Diabetes and your vision

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Diabetes and your vision

• Presented by

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In Australia 5 of people have diabetes

• More than 70 of these will develop diabetes
  related eye conditions within 15 years of the
  initial diagnosis

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Symptoms of diabetic eye changes

• Blurry or fluctuating vision can occur quite
  early on in the disease
• An Optometrist will often be the first person to
  pick up that someone has diabetes

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Changes to the eye with diabetes

• Changes to the retinal blood vessels
  (retinopathy)
• Increased likelihood of Cataract and glaucoma
• Changes to your refractive error ( glasses
  prescription)

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How does the retina work?

• The retina is made up of numerous cells which are
  a arranged next to each other.
• The main cells are the rods and cones.
• .

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How does the retina work?

• These cells take up light and convert it into
  electrical messages, which are then sent onto the
  brain.
• Cells receive their oxygen and other nutrients
  from tiny blood vessels.
• Blood vessel walls are very thin which allow
  nutrients to pass through.
• These nutrients are food for the cells

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Healthy retina taken with a fundus camera
retinal blood vessels
optic nerve
macula
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Three stages of diabetic retinopathy

• Background diabetic retinopathy
  (non-proliferative)
• Pre-proliferative retinopathy
• Proliferative retinopathy

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The roll of the blood vessels in Diabetic
retinopathy

• Nutrients pass through a healthy capillary (tiny
  blood vessel) to reach retinal cells.
• Waste products from the retina pass into it to be
  taken away.

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• In retinopathy the damaged capillaries start to
  leak fluid.

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• The damaged capillaries start to make a special
  growth chemical (VEGF).
• New capillaries begin to grow.

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• The capillaries start to close up and block.
• The retinal cells nearby can become damaged, and
  slightly reduced

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The role of the blood vessels in Diabetic
retinopathy
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Background diabetic retinopathy

• Rarely causes loss of vision
• No treatment required if there is no obvious
  involvement of the macular area
• Need to monitor regularly
• Fundus photography is the gold standard for
  monitoring and comparing over time

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Proliferative retinopathy

• A far more serious condition. In this stage
  circulation problems cause areas of the retina to
  become oxygen deprived
• New, fragile vessels develop as the circulatory
  system attempts to maintain adaquate oxygen
  levels within the retina

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• These delicate new vessels easily haemorrhage
• Blood may leak into the retina and vitrious
  causing spots or floaters along with decreased
  vision

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Worst case scenario

• In the later phases of the disease continued
  abnormal vessel growth and scar tissue may cause
  retinal detachments and glaucoma.

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How retinopathy can affect sight
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• Normal fundus Background
  retinopathy

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• Pre-proliferative Proliferative
  retinopathy retinopathy

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Cataract

• Clouding of lens inside eye
• Gradual loss of vision
• Increased awareness of glare
• Occurs at an earlier age with diabetes

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Glaucoma

• Disease of the optic nerve
• Affects peripheral vision first
• Difficult to detect in the early stages
• Slightly more common with diabetes

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Be sure to see your optometrist if

• You see spots or floaters
• Straight lines do not look straight
• Your peripheral vision (side vision) is limited

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Be sure to see your optometrist if

• Your vision becomes blurry
• You see double
• One or both eyes hurt
• Yours eyes get red and stay that way

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Fundus photography

• Pictures are used to document the health of the
  of the internal eye
• Vitreous, macula, retina and its blood
  vessels and optic nerve can recorded
• The photos are used to compare the progression of
  the condition of the retina

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Optometric Management of the Patient
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What else can you do?

• Keep blood sugar levels under tight control
• Get high blood pressure under control
• Quit smoking
• Maintain a healthy diet and exercise regularly