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Keep a watch out for your eyes

source(ophtalmologie.fr)

Diabetes is the first cause of blindness between the age of 20 and 60
Treating diabetes helps avoid complications, including those concerning your eye-sight as they could eventually lead to blindness.

What is the link between diabetes and your eyes ?

More than half of diabetes patients show complications after 10 years, especially if their condition is not treated correctly.
If the rate of glycosylated hemoglobin in the previous 2 months is below 6.5%, complications are rare.
Any decrease in the glycosylated hemoglobin rate by 1% is followed by a 40% decrease in the retinopathy
As a result a strict balance of the blood sugar level is the permanent goal of the diabetic.
If this is not reached irreversible damage to the microcirculation will show up eventually .

The damage is provoked by a hyperglycemia and aggravated by general conditions for which treatment is recommended: especially high blood, obesity, lipid defects and smoking.

The retina is irrigated by small blood vessels which could be damaged by an excess of blood sugar.
As the retinopathy condition progresses, a blocking of the vessels occurs and thus deprives the retina of aliments and oxygen.
New vessels can be formed but they are very fragile and could bring about a haemorrhage which in turn would be the cause of a partial or total loss of eye sight. A retinopathy could also favor the formation of edema in the eye.

The retinopathy remains indolent and asymptomatic for a long time but if the eye sight weakens, there is proof that the lesions have progressed which could lead to blindness.
This explains why the diabetic should consult an optometrist each year for a fundus oculi exam.
If the condition is caught in time, the retinopathy could be treated early and stopped.

Screening of retinopathy

Diabetes could be the cause of a degeneration of the capillaries which irrigate the retina and could be the cause of blindness. A screening for retinopathy is carried out by an optometrist. On the left a normal fundus oculi. On the right a fundus oculi showing an advanced state of diabetic retinopathy. We can especially take note with this exam hemorrhage spots (red) and exudates (yellow spots) A stable blood sugar level helps either to avoid or to decrease the importance of these optical complications.

Diabetic retinopathy progresses in steps which could eventually lead to blindness if not treated. The various aspects are evident following an exam called angiography activated by fluorescence. A colorant is injected into a vein in the arm and then a picture of the retina is taken.

Early stages of diabetic retinopathy

No functional sign is evident in early stages of diabetic retinopathy which can be revealed only with a fundus oculi exam, since vision most often remains normal for a long period. The existence of micro-aneurysms, of micro-hemorrhages, of a vasodilatation of major veins are early signs of a retinopathy. However a fundus oculi is insufficient and a fluorescence angiography is required to screen the first sign of capillary damage.

Autres risques

Edema macular

The macular is a small centralized zone in the retina (with a 5mm diameter) situated in the visual axe and which is responsible for precise vision: reading, writing, recognition of details and colors.

The most common cause of visual injury is an edema macular. An extended edema leads to a complete loss of near sightedness (reading). This is a severe complication, the most difficult to treat. The treatment is often disappointing and requires various medical or surgical interventions, depending upon each case.

Cataracts with a diabetic patient are often premature and prevent the control of the fundus oculi.
A surgical intervention is no different from a traditional one since the artificial crystal is easily inserted.
This intervention can be handled under a local anesthesia (peri bulbaire) or with a topic anesthesia (collyre anesthetic) .

Infection is more risky with diabetes. This explains why before an operation all infections, especially urinary ones should be eliminated and aseptic precautions reinforced.

Glaucauma is more frequent with a diabetic subject than with a non-diabetic one.
A systematic screening is a precaution taken to avoid an irreversible loss of vision due to an optical nerve injury.
Diabetes is not a minor disorder.

The level of visual harm increases with the duration and importance of a blood sugar imbalance, as well as the absence of control.

Collaboration between the doctor, optometrist and patient gives an opportunity to conserve eye sight over a long term.
A quick reaction should follow the discovery of anomalies.

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