Management Eye Complications
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Sight threatening eye disease is a serious complication of diabetes and can often be present without visual symptoms. |
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Early detection and appropriate management can greatly reduce risk of visual loss. |
All Patients with Type 2 Diabetes must have a Baseline Visual Examination
This must include :
History of visual symptoms.
Measurement of
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Visual acuity . |
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Intraocular pressure . |
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Refractive errors should always be corrected after a period of stable control . |
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Cataract and Glaucoma (with special focus on open angle glaucoma) are more common in diabetics and should be actively looked for. |
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Ophthalmoscopic examination through dilated pupils. |
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Annual fundal (retinal) photography has been recommended but this may not be necessary, or feasible in most patients. This examination should be done at the time of diagnosis and repeated on an annual basis. It should be carried out by a person killed in diagnosing diabetic eye involvement. |
Patients at special risk, and those who show the presence of abnormalities, may require more frequent checkups; these patients should be seen along with a specialist.
Patients at special risk include.
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Women who are planning a pregnancy, must have a detailed eye examination. |
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All pregnant women must have a detailed eye examination for the presence of retinopathy at the time of diagnosis and then as frequently as warranted. |
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Patients with unexplained visual symptoms, deterioration in visual acuity, increased intraocular pressure, any retinal abnormalities any other ocular abnormality that threatens vision. |
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Patients with preproliferative retinopathy (multiple cotton wool spots, multiple intraretinal hemorrhages, intraretinal micro vascular abnormalities venous beading.) |
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Patients with proliferative retinopathy (retinal neovascularisation, preretinal or vitreous hemorrhage, fibrosis, traction retinal detachment.) |
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Macular edema (hard lipid exudates and/or retinal thickening in side the temporal vascular arcades). |
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Presence of microalbuminuria, hypertension and smoking. |
Maculopathy
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macular (central vision area of retina) involvement in diabetic retinopathy is an emergency; |
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unless diagnosed in the very early stages and managed adequately, it can lead to significant visual loss (central vision loss). |
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It is recommended that all Patients use an Amslers Recording Chart which allows early detection of maculopathy. |
Management strategies for Diabetic Retinopathy.
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Meticulous glycemic (sugar) control. |
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Maintenance of normotension (normal blood pressure); although association not proven, will help in the associated cardiovascular and renal disease states. |
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Treat Dyslipidemias. (Lipid abnormalities) |
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Close surveillance and early referral for photocoagulation. |
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There are no known specific drugs which have been proven to be of help in reducing the progression of retinopathy, although some recent studies have shown that ACEI (a class of antihypertensive drug) may be some help in retarding the progression of diabetic retinopathy. |
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Laser photocoagulation therapy is effective in reducing the risk of further visual loss and is generally useful in preventing blindness in diabetics with high risk proliferative retinopathy and macular edema. There is now evidence that early treatment with laser photocoagulation, without waiting for the development of severe changes, may lead to a better prognosis in preventing vision loss. |
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Vitrectomy may restore vision in some patients with recent traction retinal detachment or vitreous hemorrhage |