Are you keeping your sugar level at check? If you have diabetes, are you visiting your doctor on a regular basis? And if you do not have diabetes, are you living a healthy lifestyle?
If not, then read this real case study by Dr Paras Agarwal, Consultant, Diabetes and Endocrinology, Max Super Speciality Centre Panchsheel Park and Max Hospital Gurgaon.
“There was a 52 year old male type-2 diabetes patient who was referred to me. He had been a diabetic for the last 10-12 years. When he met me his HBA1C was very high at 10.2%."
HBA1C is the last three months metabolic memory average of diabetes control. Every patient has the target to keep. If one is not able to maintain the control, one might get complications like Diabetic Retinopathy.
"So that patient was basically treated with some medicines which he took on and off. I looked at the old history of the patient for the last 10-12 years and found his blood sugar levels had never gone below 200 mg/dL."
His kidney functions were impaired. Typically, if kidney functions are impaired doctors often suspect that the eyes are impacted as well.
A retina test was prescribed, and not surprisingly, the patient was diagnosed with “Proliferative Diabetic Retinopathy”.
Proliferative Diabetic Retinopathy indicates that blood vessels of the retina have got damaged. Blood vessels start leaking, swell up or there might be new blood vessel formulations which can create problems. More importantly, retina is the place in the eye where the image is formed, so any hampering there might lead to vision loss.
In this patient's case, since his diabetes remained uncontrolled, he was developing progressive vision loss. He was put under the care of an ophthalmologist and consequently his therapy treatment was started and he had to be given some injections in the retina.
"No doctor wants a patient to reach this stage of damage, but uncontrolled diabetes can lead to this,” says Dr Agarwal.
What is Diabetic Retinopathy?
Diabetic Retinopathy refers to the impact gradual and long term diabetes can cause to the retina of the eye.
“Over a long period of time, diabetes can affect small blood vessels, arteries, veins and the small arteries are affected in the retina also. These blood vessels may start leaking or get ruptured. This may be problematic for the flow of blood in the eye and blockage of blood may lead to deficiency of blood supply in that area as well.”Dr Sanjay Dhawan, Senior Director and Head, Ophthalmology, Max Healthcare
Diabetic Retinopathy is often completely asymptomatic and sometimes is not detected till the last stage, when there may be no turning back.
What Causes Diabetic Retinopathy?
Apart from diabetes, if your blood pressure levels and cholesterol levels are out of control, and if you are is a smoker, you are high risk.
Dr Richa Chaturvedi, Senior consultant Endocrinologist, Indraprastha Apollo Hospital, New Delhi, says, “hypertension, presence of urinary protein leakage ( Albuminuria) and increasing age along with diabetes are also the risk factors of Diabetic Retinopathy.”
Initial signs like blurring eyes, splashes of light, floating spots should not be ignored, say doctors.
Retinopathy in Younger Diabetics
Diabetes in India is hitting younger and younger people. Lifestyle, bad eating habits, poor sleep and lack of exercise all contribute to it.
“The prevalence is increasing. Obesity, bad lifestyle habits, lack of exercise are the main culprits for the same. People from across age groups have shown an increased risk of diabetes.”Dr. Danendra Sahu, Associate Consultant, Endocrinology, Fortis Hospital Shalimar Bagh
Dr Dhawan adds, “Diet which is rich in sugar, carbohydrates, fats, more processed food and indoor living conditions, all this leads to development of diabetes.”
Doctors warn pregnant diabetic women have to be more careful and get regularly screened.
According to the World Health Organisation, 79.4 million people may have diabetes by 2030 in India. Almost two-third of all Type 2 and almost all Type 1 diabetics are expected to develop diabetic retinopathy (DR) over a period of time. DR prevalence in India, as per a study done in 2014 was 21.7%, with a larger percentage in men.
“People in the younger age of 20’s, 30’s and 40’s are getting diabetes, so everything is happening much sooner and much faster. Also, increase in the number of diabetic patients, increase in longevity, leads to the bulk of diabetic patients here and hence more prevalence of Diabetic Retinopathy patients if they do not take care of it earlier,” warns Dr Dhawan.
“In India, I can tell the problem is because of the poor awareness about Diabetic Retinopathy. Screening is hardly done and if you randomly check the patients data, that how many patients have got Retina scan done, would be even less than 10%.Dr Agarwal had some different take on India’s condition as he said.
Treatment
Doctors warn that the damage once done cannot be reversed, but therapy, treatment and regular screening can help prevent further damage and vision loss.
If you have mild or moderate non proliferative diabetic retinopathy, your eye doctor will keep an eye on the progression and diabetes management can help slow the progression.
Advance cases may require laser or surgical intervention.
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