World Diabetes Day 2020

The facts:

• Every 5 minutes, 1 person is diagnosed with diabetes in Australia¹
• Diabetes is the leading cause of preventable blindness in Australia²
• The rates of diabetes is increasing faster than heart disease or cancer¹
• Diabetic eye disease occurs in 25-35% of Australians³

What is diabetes?

Diabetes is a condition which can affect many systems in the body. It occurs when the level of sugar (glucose) in our blood is higher than normal. Sugar levels in the blood are primarily controlled by a hormone called insulin which is released by the pancreas. When insulin is released, blood glucose levels in the body reduce.⁴

There are two main types of diabetes. Type 1 diabetes is autoimmune, meaning the immune system of your body attacks its own insulin-releasing cells in the pancreas, causing a rise in blood glucose.⁴ Type 2 diabetes is a progressive condition where the body becomes resistant to the effects of insulin and/or slowly produces less insulin.⁴ This type represents approximately 85-90% of all cases of diabetes in Australia.¹

How does diabetes affect the eye?

Diabetes can affect many aspects of your ocular health and vision.

Diabetic retinopathy (DR) is a condition where high blood sugar levels damage the small blood vessels (or capillaries) in the back of your eye, also known as the retina, which leads to reduced oxygen supply as the blood is no longer effectively delivered to this area. There are two major categories of diabetic retinopathy:

1. Non-proliferative: Damage to vessels causes small haemorrhages, fatty lipid deposits and reduced blood circulation in the retina.⁵
2. Proliferative: Damage to vessels becomes so severe that the retina is significantly starved of oxygen, leading to the creation of new, leaky vessels to compensate which can cause extensive bleeding and vision loss.⁵

With these changes, other conditions can arise, including cataracts, dry eye disease and fluid build-up at the back of the eye (diabetic macular oedema, or DMO).^5,6

Diabetic eye exams at Innovative Eye Care

At Innovative Eye Care, we routinely assess many diabetics to prevent or detect diabetes-related complications sooner rather than later.

Our optometrists will often use eye drops to increase your pupil size (dilating drops), allowing for a better view into the back of the eye. A good analogy is like looking through a keyhole compared to opening up the door. A full dilated retinal examination is recommended at least every year for diabetics to monitor for signs of diabetic retinopathy and DMO, which often arise stealthily without your knowledge.

With the aid of our Heidelberg OCT, we are able to detect signs of diabetic retinopathy and diabetic macular oedema in all stages of the conditions. With the addition of OCT-A imaging, we can perform non-invasive 3D scans of the blood vessel network in the eye. Monitoring the movement of individual blood cells allows for greater analysis of diabetic eye health. We also have specialised equipment to help detect and manage cataracts and dry eye disease, including corneal tomography, corneal topography and slit lamp biomicroscopy.

How else can my diabetic eye disease be managed?

Studies have shown that good control of blood sugar levels, blood pressure and cholesterol has positive effects on the risk of diabetic eye disease.^7–10 Currently, diabetic retinopathy and DMO are both treated with injections in the eye.¹¹ The injection works by reducing the production of the new leaky blood vessels, and are usually only required in moderate to severe stages of these conditions. Those with severe diabetic retinopathy may need thermal burns to the retina to seal leaky blood vessels.¹²

References

1. Diabetes Australia. Diabetes in Australia [Internet]. n.d. [cited 2020 Nov 19]. Available from: https://www.diabetesaustralia.com.au/about-diabetes/diabetes-in-australia/
2. Bayer Australia Ltd. The economic impact of diabetic macular oedema in Australia [Internet]. 2015 Apr [cited 2020 Nov 19]. Available from: https://www.diabetesaustralia.com.au/wp-content/uploads/The-economic-impact-diabetic-macular-oedema.pdf
3. Keel S, Xie J, Foreman J, van Wijngaarden P, Taylor HR, Dirani M. The Prevalence of Diabetic Retinopathy in Australian Adults with Self-Reported Diabetes: The National Eye Health Survey. Ophthalmology. 2017;124(7):977–84.
4. Sapra A, Bhandari P. Diabetes Mellitus. In:StatPearls [Internet]. Treasure Island (FL):StatPearlsPublishing; 2020 [cited 2020 Nov 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551501/
5. Fraser CE, D’Amico DJ. Diabetic retinopathy: Prevention and treatment [Internet]. 2014 [cited 2016 Oct 14]. Available from: https://www.uptodate.com/contents/diabetic-retinopathy-prevention-and-treatment?source=see_link
6. Sayin N, Kara N, Pekel G. Ocular complications of diabetes mellitus. World J Diabetes. 2015 Feb 15;6(1):92–108.
7. The Diabetes Control and Complications Trial Research Group. The Relationship of Glycemic Exposure (HbA1c) to the Risk of Development and Progression of Retinopathy in the Diabetes Control and Complications Trial. Diabetes. 1995 Aug 1;44(8):968–83.
8. The Diabetes Control and Complications Trial Research Group. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. N Engl J Med. 1993 Sep 30;329(14):977–86.
9. Stratton IM, Kohne rEM, Aldington SJ, Turner RC, Holman RR, Manley SE, et al. UKPDS 50: Risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia. 2001 Feb 5;44(2):156–63.
10. Turner RC, Cull CA, Frighi V, Holman RR, for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2diabetes mellitus: Progressive requirement for multiple therapies (UKPDS49). JAMA. 1999 Jun 2;281(21):2005–12.
11. Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, et al. The RESTORE Study. Ophthalmology. 2011 Apr;118(4):615–25.
12. The Diabetic Retinopathy Study Research Group. Photocoagulation Treatment of Proliferative Diabetic Retinopathy: Clinical Application of Diabetic Retinopathy Study (DRS) Findings, DRS Report Number 8. Ophthalmology. 1981 Jul 1;88(7):583–600.