Cataract due to Diabetes

Emmanuel Nobre from Kabankalan City came to us last April 14, 2010.  I found him young to be operated on for cataract and i got curious what caused the amputated foot. 

Years back he was diagnosed to have diabetes but didn't mind it until a wound on his toe started swelling and took really long time to heal.  It was too late when he decided to consult a doctor.  He has no choice but to have it amputated. To worsen the situation his vision was affected too.  Suddenly things are not clear anymore.  Losing a foot and eventually losing the eye sight is not something to look forward to in the future. 

Good thing is that he has been referred to our partner NGO, NORFI, and he will have a leg prosthesis soon. =)  He's quite hesitant to submit himself for cataract surgery but we encouraged him to go for it. Take a risk and hope for the best rather than have a dark life for whatever years he still has. 

There may be more Emmanuel Nobre's that you know of. Tell them to take action when they have diabetes as it can cause them to be blind.  Don't wait too long as it may too late when they have gather their courage to consult a doctor.  It is a must that if you have diabetes, you must see an eye doctor at least twice a year.

Here in Bacolod City we have a regular eye screening every Wednesday, IT IS FOR FREE, come before 1pm in the chapel of Dr. Pablo O. Torre Memorial Hospital (Riverside Hospital)

You may also call +63 4 4350714 or text +639228606763 for further inquiries.

on CATARACTS

Cataracts

Normally light enters the eye from the front, passes through a clear lens, and reaches the back of the eye so you can see.
If the lens becomes cloudy like frosted glass, light cannot pass through, and you cannot see properly. 'Cataract' is the name of the 'cloudy' human lens.
Think of a camera, with a lens that bends the light so that the light 'focuses' onto the film at the back. If this lens becomes scratched or greasy, it cannot bend the light in the correct direction, and the light is scattered in all directions. You may notice blurred or misty sight, see double, or notice colours appear much duller than they did previously.

top: a clear lens, no cataract. Light enters the eye directly

bottom: a cloudy lens = a cataract. Light entering the eye is scattered

What you can do

A cataract will not damage your eye in any way.  It can be operated on safely at any time, thick or thin. A cataract may change the focusing in the eye, and you may need new spectacles now and again. But glasses themselves do not help you see better if you have a cataract.
Some cataracts get worse quickly, others slowly: most do get worse over months or years. If your sight gets worse very slowly, the cataract is only slowly becoming thick.
The thicker or cloudier the cataract becomes, the worse the sight.  A doctor cannot predict with certainty.

Reading

Large print is naturally much easier to read, and a magnifying glass may help.  A good light may help, particularly an anglepoise light behind the shoulder. Stronger glasses that mean you can bring books closer to your eye to make reading easier, and an optician (optometrist) can advise you.

Driving

You may notice great difficulty driving at night, when car headlights are shining into your eye. This may be so bad you have to stop driving at night, and at this stage, if you want to keep driving, you may need a cataract operation.

Sunlight

You may notice difficulty seeing in sunlight. Dark glasses may help, or a hat with a large peak. Eventually you usually need an operation.

Causes of cataracts

Cataracts occur as people get older. They are much commoner if you smoke, whether cigarettes, cigars, or a pipe. They occur more often in diabetes, and they can run in families. Steroid tablets may help to cause cataracts if given at a high dose or for a long time. There are many other causes, including other types of eye disease and eye injury.

Does a cataract damage the eye, or your other eye?

A cataract does not usually damage your eye in any way. A cataract in one eye cannot lead to any damage in the other eye, and you cannot use the good eye too much and damage it. Similarly, sit close to the television if this helps you see it better: this will not damage your eyes. A cataract often develops in the other eye, but many people only get one in one eye.

Will your sight get worse?

Many cataracts do get worse, especially if you are middle aged and have diabetes. Many people with diabetes do eventually need cataract surgery.

Does a diet help?

There is no specific diet or drug treatment for cataracts, but following UK Department of Health advice may help: a diet low in animal fat and salt, with five portions of vegetables or fruit a day, with 30 minutes exercise such as walking, and not smoking.
In diabetes, diet, control of the blood sugar and blood pressure are important to prevent other problems.


When do you need an operation and should you control your diabetes?

An operation to remove the cataract is usually the only way to make improve your sight. But before you can decide, you need to know the pros and cons of an operation. A cataract operation is generally safe, and with a surgeon who is experienced in cataract keyhole surgery, the risk of a serious problem is about 1%.
So in a way you are the best person to decide: certainly, if you cannot do what you want to do, such as read, watch TV,  or walk in the street, an operation is usually helpful (if your eye has no other conditions.) Remember, many patients who have surgery are in their 80's.
The diabetes ideally should be controlled before surgery, as otherwise complications are more likely. 

The Operation

Typically, you have the operation as a day case. You go to the hospital in the morning, and go home later that day. You have a local anaesthetic injection, wait for it to work, then have the operation which takes about 20-30 minutes. A key hole operation is often used: a small tube is inserted into the eye to suck the cataract out, and a plastic lens implant is put in its place. The plastic lens implant is placed in the 'capsule' of the cataract.
Routinely, the only major discomfort can be the local anaesthetic injection. At home, you have drops to put in, and routinely have one or two visits to the hospital, before seeing your optician for glasses. Normally after an operation, you see well.
However, if there are other problems in your eye, such as a damaged retina (the film at the back of the eye), your sight will not be so good. In diabetes the operation may make the retinopathy worse and laser may be needed. Often the ophthalmologist recommends laser before the operation to try and stabilise the retinopathy.
You usually do need glasses after an operation, because the implant cannot change its focus like a camera. You may need reading or distance glasses, or both.

A small hole is made in the side of the eye and a probe is placed in the eye to cut and suck the cataract out.	A plastic lens is placed in the eye to replace the cataract. The lens focuses the light onto the retina, like the lens of a camera.

Extra risks in diabetes

Unfortunately a few people do develop problems. Without diabetes, there is 1 in 100 risk of severe complications such as needing a second operation, infection, etc. But in diabetes there is a slightly greater risk of such problems as:

• macula oedema
• complications from proliferative retinopathy
• the retinopathy itself may progress see
• higher risk of infections

5 Crucial Diabetes Symptoms to Watch

Diabetes is by far one of the nations largest health problems as a society. From the foods we eat to how we live our lives in today's world completes an almost perfect recipe for diabetes. One of the most important ways to protect ourselves and keep ourselves safe from diabetes the best way we can is to know the main symptoms of diabetes as early detection along with preventative maintenance can greatly lower your health risks in addition to living a much healthier life.

Knowing the general diabetes symptoms allows the individual to take action immediately and in-turn be proactive to treating a possibly increasing issue which can eventually lead to a multitude of serious health problems. The key is early detection and creating change for the better.

Common Diabetes Symptoms:

•Frequent Urination - This diabetes symptoms is one of the more easier ones to identify. If you are noticing that you must be excused from the table much more than anyone else around, this is a sign that you may be having frequent urination problems and should be addressed.

•Blurry Vision - Although blurry vision can be caused by many things, diabetes definitely does cause blurred vision to those who have this disease or those who are at risk. IF this is one of the diabetes symptoms you are experiencing, it would be highly advised that you seek a professionals opinion of why this is happening to you. Blurred vision can be a sign of numerous health problems and should be addressed as soon as the problem is recognized.

•Excessive Thirst - Now frequent urination and excessive thirst do go hand-in-hand however diabetics have a tendency to feel much more thirsty, much more frequently than someone who doesn't have diabetes

•Unusual Weight Loss or Sudden Change of Eating Habits - Diabetics can have extreme hunger or virtually no appetite at all. In addition on the major diabetes symptoms is more than unusual weight loss or less commonly, weight gain. The most common combination is excessive hunger combined with a large amount of weight loss - This is definitely a sign to watch out for.

•Irritability and/or Confusion - Now, simply because someone is irritable doesn't necessarily mean they have diabetes. However, any of the diabetes symptoms in combination could be a sign that certain diet changes may need to be addressed and can definitely be warning signs of diabetes.

Please keep in mind that if you do have diabetes it doesn't mean the end of the world. Many people live long, happy healthy lives with diabetes and through proper diet and healthy habits, one can overcome the various diabetes symptoms and in turn virtually fight off diabetes alltogether. Diabetes however, if left untreated and with no change in lifestyle, can be extremely debilitating and cause more severe health problems eventually leading to death. Early diagnosis is key when treating the various diabetes symptoms and by taking action you can significantly minimize and even eliminate the negative effects of diabetes.

Diabetic Retinopathy

There are many myths surrounding diabetes, and it can be hard to determine what is true and what is not. Many patients want to know if diabetes will really make them go blind. The fact is that the disease can certainly cause blindness, and is one of the top causes of blindness among adults. Equally important, however, is the realization that proper testing and eye care can often prevent the condition from occurring.

The vision problem that causes blindness in diabetics is also known as retinopathy. Retinopathy is damage to the eye due to blood flow problems. It causes decreased vision and when left untreated leads to blindness.
When your blood sugar is not well controlled, the blood vessels in the eye become weak. This leaks fluid into the part of the eye responsible for vision. Eventually the blood vessels close off, stopping blood flow to the retina. As the disease progresses, new blood vessels form. These vessels are quite fragile and bleed into the eyes causing severe vision problems and blindness.

Retinopathy occurs in approximately 8% of patients in the first three years, with statistics rising to one quarter after five years and jumping to 80% after approximately fifteen years of being diagnosed with diabetes of any form. These percentages are quite large, but they do not mean that the same percentage of patients will go blind. They point instead to the reasons you should be tested annually for the problem.
When you have your vision checked annually, your eye doctor will be able to catch retinopathy in the early stages. In this stage, the condition is easily treatable. Controlling your blood sugar can also prevent the condition or help delay the onset and progression. It is very important to contact your eye doctor if you experience any vision changes including blurriness or trouble seeing clearly.

Blindness is still considered a side effect of diabetes even though it is preventable. Many patients do not have their vision tested often enough or fail to report symptoms. When you are diagnosed with diabetes, it becomes imperative that you have annual vision tests. When retinopathy is diagnosed early, it can be treated before symptoms become permanent and severe. Your vision is very important to your quality of life. If you are experiencing blurred vision or have not recently had your vision tested, seeking an eye exam is one of the best things you can do for yourself.

Lately, the leading cause of blindness is diabetes. This should all the more spur us to manage diabetes properly. Sure, it will take time and effort, but it will be worth it.
While it is true that facts about diabetes say common eye conditions like farsightedness and nearsightedness are not due to high blood glucose, there is a condition that's exacerbated by it. What is it, you asked? It's cataract. Others say though that nearsightedness or myopia happens when high glucose levels result in the buildup of chemicals in the lens of the eye.

You see, abrupt changes in the blood sugar can cause the lens to swell up a little bit and this makes the vision blurry. Facts about diabetes give the assurance this is only temporary because once the blood sugar stabilizes, the blurry vision should go away. Consult with the doctor if it doesn't.
Make sure you tell the doctor you have diabetes and that your blood sugar has been fluctuating. This way he will be in the know and may suggest to wait till your blood sugar stabilizes to see if you need eyeglasses. The important thing here is to control blood sugar because if it stays high for a number of years, it can cause blindness. This we learned from the facts about diabetes that we have been researching.
Facts about diabetes have more surprises for us. One is that diabetics should be aware of dry eye syndrome. Often they don't know this because they do not feel the symptoms. Diabetes can affect the eye nerves. So ask the doctor to check the eye surface for signs of dry eye syndrome. But let's list the symptoms anyway. It does not hurt to know what they are:

• Burning sensation
• Stinging sensation
• Gritty sensation
• Eye discomfort

Since facts about diabetes say that dry eye syndrome is a frequent complication of diabetes, it is crucial to be alert to this. Have routine checkups and ask the doctor to check the eye surface tissue. What can we do to become comfortable with this dry eye syndrome?

• Wash the eyelids properly with a clean washcloth.
• Open and close the eye or blink regularly.
• Keep electric fans and car vents away from the eyes.
• Stay away from smoky places.
• Use artificial tears to calm down the eyes.

Here's a warning from the facts about diabetes. Do not use drops for treatment that get the red out. Why? Because prolonged use of this may result in more redness. Make sure to follow the doctor's orders on how to use the prescribed drops regularly.
Unpreserved artificial tears and ointments may help those suffering from more severe dry eye syndrome. Use the ointments though before going to bed because the vision will be blurry as a result.

Early detection is crucial. Eyesight is such a precious commodity, special care is the key especially diabetics are prone to having cataracts which is a state in which the lens are cloudy and milky. They are also at risk for glaucoma. 

 

Glaucoma is due to increased pressure in the back of the eye. If left unattended, this can lead to vision loss, headaches and pain in the eye. The most common is open-angle glaucoma which usually occurs in older people. The older and the longer one has diabetes, the greater is the chance to develop this.
The other type and the one that seems to affect diabetics is the neovascular glaucoma. This is more serious and usually develops in diabetics who have severe diabetic retinopathy. If detected early enough, it can be treated with laser surgery.
Remember that all of the aforementioned diseases can be treated with early detection. The trouble is, symptoms do not always happen so make it routine to see your eye doctor. Be sure that this eye specialist is part of the health care team. 

DIABETES and its IMPACT on the EYE

MAGNITUDE OF DIABETES

Diabetes epidemic is underway. An estimated 30 million people worldwide had diabetes in 1985. A decade later, the global burden of diabetes was estimated to be 135 million. The latest WHO estimate – for the number of people with diabetes, worldwide, in 2000 – is 171 million. This is likely to increase to at least 366 million by 2030. Two major concerns are that much of this increase in diabetes will occur in developing countries, due to population growth, ageing, unhealthy diets, obesity and sedentary lifestyles, and that there is a growing incidence of Type 2 diabetes – which accounts for about 90% of all cases – at a younger age. In developed countries most people with diabetes are above the age of retirement. In developing countries those most frequently affected are in the middle, productive years of their lives, aged between 35 and 64.

How can diabetes affect eye?
Diabetes can affect the eyes and vision in a number of ways. It may lead to frequent fluctuations in vision, cataract in young age, decreased vision due to involvement of optic nerve, temporary paralysis of the muscles controlling the movement of eyes and thus double vision. The most significant complication of diabetes in eye is diabetic retinopathy and its complications.

What is diabetic retinopathy?

Retina is the layer at the back of the eye that is sensitive to light. Diabetes affects the small vessels of the retina in the eye. There are various stages of diabetic retinopathy

:

Non-proliferative or background diabetic retinopathy: When blood vessels in the retina are damaged, they can leak fluid or bleed. This causes the retina to swell and form deposits called exudates. This is an early form of diabetic retinopathy and may not lead to any decrease in vision, but it can lead to other more serious forms of retinopathy that affect the vision.

Macular edema: The fluid and exudates collects in the macula (the part of the retina that allows us to see fine details), thus decreasing the vision. Sometimes there may be a macular

edema without any loss of vision. Therefore it is important to have periodic checkup to detect and treat these conditions at an early stage.

Proliferative diabetic retinopathy: This is an advanced stage of diabetic retinopathy, where the blood supply of retina is compromised. In response to this, new fragile blood vessels grow on the surface of the retina (neovascularization). These new vessels are very fragile and bleed easily. These may lead to serious vision problems if they bleed into the vitreous (the clear, jelly-like substance that fills the center of the eye) which is known as vitreous hemorrhage. This prevents the light from reaching the retina and thus can blur the vision.

The new blood vessels and the bleed into the vitreous can also cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and can lead to blindness if untreated.

In addition, abnormal blood vessels can grow on the iris (the colored part in the front of your eye, which can lead to glaucoma).

What are the risk factors for diabetic retinopathy?
The longer the person has diabetes, the greater are his/her chances to develop diabetic retinopathy. Almost 80% of people, who have diabetes for 15 years or more, have some damage to the blood vessels in their retina. The other risk factors are high blood pressure, anemia, kidney diseases, and pregnancy.

Can something be done to prevent diabetic retinopathy?
There is no treatment that can prevent diabetic retinopathy altogether. Persons with any form of diabetes may develop diabetic retinopathy. But it has been proven that a good control of diabetes can delay and slow down the rate of progress of diabetic retinopathy and its complications. Besides a good control of blood sugar, one must exercise regularly, keep the blood pressure under control, avoid smoking, and avoid obesity.

How do I know if I have diabetic retinopathy?
You might not know that you are having diabetic retinopathy, as there are no symptoms in the earlier stages of the disease. Therefore it is essential to have periodic evaluation of your eye by an ophthalmologist to detect the condition early. Early diagnosis and timely treatment is very essential in preventing the complications of this disease and thus maintaining vision.

How frequently should I get my eye examined?
If you have diabetes, you should get a yearly examination with your ophthalmologist. Your pupils may be dilated with eyedrops, so that your ophthalmologist may have a good look at the back of your eye. Once you develop diabetic retinopathy, then your ophthalmologist will advise you if you need some investigations, treatment or just need to follow up. In these cases the frequency of follow up visits is decided on basis of the severity of the disease.

What are the tests done for diabetic retinopathy?
Your vision is assessed by the usual charts. The back of your eye is examined after dilating your pupils, using an instrument called ophthalmoscope. Sometimes your ophthalmologist may advise a special test called Fluorescein angiography.

What is fluorescein angiography?
It is a test in which a series of photographs of the retina are taken with the help of a special camera. These photographs are taken after giving the patient an injection of a yellow dye. This dye reaches the retina through the blood stream and helps in seeing the blood vessels of retina more clearly. This test helps the doctor to determine which areas to be treated with laser.