Diabetes is probably the most serious medical issue in the world today. The figures are frightening. In Malaysia, more than 20% of our population has diabetes and this figure is projected to increase by another 50% in the next 20 years.
Currently 250 million people worldwide have diabetes and this will increase to 380 million by 2025. Diabetes can affect our kidneys, feet, and heart. Almost all patients with diabetes will have changes in their eyes. More than half of all my retinal patients have diabetes.
One of the serious complications of diabetes is diabetic retinopathy. This is bleeding from small blood vessels on the retina at the back of the eye. This occurs in 1 out of 3 diabetic patients. Diabetic patients can also get macula edema or swelling of the centre of the retina.
The macula is the most sensitive part of our eye and is used for seeing sharp images. Macula edema causes more blindness in the working diabetic population than retinopathy itself.
Symptoms of diabetic retinopathy include blurring of vision, and, pain, if there is glaucoma. Diabetic retinopathy can be diagnosed by taking photographs of the back of the eye with a special camera.
The best way to diagnose retinopathy is to see a retinal specialist who will dilate your eyes with eyedrops and examine your eyes carefully.
Diagnostic tests that can be done by the retinal specialist include fundus fluorescein angiography (FFA) to look for leaking blood vessels, and optical coherence tomography (OCT) to look for macula edema.
Diabetic retinopathy is treated with laser to the peripheral retina. This helps shrink the bleeding blood vessels in the eye and stop further bleeding. Macula edema can be treated with gentle laser and drug injections into the eye. Drugs that can be injected into the eye include steroids.
Anti-VEGF antibodies like Lucentis, Avastin, and VEGF-Trap-Eye. 10 % of diabetic patients get macula oedema and, often, also have concurrent diabetic retinopathy. Retinal detachment, vitreous haemorrhage and glaucoma are serious eye complications of diabetes that requires surgery.
Of course, good control of your diabetes, and other, diseases like hypertension and cholesterol, with drugs and good diet control, can help prevent these eye complications from occurring.
Diabetic retinopathy and diabetic macula edema should be treated by eye doctors that are retinal specialists. Surgery in diabetic patients who have vitreous haemorrhage or retinal detachment should only be performed by trained retinal surgeons that have undergone extended fellowship training with experienced retinal surgeons.
Modern retinal surgery is done with sutureless small gauge vitrectomy systems under local anaesthesia. This allows rapid and comfortable recovery for patients. Retinal surgery is sometimes combined with cataract surgery as diabetic patients often have cataracts as well as diabetic retinopathy. Results of surgery is very good.
All diabetic patients should have their eyes checked annually and even more frequently if there are early changes of diabetic retinopathy or macula edema found. If you live far away from an eye doctor, you can have your retina photographed by a trained technician and the pictures sent digitally to an eye doctor be looked at.
If there are any suspicious things like bleeding or swelling in your retina seen, you will be referred to your nearest eye doctor for further assessment.
A cataract is clouding of the lens in your eye. This is usually due to old age but can also occur due to trauma, diabetes, or due to medications.
Cataract surgery is done when the lens in your eye has become cloudy making it difficult for you to see well enough to carry out your usual daily activities. If the cataract is not removed, your vision may stay the same, but it will probably gradually get worse. Waiting for a longer period of time may make the operation more difficult. If you are considering surgery, please let the doctor know if you are taking the following medications: Flomax (Tamsulosin), Doxazosin, Asprin, or any blood thinning drugs like Warfarin, Plavix or Ticlid (Dipyradimole). These medications may need to be stopped before surgery.
You can listen to Dr Fong talking about cataract surgery.
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