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HomemistoryDiabetic Retinopathy: The preventable blindness

Diabetic Retinopathy: The preventable blindness

Diabetes is increasing at an enormous rate in all countries of the world. Our lifestyles and diets continue to add to the alarming statistics as the number of people overweight and obese continues to rise. It is estimated that diabetes currently affects 246 million people worldwide and is expected to affect 380 million by 2025. All these people are at risk of diabetic retinopathy.

Almost one million Australians have been diagnosed as having diabetes with at least the same number unaware that they too have diabetes and are at serious risk. Of these, more than three quarters have Type 2 Diabetes.

Diabetic eye disease, caused by diabetes, is the leading cause of vision loss in people aged 20 to 65 and the most common cause of preventable blindness. It’s also important to note that young people with diabetes, who have to move their care from the Children’s Hospital system at 18 years of age to mainstream hospitals, often have a gap in time before they connect again to proper care and should be screened carefully to prevent eye complications.

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of this disease. All can cause severe vision loss or even blindness. Diabetic eye disease include diabetic retinopathy, cataract and glaucoma.

It is surprising how many diabetic patients simply do not know that diabetes can cause blindness

Most diabetic eye diseases can be treated to prevent further deterioration; however treatment cannot restore vision once it has been lost. Regular eye examinations and early treatment are therefore essential in preventing vision loss. The key to preventing blindness in people with diabetes is screening, early diagnosis and treatment. Yet in Australia one in three people with diabetes are not having their eyes screened appropriately!

Diabetes Australia reports that people with diabetes are 25 to 30 times more likely to lose their sight from retinopathy, cataracts or glaucoma. Because of the high risk for eye disease, all people with diabetes should have an annual dilated eye exam.

Diabetes Prevention

Diabetes Australia, the peak body in Australia, providing information and support to people with and affected by diabetes, is calling on health professionals to join their efforts in alerting and educating the community and preventing the disease. They state that in 2002, it was proven that Type 2 diabetes could be prevented in up to 58 per cent of people at high risk of Type 2 diabetes.

According to Greg Johnson, CEO of Diabetes Australia (Vic): “Millions of Australians are at risk of developing Type 2 diabetes and the serious complications including heart attacks, strokes, blindness and limb amputation. People under-estimate diabetes, most Australians don’t think diabetes is serious, don’t know if they are at risk, or don’t think they’ll get it.

“We now have a National Type 2 Diabetes Risk Test, with a series of questions covering risk factors such as overweight, age, family history of diabetes, and cultural background. All health professionals should use this risk test with their patients. If people score 15 or more they are at high risk and need to act and we know we can prevent Type 2 diabetes with intensive lifestyle behaviour change programs,” says Mr. Johnson.

Mr. Johnson points out that those people who are not yet at high risk need to understand that they can reduce their risk of developing Type 2 diabetes by maintaining a healthy weight, being physically active and following a healthy eating plan. Prevention is better than cure.

“People who already have diabetes should know that retinopathy affects about one in six people with diabetes and is the most common cause of blindness in people aged 30 to 69 years. The best treatment for retinopathy is early diagnosis and treatment. All people with diabetes should have an eye examination when they are first diagnosed and then at least every two years after that. Diabetic retinopathy often has no warning signs until it is very severe and advanced,” he says.

Diabetes Retinopathy

All people with diabetes are at risk of diabetic retinopathy. Diabetes can affect a person’s eyes and cause retinal damage, optic nerve damage, corneal ulcers and many other problems.

Diabetes retinopathy occurs as a result of damage to the tiny blood vessels at the back of the retina. It can seriously affect a person’s vision and sometimes cause blindness.

Whilst damage to the retina caused by diabetic retinopathy can eventually lead to blindness, research indicates that at least 90 per cent of new cases of blindness could be prevented if there was proper and vigilant treatment and monitoring of the eyes.

Diabetes Australia implores eye care professionals, specifically optometrists, to first and foremost find out from patients if they have diabetes. It is critical that in order to prevent blindness as a result of diabetes retinopathy that those diagnosed with the disease tell their optometrist they have diabetes at every visit.

Dr. Simon Chen, an ophthalmologist from the Vision Eye Institute, is an expert in conditions affecting the macula and retina. He is at the forefront of leading edge retinal treatments including new treatments for diabetic eye problems.

Dr. Chen is stunned that most patients with diabetes aren’t aware diabetes can cause blindness and that they need to have regular, thorough, eye examinations so as to detect the early signs of retinopathy. He believes optometrists have a vital role to play in “educating diabetic patients about the importance of good long term control of blood glucose, serum lipids and blood pressure in reducing the risk of visual loss.

“It is surprising how many diabetic patients simply do not know that diabetes can cause blindness,” he says.

“Diabetic patients need to undergo dilated slit lamp biomicroscopy with a suitable lens (e.g. 78 D) or fundus photography to detect the presence and severity of diabetic retinopathy. Early detection of sight-threatening retinopathy by regular eye exams is the key to reducing visual loss and blindness from diabetic retinopathy.

“Indications for urgent referral (within four weeks) to an ophthalmologist include an unexplained fall in visual acuity, or any suspicion of diabetic macular oedema (DMO) or proliferative diabetic retinopathy (PDR). Large, multicentre randomised controlled trials have shown that timely laser treatment will prevent vision loss from DME and PDR,” he says.

Managing Diabetes Type 2

One effective way of managing Type 2 diabetes experts say is by eating healthier foods. Reducing your intake of high fat and quick-releasing (high Glycaemic Index) sugar foods helps control blood sugar levels and cholesterol, and ensures you don’t gain weight.

The traditional food pyramid – with an emphasis on fruits, vegetables, grains, lean meat and poultry, and fish – is a useful guide, not just for people with diabetes but for everyone. Eating larger servings of food can also increase blood sugar levels – so it is suggested that eating smaller meals on a regular basis may be better.

People should also increase their physical activity, even if it’s simply walking for an extra 15 minutes or so. This gets the blood circulating and helps reduce weight.

According to Professor Helen Teede, the Head of Diabetes Southern Health in Melbourne: “Small changes such as walking for 20 or 30 minutes a day do make a difference. You don’t need to spend a lot of money at the gym. Even a small amount of weight loss helps significantly. Losing 5 per cent of your body weight brings health benefits and can prevent or delay the complications of diabetes,” she says.

Experts suggest people with diabetes have a flu vaccine before winter and have the Pneumovax every five years.

There are a number of other precautions sufferers should take including, reducing their stress levels and understanding the importance of their medication.

World Diabetes Day: 14 November

On 20 December 2006, the United Nations (UN) passed an historical resolution recognising diabetes as a serious global health threat. It is the first time a non-infectious disease has been acknowledged in this way. The Resolution designates 14 November each year as the United Nations World Diabetes Day and calls on all nations to develop national policies for the prevention, treatment and care of people living with diabetes as well as those at risk of developing diabetes.

Diabetes Australia is committed to turning diabetes around through awareness, prevention, detection, management and the search for a cure. Eye health professionals play a key role in this important program.

World Diabetes Day is on the 14 November. For more information on Diabetes Retinopathy or Diabetes Type 2 go to www.diabetesaustralia.com.au.

Carl Zeiss Vision & Diabetes Australia in partnership

Body ContenAs announced in the April 08 issue of mivision, Carl Zeiss Vision is a proud supporter of Diabetes Australia. Carl Zeiss Vision and Diabetes Australia have joined forces to help educate the community about the importance of people with diabetes receiving regular eye health checks, which can assist in the early detection of diabetic retinopathy.

Carl Zeiss Vision has now begun introducing several initiatives to create awareness about Diabetes and the need for regular eye tests both within the optical community and to consumers. As from the 1 November Carl Zeiss Vision lens packaging will promote the work of Diabetes Australia and include messages along the lines of: “Diabetes Australia is committed to turning diabetes around through awareness, prevention, detection, management and a cure”. Diabetes Australia representatives will also be attending major trade shows with Carl Zeiss Vision where possible. Carl Zeiss Vision will continue to work on activities and initiatives focused on raising awareness of diabetes.

Ophthalmologist Saves Colleen McCullough’s Sight

The threat of vision loss or blindness is anyone’s worst nightmare and so it was for one of the world’s greatest authors, Australian Colleen McCullough, who suffers from diabetic retinopathy.

That immediate threat has now been averted thanks to Sydney ophthalmologist, Dr. Mark Gillies and his pioneering technique of injecting steroids directly into the eye.

McCullough, the author of world best sellers, The Thorn Birds and The Masters of Rome series, had suffered failing vision for some time when one day she woke up and said to her husband Ric: “I’ve got a grey spot”.

Talking to the media about her problem, McCullough said she visited an optometrist who first told her there was nothing to worry about, before informing her a couple of weeks later that she had macular degeneration in the left eye.

“I’ll never forget his words,” she told the media. “He said, ‘Oh, you poor woman’. The phrase spoke volumes. It said, ‘S..t, you’re going blind’. It’s insidious.”

McCullough told The Australian newspaper that sight in her left eye had dwindled to 15 per cent when Dr. Gillies first saw her in 2002.

“We still did not have the new treatments so I cauterised the abnormal vessels invading her macula with laser,” he told the newspaper. “This preserved her peripheral vision but she has lost the central vision there.”

Two years later, McCullough returned with heavy bleeding and loss of vision in her second eye. She wasn’t treating her diabetes and was now suffering diabetic retinopathy.

“I used the treatment we were developing for diabetic retinopathy: an injection of steroids into the eye,” Dr. Gillies said.

“Then when the bleeding receded from the very centre, I treated the source – which was fortunately away from the centre – with heavy conventional laser and she had one of the best results I had ever seen,” he said.

Despite using reading tools such as magnifiers with fluorescent lights, McCullough told The Australian that her failing vision has severely affected her ability to read. “I’m a natural speed reader,” she said. “When I was a child, I read a novel in 40 minutes. Now it takes me 40 minutes to read a page.”

Dr. Gillies research has not only saved what was left of Colleen McCullough’s sight, but his group’s pioneering treatment of injecting steroids into the eye to stop bleeding in the retina, is now used worldwide for people with advanced diabetic retinopathy when conventional treatments have failed.