Diabetic Retinopathy
This week’s blog on Diabetic Retinopathy has been contributed by Dr Paola Salvetti, Consultant Ophthalmologist and Specialist in Medical Retina.
Diabetes
Diabetes is a disease related to the body’s inability to properly absorb, store and use sugar from food. This results in higher levels of sugar in the blood (hyperglycaemia).
Differences between type 1 and type 2 diabetes
Type 1 diabetes is often referred to as ‘insulin dependent’ and is mostly diagnosed in children or young adults. Type 2 diabetes is the most common type; it usually appears in adults over the age of 40 and is often related to overweight, obesity and lack of physical activity in people who are genetically predisposed.
Genetic predisposition affects people differently, depending on the type:
- In type 2 diabetes, if one parent is affected the risk of transmission to children is about 40%, which increases to 70% if both parents have the disease.
- In type 1 diabetes, the risk is much lower, being only 5%.
Diabetes is a significant public health issue in the region, with the UAE, Saudi Arabia, Bahrain, Kuwait all featuring in the top 15 countries in terms of the prevalence of diabetes worldwide. According to data from The Institute for Health Metrics and Evaluation from 2015, 19.3% of the UAE population between the ages of 20 and 79 have type 2 diabetes, which is almost 1 in 5 people, meaning that there are over 1 million people living with diabetes in the UAE. In the UAE, diabetes is also among the top seven causes of premature death and is 4th among the top causes of disability; diabetes increased by a staggering 174% between 2005 -2015.
Type 2 diabetes can sometimes be difficult to diagnose, as it is often painless and without symptoms, at least at the beginning. In fact, it is estimated that the interval between the first appearance of hyperglycaemia and the diagnosis of diabetes is around 5 to 10 years.
Prolonged and repeated hyperglycaemia leads ultimately to the damage of blood vessels and nerves throughout the body, and this includes complications in the eyes, kidneys, heart, brain and limbs.
Diabetic Retinopathy
Diabetic Retinopathy is one of the most common and serious complications of diabetes and its prevalence increases with the amount of time diabetes is present, with age, poor control of blood sugar, blood pressure, cholesterol and lipids.
Although some visual problems can indicate the presence of Diabetic Retinopathy (such as blurred letters when reading, vision difficulties when moving from light to dark) more commonly the disease starts in a completely silent way with no obvious symptoms.
Diabetic Retinopathy can be present even in patients with excellent visual acuity and no symptoms, and can only be diagnosed by the ophthalmologist with a Fundus examination. Sometimes, additional tests are required, such as OCT and Fluorescein Angiography to evaluate the risk of the progression of retinopathy. Some early cases can be just observed, whilst more advanced cases require active management.
Diabetic Retinopathy Treatment
Different treatment options are available, and sometimes a combination of the possible treatments is used. These include intravitreal injection of medications (anti VEGF and or steroids), conventional peripheral laser, subthreshold micropulse laser. In more advanced cases, with prolipherative retinopathy or with intravitreal haemorrhages, surgery may be the only possible option.
Early diagnosis of the complications of diabetes generally leads to better management and better outcomes, and that is why it is vitally important to make regular visits to the ophthalmologist.