Diabetes mellitus is a disease where there is too much sugar (glucose) in the blood. It is caused by abnormal metabolism of insulin, a hormone that regulates blood sugar in the body. Unless it is treated, diabetes will damage the eyes, kidneys and other important organs in the body.
Diabetes is a major health problem in Malaysia, affecting more and more people each year. In 2015, the Malaysian Health Ministry estimated that 1 out of 6 persons (17.5%) aged 18 years and above had diabetes. Currently, Malaysia has the highest rates of diabetes and obesity in South East Asia, ranking among the highest in the world.
Diabetic retinopathy is a complication of diabetes that can cause blindness. Diabetes damages blood vessels in the light-sensitive nerve layer inside the eye (retina). When damaged blood vessels leak, they cause the retina to swell. They may also get blocked, causing less oxygen to reach the retina. The longer a person has had diabetes, the more likely it is for diabetic retinopathy to develop.
Diabetic retinopathy usually affects both eyes. It is a common cause of poor eyesight in diabetes. It is also a leading cause of blindness among adults of working age.
There are 3 main ways to describe diabetic retinopathy:
This is an earlier and less severe stage. Blood vessel damage can be seen as areas of bleeding, leaking and swelling on the retina. Patients usually do not notice any eyesight problems at this time.
This is a later and more serious stage where abnormal new blood vessels and scar tissue form inside the eye. These new blood vessels break easily, causing bleeding into the eyeball. As the condition gets worse, patients start to have problems with their eyesight. The retina will become permanently scarred if proliferative retinopathy is not detected and treated quickly.
The macula is the vital part of the retina that is responsible for sharp vision. When diabetic retinopathy affects the macula (diabetic maculopathy), patients will find it difficult to read small print or to recognise faces easily.
At first, there are no symptoms and most patients are unaware that they have retinopathy. Later, they may experience:
Diabetic retinopathy damages vision in the following ways:
Diabetic retinopathy, neovascular glaucoma, or both can finally lead to blindness. Although the blind eye is usually painless, patients with neovascular glaucoma frequently experience constant eye irritation or pain.
The longer a person has had diabetes, the higher the risk of developing diabetic retinopathy. Although diabetic retinopathy is not completely avoidable, you can reduce your risk of getting it, if you:
Patients with early stages of retinopathy do not need treatment but they must be followed up regularly in case treatment becomes necessary.
Treatment is needed when patients have more severe retinopathy and are at risk of losing their sight. Various treatments are available to stop blood vessels from leaking; reverse the growth of abnormal new vessels; and remove blood or scar tissue in the eye.
It is important to know that damage from diabetic retinopathy cannot be completely reversed, and successful treatment only slows or stops it from getting worse. Patients will have some degree of permanently blurry eyesight if they receive treatment late.
If all treatments fail, as can happen in very late stages of diabetic retinopathy, the eye will go blind. Early detection and timely treatment of diabetic retinopathy reduces the risk of blindness by 95 percent.
A diabetic eye examination involves an examination of the retina (the light-sensitive nerve layer inside the eye).
It is not only a test of how well you can see, or a test to see if you need to wear glasses.
There are two kinds of diabetic eye examination:
Screening tests are done to detect diabetic retinopathy before patients themselves notice any problems with their vision.
It involves using a special camera to take photographs of the retinae. Apart from seeing a bright flash of light, you will experience no discomfort at all. This test may not be possible if your pupils are too small or if your eye tissues are not clear.
Some centres may put an eye drop into your eyes to dilate your pupils for the test. If this is done, you will experience slightly blurry vision for up to several hours.
An eye doctor reviews your medical history and does a detailed eye examination, checking for diabetic retinopathy and other conditions like cataract and glaucoma.
This takes longer than a screening test and usually involves dilating your pupils with eye drops. You will experience slightly blurry vision for several hours until the eye drop wears off. In the meantime, sunglasses will help to reduce any glare. You may wish to arrange for someone to drive you home after the test.
If you live in Malaysia, these are the ways you can get a diabetic retinal examination:
If you are a diabetes patient of a government clinic, you can get screening with retinal photography every year at a Klinik Kesihatan or government eye clinic. You will be given an appointment to see an eye doctor if your photographs are abnormal or if your eyesight is poor.
If you are not a patient of a government clinic, you could see a Medical Officer in a Klinik Kesihatan and ask for a diabetic eye examination. The charges are nominal but getting an appointment may take time.
There are very few places that have this service. You may choose this option if you do not have any eyesight symptoms. However, if you already have symptoms, you should go directly to see an eye doctor instead of doing this screening test.
The few available services include:
You may find other retinal photography services by making local inquiries. If you know of any other services available, please contact us for listing.
Most people with type 2 diabetes or non-insulin dependent diabetes mellitus (NIDDM) should have their first eye examination as soon as they are diagnosed, and then once a year.
Children with type 1 diabetes or insulin-dependent diabetes mellitus (IDDM) may have their first eye examination within 2 - 5 years after diagnosis, and then once a year.
Pregnancy can seriously worsen diabetic retinopathy. Women with diabetes are recommended to have their eyes checked and treated for any diabetic retinopathy before, or as soon as possible after, getting pregnant. The check should be repeated every 3 months throughout the pregnancy. This recommendation also applies to women with gestational diabetes in their first trimester of pregnancy. Generally, women who develop gestational diabetes after the first trimester do not need an eye examination.
You will need more frequent eye examinations once diabetic retinopathy has developed.
* Adapted from the Clinical Practice Guidelines for the Screening of Diabetic Retinopathy, Malaysian Ministry of Health, 2011.