World Diabetes Day: Eyes in focus

An early detection and treatment of retinopathy can prevent most cases of

severe vision loss and blindness in people. Unfortunately poor and lower middle class people end up with the problems than the rich who can afford regular care

Diabetes is fast becoming one of the most challenging and major public health problems worldwide.

Unfortunately, very few are aware of complications created in the eyes. It is presumed that this disease would affect a total of 4.4% by the end of 2030. Moreover, 183 million people (50%) are undiagnosed and 4.6 million deaths were caused by diabetes in 2011.

It is the fifth leading cause of death in most high-income countries and there is substantial evidence that it is epidemic in many economically developing and newly industrialized countries.

In Nepal, one out of three people aged 40 years or more are found to be suffering from pre-diabetes, a silent killer disease.

In a survey in Kathmandu, one out of four people aged 60 years (25.99%) were found to be suffering from the disease. Reports till date show that there are 900,000 diabetic people in Nepal.

Diabetes patients are found more in urban areas than in the rural and two-thirds of the diabetes patients are diagnosed during health camps, while the life expectancy of people suffering from diabetes is 13 years less than the normal life expectancy rate of the country.

Diabetes affects different parts of the body leading to complications including heart disease, stroke, loss of limbs, kidney problems, and in pregnancy causing fatality.

This disease can gradually disturb people’s vision, finally resulting in blindness due to diabetic retinopathy. It is one of the leading causes of visual impairment and blindness in our country.

It is indeed an emerging public health issue as patients usually come for treatment very late with no possibilities of good visual recovery.

Prevalence of diabetic retinopathy (DR) among the diabetics varies from 18 to 43%. In a hospital-based study in Tilganga, prevalence of DR was 44.7% with 33.7% in sight threatening stage of retinopathy needing urgent treatment.

Among the new diabetic patients attending the vitreo-retina service, almost half of the subjects never had a retina evaluation prior to their initial visit to Tilganga Institute of Ophthalmology.

Awareness of diabetic retinopathy was poor among them while only one third knew about the possible effects on the eye.

It was found that 4.8% of the total blindness is due to the complication of diabetes in the eye. They are more prone to infection as high blood sugar level makes them less resistant.

Diabetics have dryness and gritty feeling in their eyes. It is advised not to rush to buy a new pair of glasses till the blood sugar level is stabilized. People with diabetes can get cataract (clouding of lens) earlier which progresses more rapidly than those without diabetes.

However, cloudy lens can be successfully removed and replaced by a man made lens implant. Glaucoma is an eye condition with high eye pressure, which robs our vision slowly and the patient is usually unaware of any symptoms.

Therefore, the damage is found only during the eye examinations in diabetic population.

Another very important complication is Diabetic Retinopathy, which is the fifth commonest cause of blindness in the world. The longer the duration of diabetes, the greater the risk of this serious eye problem.

If retinopathy is not found early or is not treated, it can lead to blindness. Early-stage retinopathy may not need to be treated, but more advanced retinopathy with bleeding inside the eye may require laser treatment or injections of medicine into the eye.

One should have his or her eyes examined every year by an ophthalmologist so the condition can be closely monitored.

If the damage is not profound, it can be treated with laser called photocoagulation. It uses the heat from a laser to seal abnormal, leaking blood vessels in the retina.

If it is performed in an appropriate and timely manner, laser treatment may reduce the risk of future vision loss.

Educating each individual about diabetes and its preventive measures is very important to lessen the financial burden on the family, on society hence the country.

World Diabetes Day (WDD) is celebrated every year on November 14 to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea, which led to the discovery of insulin in 1922.

The day engages millions of people worldwide in diabetes advocacy and awareness. Each year World Diabetes Day is centered on a theme related to diabetes.

Topics covered in the past have included diabetes and human rights, diabetes and lifestyle, and the costs of diabetes. Recent themes include “Healthy living and diabetes” with the main slogan on ‘Eyes on diabetes’ this year.

Many complications can be picked up in the early stage through screening so that treatment can be given to prevent them becoming more serious.

‘Give my sight to a man who has never seen a sunrise, baby’s face or a love in the eyes of a woman’, is a part of a poem by Robert N Test.

Today, on World Diabetes Day, we should all say that let’s try to help people who have lost their sight from diabetes and let them be able to see again everything that they missed.

Finally, an early detection and treatment of retinopathy can prevent most cases of severe vision loss and blindness in people.

Once considered as a rich man’s disease, unfortunately poor and lower middle class population are more likely to end up with problems than the rich who can afford regular care.

Dr Pradhan is MD, MRCSEd (UK) and Medical Retina consultant