Now I see you, Now I don’t – Part 2


In our continuing series on Eye Health, we interview Dr S.S. Gill, Consultant Ophthalmologist at Hospital Fatimah about Diabetes Mellitus and blindness.

Dr. S.S. Gill Resident Consultant Ophthalmologist

Dr. Gill shares with us about patients like Jennifer (not her real name) who was doing household chores at home one day when suddenly her vision blurred. Within minutes, she was nearly blind. Prior to this, Jennifer, who is diabetic, was already having blurring vision for about a month but did not seek any treatment because she did not expect to lose her eyesight so suddenly.

She remembers vaguely when she picked up her regular diabetic medication that her general practitioner had told her in passing to go for an eye check but she did not think much of it then. Now she wishes her GP had put more pressure on her to go for an eye check so she would not have lost so much of her eyesight. This is a common story that Ophthalmologists often hear in their consultation rooms. 

Diabetic Eye Disease may include:
Diabetic retinopathy—damage to the blood vessels in the retina.
Cataract—clouding of the eye’s lens.
Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.

Diabetic Retinopathy is the most common of all the Diabetic Eye Diseases and the leading cause of blindness. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels leak fluid. In other people, abnormal and weak new blood vessels grow on the surface of the retina and these vessels bleed. “If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss,” says Dr. Gill.

Diabetic retinopathy has four stages:
Stage 1: Mild Nonproliferative: There is ballooning of small vessels in the retina’s tiny blood vessels. At this stage there are no symptoms and vision remains normal.
Stage 2: Moderate Nonproliferative:. As the disease progresses, some blood vessels that nourish the retina become blocked.  At this stage, again there may not be any symptoms even though the diabetic eye complication is progressing.
Stage 3: Severe Nonproliferative: With vessel blockage, several areas of the retina becomes deprived of blood supply. These areas of the retina send signals to the body to grow abnormal new blood vessels for nourishment. The patient will start having blurring vision and will require urgent treatment.
Stage 4: Proliferative Retinopathy. This is the advanced stage where new blood vessels grow and bleed profusely. If they leak blood, severe vision loss and even blindness results.

According to Dr. Gill, the main aim is to pick up diabetic eye problems early in stages 1 and 2, and to avoid regressing into stages 3 and 4.  Regular eye exams for diabetics offer the best chance of detecting retinopathy in its treatable stages.

“If you are diabetic and have fluctuating and sometimes blur vision especially after a meal, and then it becomes clear again, it often reflects fluctuating blood glucose levels and this signals alarm bells!” 
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