find a dietitian at

Build healthy relationships

Could love improve heart health? Satisfying relationships and social support don’t only make us feel happy and loved, but may also provide health benefits. One reason for this is that it may lower harmful levels of stress and stress hormones. Many behaviours, such as human touch or showing affection; affirming our love for one another; caring behaviours or offering help, could elicit this calming effect, sense of security and support. Loved-ones may also provide encouragement for us to take better care of ourselves by preparing and enjoying healthy meals together and supporting us to go for regular health check-ups.

Avoid smoking

Even though most people associate smoking with lung health, more smokers will in fact suffer heart disease. Smoking almost triples the risk of heart disease and more than doubles the risk of having a stroke. Therefore, you can’t have a good relationship with your heart if you light up a cigarette daily. It’s like saying ‘I love you, but I don’t want to be with you’. Quitting however, is not easy, it’s like getting out of a bad relationship. So don’t do it alone, ask for help or get in touch with any of the following support programmes:

Mind your mental health

Stress and depression have both been linked to an increased risk of heart disease. While we can’t always escape day-to-day stress, we can manage it effectively. Instead of reaching for a cigarette or a donut, try to relieve your stress with something healthier like going for a brisk walk, speak to a friend or take time to do something you enjoy.

Depression is a common mental disorder characterized by lowered mood, negative thoughts, low energy levels and a change in appetite. It increases the risk of heart disease by 50% compared to someone without depression. If you think you may suffer from depression, then speak to someone you trust and seek professional help from a psychologist or psychiatrist. Depression can be effectively treated but the first step is recognising it.