Tag Archives: eye health

The Sun and Our Eyes

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Dr S S Gill, Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S S Gill, Consultant Ophthalmologist

EYE HEALTH

Ipoh Echo’s EYE HEALTH series continues with Consultant Eye Surgeon Dr. S. S. GILL talking to us about THE SUN AND OUR EYES

Many people are not aware of the dangers that ultraviolet (UV) light especially from the sun can pose. Harmful UV radiation from the sun can damage various parts of the eyes including conjunctiva, lens and also the retina (nerve). Long-term exposure to sunlight increases the risk of cataract formation and also pterygia (a growth on the surface of the eye).

In short, the sun that can burn our skin can also burn our eyes! In fact, staring at the sun can cause permanent burns (solar retinopathy) resulting in scarring of the retina which is the nerve behind the eye that is very important for good vision. It is important therefore to take adequate precautions to protect your eyes from too much UV rays. Here are some tips to protect your eyes from the sun:

SUNGLASSES:

Dr S.S. Gill, ultraviolet light and eyesGet a good pair of sunglasses that block off the harmful ultraviolet or UV rays.

The ability to block off UV light does not depend on how expensive are the sunglasses, or how dark the sunglass lenses are.

Brand does not matter! Of course looking like James Bond or Audrey Hepburn when wearing them is a bonus but it’s the quality of the glass that matters most.

Choose a pair of sunglasses that either has a CE mark, a label that says 100% UV protection from UVA and UVB rays, or has a UV400 tag.

Buy your sunglasses from a reputable retailer who is unlikely to sell you anything inferior.

Choosing a pair of sunglasses that wraps all around to the side of your face is preferable as it prevents strong sunlight from passing through the unprotected sides.

CLOUDS DON’T MATTER:

The sun’s rays can easily pass through thin clouds and even the haze that has affected Malaysia of late. Do not let such weather conditions fool you into thinking that you are safe from UV rays.

When you are outdoors in a country with cooler weather, it does not mean you are less exposed to UV light. You should still take similar precautions.

Be careful during peak times when the sun is strongest, between 10am and 2pm.

KIDS

Don’t forget the kids! Everyone is exposed to the same risk, including children and senior citizens. Protect their eyes too especially with hats or sunglasses. There are sunglasses made for children too.

WEAR A HAT

Broad brimmed hats, in addition to a good pair of sunglasses, work great together in protecting your eyes, not to mention make you look dashing!

NEVER LOOK AT THE SUN DIRECTLY

This can cause serious eye problems like solar retinopathy which can damage the retina (the nerve behind the eye). In fact, it can even lead to blindness.

Never view a solar eclipse directly through a camera, telescope, binoculars or photographic film or even sunglasses. This is very dangerous.

The safest way to view a solar eclipse is on the television, via live camera web-viewing on the internet

It’s never too late to begin protecting your eyes from the harmful UV rays of the sun. Take all the necessary precautions to ensure that you do not succumb to eye problems that can be prevented.

For more information, contact Gill Eye Specialist Centre at  05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

Keeping Safe from Harm at Home

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Dr S S Gill, Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S S Gill, Consultant Ophthalmologist

Eye Health

Ipoh Echo’s EYE HEALTH series continues with Consultant Eye Surgeon Dr S.S. GILL talking to us about PREVENTING EYE INJURIES.

Eye injuries that range from minor eye injuries to serious ones, are seen daily at Accident & Emergency centres of hospitals throughout the world. Most of these eye injuries are PREVENTABLE IF the proper SAFETY TECHNIQUES & PROTECTION are used. Be knowledgeable about things in your house that can potentially damage your eyes and take heed of warnings, says Dr Gill. It is not only chemicals (covered in the last issue of Ipoh Echo) that can cause eye injuries at home, but also non-chemical hazards like these.

Common Eye Injury Risks at Home:

HAMMERING or drilling screws or nails into walls or bricks

May result in the screws or nails getting chipped-off and spinning in a projectile way into the eye. Even a simple chore like installing a lamp onto the ceiling can result in eye injuries should the loose ceiling debris get into your eyes.

KEEP YOUR  D.I.Y. TOOLS IN GOOD CONDITION

Because damaged tools can easily break or get chipped-off causing injury to the eyes, replace or repair all old power tools.

KEEP ALL TOOLS AWAY FROM CHILDREN

Children have inadvertently injured their eyes when playing with such tools. I have seen a child injured in the eye by a wood-stapler that was accidentally shot into the eye causing serious eye injury.

GRASS CUTTING

Keep everyone away from the vicinity of running grass-cutters or lawn mowers. Many people have been blinded by flying debris struck by spinning blades of the lawn mower.

Pick up all stones, toys and debris from the lawn to prevent injuries from flying objects before you mow the lawn.

PRUNING PLANTS & TREES

Sharp twigs often go unnoticed and have pierced the eyes of those who have been doing pruning without goggles.

LOOSE CARPETS & SHARP FURNITURE EDGES

Loose carpets could cause the elderly and the very young to slip and fall. Worse still is if they fall and strike their eyes on the edge of a piece of furniture lying in front of them. Be sure to cushion or pad all sharp corners and edges of furniture if you have children or the elderly in your house.

MPV (multipurpose vehicle) DOORS

Be cautious when opening the door of an MPV as the door edge is quite often at the same level as the eye. There have been people who have had eye injuries as a result of the sharp door edge grazing their eye.

HIGH SHELVES AND CUPBOARDS

Avoid jam-packing items onto a high shelf or cupboard. When taking things out of the cupboard, a heavy and sharp object can fall off only to cause serious eye injury.

SATAY STICKS AND CHILDREN

Be cautious of seemingly harmless “satay sticks” as children have injured their eyes when the satay stick has ricocheted into the eye after the meat has been pulled off the stick.

CHILDREN & TOYS

Be mindful of children when they play with darts, toy guns that shoot bullets and when they play with sparklers or fireworks. Also, remind children never to throw any objects around.

HIGH POWERED WATER JETS

Do not allow children to play with high powered water jets used for cleaning and car-washing. These water jets can cause eye injuries.

For more information, contact Gill Eye Specialist Centre at  05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

Eye Health – Glaucoma (Part 2)

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Dr S S Gill, Consultant Ophthalmologist, Hospital Fatimah Ipoh
Dr S S Gill, Consultant Ophthalmologist

In conjunction with World  Glaucoma Week  2012, Ipoh Echo talks to Consultant Eye Surgeon Dr S.S. Gill about this “silent thief of sight”  –  PART 2

Glaucoma as we know is a group of eye diseases that results in permanent blindness in the affected eye(s) that is irreversible. Glaucoma is the second leading cause of blindness in the world. The disease often goes unnoticed until the loss of vision is significant, hence the nickname “silent thief of sight”.

Who is at risk of glaucoma?

Everyone is at risk for glaucoma and should go for an eye check annually. However, certain groups are at higher risk of developing glaucoma. The following conditions and groups have a higher risk of glaucoma:

  • Aging
  • Family members of glaucoma patients
  • Diabetes Mellitus
  • Short sightedness (Myopia)
  • Long sightedness (Hyperopia)
  • High blood pressure (hypertension)
  • Past or Present use of steroids
  • Migraine
  • Eye injuries
  • Certain ethnic groups – Asians & Africans

People Over 60

Glaucoma is much more common among older people. You are 6 times more likely to get glaucoma if you are over 60 years old and that is why it is important to have your eyes checked as you advance in years.

Family Members with Glaucoma

The most common type of glaucoma is primary open-angle glaucoma (POAG). This glaucoma is hereditary. The risk of glaucoma increases by 5 to 9 times if you have a family member who suffers from glaucoma. This hereditary link has been confirmed by two studies, i.e., the Baltimore Eye Study and the Rotterdam Eye Study.

Glaucoma-Rubeosis - eye health - S.S. Gill
Glaucoma-Rubeosis

Diabetes

Several large studies suggest that people with diabetes are more likely to develop glaucoma. If diabetes and glaucoma are treated early, vision can be saved. Otherwise, abnormal vessels in diabetes may form resulting in bleeding in the eye and rubeotic glaucoma (picture on left).

Dr Gill will elaborate more on glaucoma in the next issue of the Ipoh Echo.

For more information, contact Gill Eye Specialist Centre at  05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

Eye Chat: Eye Stroke

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Dr Lee Mun Wai

Eye Chat with Perak’s Only Fellowship-Trained Retinal Surgeon, Dr. Lee Mun Wai

What you should know about “Eye Stroke”

Most people are familiar with the term “stroke” which refers to a blockage of blood vessel(s) in the brain resulting in partial paralysis, slurred speech and even death in the most severe cases. Not many people however, are aware that the eye itself can also have a “stroke”. The eye is like a camera; light is focused by the cornea and lens onto the “film” of the eye – the retina. The retina is responsible for converting light energy into electrical impulses which are transmitted to the brain and interpreted as images. That is how we “see”!

Like any other tissue in the body, the retina is dependent on nutrients and oxygen from a series of blood vessels comprising of arteries and veins. When blockages (occlusions) occur in these blood vessels, the result is a “stroke of the eye”.

Symptoms of Eye Stroke

People with eye stroke usually have little warning when it occurs. They could go to sleep with normal vision and wake up with loss of vision in one eye. There is no pain at all and some people notice a dark area or shadow which affects the upper or lower half of their vision.

Types of Eye Stroke

Blockages can occur in either the arteries or veins of the retina. The extent of visual loss depends on whether it is the central or branch artery (or vein) which gets blocked. Artery occlusions are usually caused by a clot or plaque (embolus) which breaks free from the major artery in the neck (carotid) or the valves or chambers in the heart. The embolus may be very small and not cause any significant interruption of blood flow in the larger arteries but when they reach the retina where the vessels are so fine, that’s where the occlusion occurs.

Vein occlusions are caused by a localized clot (thrombus) which forms as a result of hardening of the artery adjacent to the vein. The arteries and veins of the retina are crossing over one another and it is at these crossings where vein occlusions can occur.

Treatment

The occurrence of an “eye stroke” is often an indication of more widespread vascular disease in the body. The major risk factors are age, high blood pressure, high cholesterol, diabetes and heart disease. A referral to the cardiologist to look for abnormalities in the heart as well as narrowing of the carotid arteries is often necessary. In vein occlusions however, raised pressure in the eye (glaucoma) can also be a risk factor. In artery occlusions, treatment in the acute stage may involve lowering the eye pressure with medication or sometimes by releasing fluid from inside the eye and ocular massage. This has limited success but may help to dislodge the clot and allow normal blood flow again.

In vein occlusions, depending on the amount of bleeding and swelling in the central retina (macula), laser treatment can be done. More commonly now, an injection of a medication which is an anti-VEGF, is given directly into the eye. VEGF is a growth factor which is found in abundance in a vein occlusion and is responsible for causing the retinal swelling and bleeding.

Prognosis

Eye stroke is a potentially devastating eye disease and is often related to other vascular problems in the body. It is therefore, very important that if you have any sudden vision loss, you should visit your ophthalmologist immediately. It is also vital that if you have any risk factors for eye stroke such as hypertension, diabetes or heart disease, that these conditions are well controlled.

For more information, contact:  Lee Eye Centre Ipoh

Tel: 05-254 0095 or email: enquiry@lec.com.my. Website: www.lec.com.my

Dr Lee Mun Wai - Retinal Surgeon’s Perspective

Eye Chat – from a Retinal Surgeon’s Perspective

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Dr Lee Mun Wai

Welcome to the inaugural column on eye care from the perspective of Dr. Lee Mun Wai, Perak’s only fellowship-trained retinal surgeon. This column will serve as a forum for the discussion of eye diseases with an emphasis on the impact and treatment of diseases of the retina.

What is the Retina?

The retina is a light-sensitive tissue lining the back of the eye and is responsible for converting light rays into electrical impulses which are then transmitted to the brain for interpretation as images. If you think of the eye as a camera and the retina as the film of a camera, you will understand how a healthy intact retina is vital for normal vision.

Floaters in field of vision

What are floaters and what are their effects?

Floaters are specks, clouds or cobwebs moving in your field of vision and most often seen when looking at a plain background like a wall or the sky.

While floaters look as if they are moving outside the eye, they are actually tiny clumps of vitreous (gel-like substance) inside the eye. As we age, the vitreous thins and shrinks forming clumps and pulling away from the back wall of the eye; this is called a posterior vitreous detachment. Sometimes, as the vitreous pulls on the retina, one may experience flashes of light as well.

What causes a retinal detachment?

Partial loss of vision

In the vast majority of people with floaters, a posterior vitreous detachment is the cause and this is usually of no consequence. The floaters become less apparent with time and no treatment is usually necessary.

In some people, when the vitreous pulls on the retina, a tear can develop and this can eventually lead to a retinal detachment. This is the separation of the nerve layer of the retina from the wall of the eye. Somebody with a retinal detachment would also see floaters and flashes but in addition to that, there would be an initial partial loss of vision and if left untreated, this would progress to a total loss of vision.

Who is more likely to get retinal detachment?

People aged over 50 are at increased risk of developing a retinal detachment. Other risk factors include very short-sighted people (more than 600 degrees), people who have had previous eye injury or eye surgery and people with certain inherited conditions (such as Stickler’s or Marfan’s syndrome).

How is retinal detachment treated?

Surgery is the mainstay of treatment for retinal detachment. The procedure is usually performed by a retinal specialist – an ophthalmologist who has undergone advanced training in medical and surgical treatment of retinal disorders.

Generally, the sooner the retina is reattached, the better the chances that vision can be restored.  There are several procedures which can be used to treat a retinal detachment – pneumatic retinopexy, scleral buckling and vitrectomy. More will be covered in future when Surgical Management of Retinal Diseases will be discussed.

Can you prevent a retinal detachment?

Unfortunately, with age being a significant risk factor, it is impossible to prevent or predict who is going to develop a retinal detachment. It is important however, to recognise the warning signs of floaters and flashes as potential harbingers of a serious visually threatening disease. This is particularly true for individuals who are at increased risk such as highly short-sighted people or those who are involved in contact sports. Early presentation to a retinal specialist could be vital to prevent further visual loss and hopefully restore vision.

Contact: Lee Eye Centre, Ipoh
Tel: 05-2540095
Email: enquiry@lec.com.my
Website: www.lec.com.my

Stye in Your Eye – Prevention

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Dr. S.S. Gill, Consultant Ophthalmologist

In our continuing series on Eye Health, Consultant Eye Surgeon Dr. S.S. Gill talks to us about STYE.

As mentioned in the previous Ipoh Echo issue, a STYE is an infection of the hair follicle of an eye lash that presents as a small painful reddish lump on the eyelid – like a small abscess or pimple.

Is a stye contagious?

Everyone has the potential to develop a stye because we all have the stye-causing bacteria in high concentrations within the nose and therefore is easily transferred to the eyelids by our unwashed fingers!

Nevertheless, if you have a stye, you don’t want the bacteria to come into contact with someone else’s eye because it might indeed cause them to develop a stye or other infection as well. It would be best to avoid shaking hands during this time but if you must shake hands, then proper hand washing with soap is very essential.

Are there any complications that can result from a stye?

The stye infection may spread to other eyelash follicles, leading to multiple styes. The infection can also spread on the other areas of the eyelid making it more generalized resulting in a condition called cellulitis where the whole skin of the eyelid becomes red and hot. This may cause quite a bit of discomfort.

The infection from the stye can spread into the eye resulting in conjunctivitis or sore eyes. Also, if the stye does not settle or drain properly, it may lead to deformity or disruption of the growth of eyelashes in that area. The good news is that progression of a stye to become a generalised infection (spreading throughout the body) is extremely rare.

Can a stye be prevented?

Good hygienic practises can help prevent the development of a stye. By this I mean, proper hand washing, and washing of face with soaps or cleansers.

  • Other measures that can help prevent styes include:
  • Never share cosmetic eye lash curlers or eyelash combs with others.
  • Keeping all cosmetics clean.
  • Not touching the eye and surrounding areas.
  • Sharing eye cosmetics is a bad idea.
  • Discarding old or contaminated eye makeup.
  • Never use eye makeup when you have a stye.
  • If you must pick your nose, (where there is a large reservoir of stye-producing bacteria), then you must wash your hands thoroughly.
  • Do not touch your eyes when you are gardening or cooking.
  • Never use contact lenses when you have a stye.

For more information, contact Gill Eye Specialist Centre at 05-5455582, email: gilleyecentre@dr.com or visit www.fatimah.com.my.

Eye Health with Consultant Ophthalmologist, Dr. S.S. Gill – Part 1

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Dr. S.S. Gill


What is eye strain?

The term EYE STRAIN is frequently used to describe a group of symptoms which are related to use of the eyes. Eye strain is a symptom, not an eye disease. Eye strain occurs when your eyes get tired from intense use, such as driving a car for extended periods, reading, or working at the computer. If you have any eye discomfort caused by looking at something for a long time, you can call it eye strain.

What causes eye strain?

The medical term for eye strain is asthenopia. The symptoms of ocular fatigue, tired eyes, blurring vision, headaches, irritated eyes, and occasionally doubling of the vision are brought on by concentrated use of the eyes for visual tasks. Some people, while concentrating on visually intense tasks, unconsciously clench the muscles of their eyelids, face, temples, and jaws and develop discomfort or pain from use of those muscles.

Eye stress affects a large majority of the population. After all, our eyes are constantly at work.  Eye stress is as much a concern as any other illness of the body. It makes the eyes tired and you drained of energy. Eye stress actually affects our well being because the eyes are used constantly at work throughout the waking hours of a day for various tasks including even socialising!

The normal blink rate in human eyes is 16–20 per minute. Studies have shown that the blink rate decreases to as low as 6–8 blinks per minute for persons working on something that requires concentration like looking at the computer screen. This leads to dry eyes which can further worsen the situation.

It is interesting to note that humans evolved biologically as hunters and gatherers. This means that our vision was developed primarily for seeing distance (98% of all humans are born farsighted). Our eye muscles (ciliary muscles) are at their most relaxed state when we use our vision to look at distant objects and large spaces. In a similar fashion, our bodies were designed for movement but we are becoming creatures who spend more and more time indoors behind desks, and so maintaining a sitting posture for long periods of time is actually unnatural for us. All of this adds to interlinked element of eye and physical strain.

Most commonly, eye strain is caused by straining ciliary muscles which are the eye muscle responsible for near vision. Typically these muscles are strained by keeping it in one position for a long time. In other words eye strain is caused by visually concentrating on one thing or on one distance for too long.

Therefore, it would be good to remember that the eyes tend to strain faster when focusing on near distances as opposed to far distances.

Briefly, common activities that may cause eye strain include: computer use and computer games; reading long hours; watching television for long periods; driving long distances; sewing & knitting.

Environmental factors that can add to eye stress include low light levels, improper lighting; poor ergonomic computer setup; low screen contrast levels; glare and brightness.

Personal factors that may contribute to eye strain are poor & uncorrected vision (refractive errors), physical stress, fatigue and tiredness, poor posture and alcohol and drug use.

There are many ways to prevent eye strain. Consciously try to reduce the strain on your eyes while you are actively using them. Try to figure out what element of the fatiguing activity is causing the problem and reduce it.

For more information, contact Gill Eye Specialist Centre at 05-5455582 or email: gilleyecentre@dr.com.

Caring For Your Eyes

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We continue our part 4 interview with Dr. S.S. Gill, Consultant Ophthalmologist at Hospital Fatimah about Diabetes Mellitus and eye complications.

It is estimated that 1.4 million Malaysian diabetics are walking around unaware that they have diabetic retinopathy that can lead to total blindness. A lot of times this is because of poor awareness of the complications of diabetes mellitus.

What are the other steps that diabetics can take apart from the regular eye checks that you have suggested in order to help reduce their risk of developing diabetic eye complications?

Good control of diabetes mellitus is the key to slowing down the complications of diabetes mellitus in the eye as well as to other organs. The best way to know whether your blood glucose control is good is to measure your blood glucose levels frequently at home with a glucose monitoring machine called a glucometer.  Keep a small booklet and write down blood glucose results in a tabular fashion with the date, time of blood check, and whether the test was done fasting or after a meal.

Do indicate in the booklet, the time of the last meal before the check was done. Better still, indicate the kind of meal that was taken. Do show this booklet to your physician when you go for your regular diabetic follow-ups. This booklet with the readings tabulated gives a lot of information to your physician should he need to adjust your diet or your diabetic medication.

Many diabetics make a mistake of only checking fasting blood glucose levels. Fasting blood glucose levels alone is not reflective of the actual blood glucose control. Check blood glucose measurements at different times of the day and even 1 or 2 hours after a meal. Even a random blood glucose reading is helpful – it’s really like doing a spot-check on the patient, says Dr. Gill.

It is also important to have other special blood tests that reflect 3-month blood glucose readings. This test is called haemoglobin A1C (HbA1c). The test is recommended to be done every 3 to 6 months. It is recommended that people with diabetes maintain an HbA1c level below 7%. Studies have shown that for every 10% reduction in elevated HbA1c levels, there is an associated 39% reduction in the risk of diabetic eye complications.

Dr. Gill adds that another step that can slow down the progression of diabetic eye complications is good control of blood pressure or hypertension. High blood pressure (hypertension) can also damage blood vessels in the nerve of the eye (retina) and can cause diabetic eye disease or retinopathy to progress.

Research shows that keeping blood pressure as close to normal as possible can help prevent the onset and progression of retinal damage. Experts recommend that people with diabetes keep their blood pressure at or below 130/80 mm Hg to prevent long-term eye complications. Here too, self-measurements of blood pressure is useful in helping your physician who is monitoring and managing the diabetes mellitus.

Next issue: more tips on how diabetics can reduce their risk of developing eye complications and what to expect during an eye examination. For more information, contact Gill Eye Specialist Centre at 05-5455582, or email gilleyecentre@dr.com.

Caring For Your Eyes

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Dr. S.S. Gill Resident Consultant Ophthalmologist
In Ipoh Echo’s series on Eye Health, we continue our interview with Dr. S.S. Gill, Consultant Ophthalmologist at Hospital Fatimah about Diabetes Mellitus and eye complications (diabetic retinopathy).

“The moment a person with diabetes notices any impairment in his or her vision, it may already be too late, because it often means that some form of complication of diabetes mellitus may have already affected the eyes” said Dr. Gill.

Almost all people with type 1 diabetes and more than 70% of people with type 2 diabetes will experience some degree of diabetic retinopathy. Without treatment, diabetic retinopathy can progress from mild, nonproliferative retinopathy to more serious proliferative retinopathy, which can lead to blindness.

Who Is At The Most Risk For Diabetic Retinopathy?
Patients with fluctuating blood sugar levels (poor control) and those with long-term (duration) diabetes. Essentially, people who have uncontrolled blood glucose levels and those who have had diabetes mellitus for more than five years are especially at risk.

What are the steps that diabetics can take to help reduce their risk of developing retinopathy or having their retinopathy progress?
1. Have Regular Eye Exams. Regular visits to an ophthalmologist are essential to detect early eye damage . This is so it can be monitored and if necessary, treated with laser therapy.  Even controlled diabetes can lead to diabetic retinopathy, so you should have your eyes examined once a year; that way, your doctor can begin treating any retinal damage as soon as possible.

An annual eye exam is recommended for people who have had type 1 diabetes for more than five years. Everyone with type 2 diabetes should have an eye exam as soon as diabetes is diagnosed, and annually thereafter. Women with type 1 or type 2 diabetes who plan on getting pregnant should have one prior to conception and subsequently one every trimester till the baby is delivered and annually thereafter.

2. Control Blood Glucose. The most important way to prevent diabetic retinopathy is to keep blood glucose levels as close to normal as possible. This is because high blood glucose levels can damage blood vessels in the retina (nerve at the back of the eye). The best way to achieve tight glucose control and reduce your risk of developing eye complications like diabetic retinopathy is to measure your blood glucose levels frequently at home with a glucose monitor (glucometer) and to follow the advice of a doctor who manages diabetes aggressively.

Keeping your blood sugar at an even level can help prevent diabetic retinopathy. Having smaller meals but more frequent meals is much better than having large food intake at meal times because this causes large spikes of blood glucose levels that can result in organ damage including eye damage.

More on steps that diabetics can take to help reduce their risk of developing retinopathy in the next issue of Ipoh Echo. For more information, contact Gill Eye Specialist Centre at 05-5455582, or email: gilleyecentre@dr.com.

Dr. S.S. Gill