Can you prevent diabetic retinopathy?

It’s the third most common cause of blindness in South Africa after cataracts and glaucoma. Diabetic retinopathy may not have any symptoms at first – but finding it early means you can take steps to protect your vision. 

At least 10% of South Africans living with diabetes have diabetic retinopathy. The longer you have diabetes, the greater your risk of developing this sight-threatening condition, but the good news is you can lower this risk by controlling your diabetes. Dr Farah Moti, an ophthalmologist at Mediclinic Sandton and Vice-President of the Ophthalmological Society of South Africa, explains further. 

“Diabetes is a systemic disease of whole body and diabetic retinopathy is a manifestation of poorly controlled diabetes,” she says. “Diabetic control can be monitored by regular eye check-ups as the eyes are often one of the first organs to be affected by the disease. Patients shouldn’t get to the stage of severe diabetic retinopathy if they go for annual screenings, which aren’t as costly as a full consult. You should have your eyes checked every year if you’re diabetic.”

Dr Moti adds that diabetes is a microvascular as well as neuro-inflammatory disease. Both these aspects can cause eye pathology. “Fluctuating blood sugar levels can damage the smallest blood vessels in the body, while the neuro-inflammatory component is the lesser understood part of diabetes,” she says. “Diabetic retinopathy is a combination of these two aspects of the condition.”

Microvascular: Your retina is full of tiny blood vessels that get damaged in long-term poorly controlled diabetes. “Endothelial cells form the lining of your blood vessels and when they’re healthy, blood doesn’t leak out to surrounding tissue. However, when that cellular structure is compromised because of high sugar levels, the blood vessels can leak and cause problems with your vision.”

Neuro-inflammatory: The eye is a round globe. “On the back part of the curve of the eye, blood vessels and nerves form the retina,” Dr Moti says. “Blood vessels provide nutrition to those nerves – and those nerves form the optic nerve that connects the eye to the brain. It forms its own sustainable ecosystem and, when it functions well, the brain interprets the signals correctly, which is how we see.” Over time, too much sugar in your blood can damage the retina that sends signals to your brain through the optic nerve. 

Although the early stages of diabetic retinopathy usually don’t have any symptoms, you might notice you’re having trouble reading or seeing objects in the distance. In later stages of the disease, blood vessels in the retina start to bleed into the gel-like fluid that fills your eye.

Treatment for advanced stages of the disease can mean surgery or injections into the eye to target swelling. However, lost vision cannot be restored. Treatment for mild and moderate stage of diabetic retinopathy entails better management of the condition through diet, exercise, medication.

Annual retina screening

“A number of diabetic patients see annual eye screenings as unnecessary unless they have a vision problem,” Dr Moti says. “There are many medical appointments they need to keep, which can become taxing and costly. But regularly screening the retina is vital. People living with diabetes need to see a lot of healthcare professionals [GP, ophthalmologist, endocrinologist, dietician] – but there’s often a lack of communication between the different disciplines.” However, a number or artificial intelligence (AI) screening programmes now allow communication between the various healthcare professionals, she adds. “While the first screening is not as valuable, year two gives a progression report so the practitioner can see whether they need to be more stringent with management of the disease.”

Studies have shown that maintaining near-normal or stable blood sugar can decrease your chance of developing retinopathy and help keep existing retinopathy from getting worse. Your healthcare provider can provide guidelines that may include insulin and other medications, diet changes, and exercise. 

It’s not always easy to stick to the disciplined lifestyle you need to control your blood sugar. If you need extra support, go to www.mediclinic.co.za and find a doctor who can help with your diabetes-related concerns.