Diabetes and Diabetic Retinopathy – Dr Rahul Shroff

The past two decades have seen an explosive increase in the incidence of diabetes mellitus worldwide, making it one of the most common non-communicable diseases today. According to the World Health Organization (WHO), there were an estimated 135 million diabetics in the world in 2000, and this number is expected to increase to 300 million by 2025.

What is of more consequence is that India has the largest number of diabetics in the world. In 1994, 19.4 million suffered from diabetes mellitus, 32 million were diabetics by 2000 and the number is expected to increase to 57.2 million by 2025. Moreover, according to current estimates, diabetics will increase by 42 per cent in developed nations and by 170 per cent in developing nations. According to an ICMR study, prevalence of diabetes mellitus, which was 2.3 per cent in urban population in 1970, increased to 12.1 per cent in 2001.

The increase in incidence of diabetes mellitus and its complications has been attributed to change in life style caused by increased urbanization, high calorie diet, decrease physical activity and stress. Other important factors are genetic factors, family history and increased longevity. And what is worrying that diabetes is striking at an early age among the urban population.

 

Types of Diabetes:

Diabetes mellitus occurs in two forms:

Type 1 (Insulin dependent) – Also called juvenile diabetes, this is seen in younger people and is characterized by absolute insulin deficiency due to which these patients are completely dependent on insulin treatment. The incidence of this form of diabetes is doubling every decade.

Type 2 (Non-Insulin dependent) – This is seen in older people and is characterized by insulin resistance or abnormal insulin secretion. These patients can be treated with tablets or may require insulin. This form accounts for 90 per cent of all cases seen globally, but its increasing incidence in India is due to changing diet, from traditional Indian food to modern diet caused by a more stressful life-style and increased urbanization. This type is being seen in younger people due to obesity. Moreover, type 2 diabetics have a greater tendency to develop hypertension and heart disease.

It’s not just the disease itself that is a cause for concern. Diabetics are more prone to develop systemic complications. They are also 25 times more likely to develop blindness, twice as likely to have a stroke, 2-4 times more likely to have myocardial infarction and much more likely to develop kidney disease or undergo amputation.

 

Effect of diabetes on the eye:

Diabetes can cause eye complications such as:

1. Diabetic Retinopathy: This is the most common complication and it has been seen that 25 per cent of all diabetics develop this complication after 10 years of diabetes and 50 per cent develop it after 20 years of diabetes. Diabetic Retinopathy is also more common in the upper socio-economic group.

 

Diabetic Retinopathy has two types –

Non-Proliferative Diabetic Retinopathy – This is the early stage in which tiny blood vessels in the retina get damaged and leak blood or fluid, which cause the retina to swell or form deposits called exudates. 90 per cent of Diabetic Retinopathy cases are of this type. This stage often has no symptoms.

Proliferative Diabetic Retinopathy – This is the advanced stage. Abnormal new blood vessels grow on the surface of the retina and often bleed into the jelly in front of the retina, giving rise to floaters, dots or lines or sometimes loss of vision. These new vessels can eventually pull the retina causing a traction retinal detachment. 10 per cent of Diabetic Retinopathy is of this type.

Maculopathy – Leaking fluid collects in the centre of the retina called the Macula giving rise to blurring of vision.

Studies have shown that there has been a 3-fold increase in the incidence of Diabetic Retinopathy in India in the last 10 years.

 

2. Cataract – This is more commonly seen in diabetics at a younger age and more commonly in the lower socio-economic group. Important causes are exposure to ultraviolet light and oxidative stress.

 

3. Glaucoma – This involves increase in intra-ocular pressure within eye and is more commonly seen in persons afflicted with diabetics.

 

4. Diabetics are also more prone to develop paralysis of the nerves of the eyes due to obstruction of the blood supply.

 

Incidence of vision loss:

The following categories of individuals are at a higher risk of losing vision in diabetes:

• Those who have had diabetes from a younger age
• Those who have had diabetes for many years
• Those who have poorly controlled blood sugar
• Those who have poorly controlled blood pressure
• Those who smoke

 

Improving diet:

Diet plays an important role in the control of diabetes and diabetic retinopathy. Studies have shown a much lower incidence of diabetic retinopathy in persons who follow a healthy diet. A good diet consists of

 

• Ghee as the cooking medium
• Fish and fish-oil capsules, which are rich in selenium and zinc. Fish is considered to be one of the best foods for diabetics
• Green leafy vegetables
• Vitamin A rich foods like carrot and green leafy vegetables

·         Vitamin C rich foods such as citrus fruit like orange, lemon

• Vitamin E rich foods like cereals and grains

 

Diabetics must avoid fried food, animal food (except milk and fish), processed food and preserved food.

Regular eye examination

All diabetics must have the eyes examined regularly with dilated pupils. Juvenile diabetics must have their eyes examined at least once a year after the age of 12 years because diabetic retinopathy is rarely known to occur before puberty. Those with diabetes at an older age must have the eye examination done once at the time of diagnosis and then at least every 6 months to one year thereafter.

If Diabetic Retinopathy has been diagnosed, they should have the eyes examined as often as recommended by their eye doctor.

 

Laser treatment:

A special test called fluorescein angiography may be required to identify areas that require laser treatment. If leakages or new vessels are detected, laser treatment must be promptly given. Sometimes there is leakage of blood from the retina of the eye into the jelly in front of the retina, which may cause blurring of vision. An operation called vitrectomy may be required to remove the bleeding and replace it with clear fluid.

Studies have shown that vision can be preserved in 90 per cent of diabetics if laser treatment in done in time.

 

Newer treatment modalities:

 Anti-VEGF Injections for Diabetic Retinopathy

 Injection treatments (Lucentis™, Avastine™) used commonly for macular degeneration have also proven to be effective for diabetic eye disease, in some cases better than laser treatment.

Results from a large clinical trial conducted by the Diabetic Retinopathy Clinical Research Network, or DRCR.net, demonstrated that patients receiving a combination of anti-VEGF treatments and laser treatments had greater gains in visual acuity as compared to others.

 

A newer injection viz. EYLEA™ (aflibercept), known in the scientific literature as VEGF Trap-Eye, is also being used as an injection into the eye to provide a therapeutic effect in patients suffering from various eye disorders including in some cases of diabetic retinopathy.

Prevention of complications:

All diabetics must adhere to the following to prevent complications:

 

• Avoid obesity and have regular physical exercise
• Control the blood sugar and blood pressure at all times
• Avoid self-medication. It is better to follow the advise of a physician
• Maintain a healthy diet. Insulin or pills is not a substitute for a proper diet
• Have your eyes examined at least once every 6 months to a year by an eye doctor

Being a diabetic does not mean that you cannot enjoy a happy and healthy life. Follow the above-mentioned simple rules with a positive attitude, and you will see the change in your life.

Issued in public interest by Shroff Eye Hospital, Mumbai, India

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ADVANCES IN CATARACT SURGERY – LIFE-CHANGING RESULTS FOR PATIENTS

Date: 6th August 2010

Author: Shroff Eye Hospital

About:  Shroff Eye Hospital is India’s First Eye Hospital that the Joint Commission International (International Division of JCAHO, USA) has given accreditation for excellence in patient care and health care delivery. Shroff Eye is also India’s first and only Wavelight Concerto 500 Hz LASIK center- The Worlds Safest and Fastest LASIK.

Contact: anand@shroffeye.org, www.shroffeye.org

Cataract is one of the most commonly known eye conditions causing visual impairment. People who remember when cataract removal involved general anesthesia, days in the hospital, weeks immobile at home and the subsequent need to wear thick glasses may find it hard to believe how much the procedure has changed. Some may be needlessly postponing surgery as a result.

While in the past people waited until a cataract was fully “ripe” and nearly blinding before having it removed, the current recommendation is to have the surgery as soon as a cataract interferes with normal activities, including driving, watching television, climbing stairs, playing games, cooking and reading. In fact, the more advanced a cataract becomes, the more difficult it is to give the desired result.

Every patient’s eye is unique, and surgery must be tailored to the individual

Cataract Surgery can now be customized to reduce and usually eliminate dependence on glasses for distance, intermediate vision and reading

The Evolution of Cataract Surgery-

“No-Stitch” “No Stress” Customized Cataract Surgery

The fundamental aim of cataract surgery, the removal of the opacified natural lens to improve vision, has remained the same for hundreds of years. However, the way in which this is achieved and the expectations of people undergoing the procedure have changed drastically. Advances allow cataract surgery to be customized for every patient.

Today, cataract surgery is nearly always performed under local or topical (eye drops) anesthesia and takes less than 15 minutes.

Microsurgical Techniques

Today the surgery is done through a very small stitch-less, self-sealing incision in the cornea. Earlier this incision used to be 6 mm, then 3 millimeters and now a very tiny incision of 2 mm called Micro Incision Cataract Surgery (MICS). MICS (Micro Incision Cataract Surgery) with stable advanced Intra Ocular lenses helps patients resume work early.

Foldable Advanced Lens Implants

Standard intraocular lenses are monofocal—that is, focused for one distance, usually far. These patients still need glasses for near and intermediate distances. The development of multifocal intraocular lenses offers a further option for patients

“We can reduce drastically, if not eliminate, nearsightedness and farsightedness without the need for glasses or spectacles after the surgery,” said Dr Anand Shroff, Cataract Surgeon, Shroff Eye Hospital, Mumbai. “We discuss in detail the needs, lifestyle and visual demands of the patient alongside the preoperative assessment which greatly helps us plan which implant is most suitable for their needs and expectations. The visual potential of the patient can be realized in many different ways, and when looked at in this context very few cataract procedures are the same”.

Patients now have different options and their surgeries can be tailor-made for them, called ‘Customized Cataract’ surgery, which is customized based on their needs, desire to be free from spectacles and their need to get back to work as soon as possible. Customized matching of lenses covers the entire range of requirements and results in highly satisfied patients.

Many people now do not want to wait for a cataract to occur, but start looking for options to correct both, their reading and distant vision. They opt for ‘PRELEX’ or Presbyopic Lens Exchange even before the cataract starts to interfere with their daily activities. Such options look after all focal points of vision: near, intermediate and distance.

In some people vision is further impaired by rather severe astigmatism, an irregularity of the cornea which makes it difficult for the eye to bring light to a point focus on the retina, no matter how good the glasses you use. So, at the same time that the cataract is removed, the astigmatism can be corrected using new implants called ‘Toric IOLs’.

‘Wavefront Implants’ have taken the cataract lens market by storm.  These are Aspheric Optics which mimic the optics of a ‘young eye’ and give exceptional contrast and night vision.

To aid the eye surgeon get accurate measurements of the lens power, the Zeiss IOL Master is an amazing device. It is engineered as a non-contact optical device that measures the power of the IOL to be implanted. Using partial coherence interferometry, the IOL Master is consistently accurate to within ±10 microns or better. Also, because the IOL Master is non-contact (nothing touches the eye itself), there is no need for anesthesia and there is no potential for spread of contamination or inter-operator variability in measurement.

With the use of accurate diagnostic and measurement tools, combined with very small incisions  and surgeon precision, we have not only delivered stable and exceptional results but also have made our patients extremely satisfied with their outcomes, said Dr Anand Shroff.

Cataract

Date: 4th August 2010

Author: Dr. Kaushik Shah

About: Eye Surgeon, Ashwini Eye Care Clinic

Contact: drkaushikshah@yahoo.com

Eyesight is one of the most precious gifts that nature has given to mankind. It’s only because of the eyes; one can enjoy the beauty of this world. It’s impossible to imagine life without eyesight.

Though a very small part of body, eye is one of the most complex human organs. It has various parts out of which cornea, lens & retina are the structures mainly responsible for normal vision. Human lens is a transparent structure like a transparent glass which focuses light rays coming from different objects on retina. This is the mechanism of normal vision.

Cataract is a condition in which transparent human lens becomes cloudy like a milky glass. This happens due to normal aging process. Though cataract is seen in old age, it can also occur in young age due to trauma. Rarely it’s seen in children either by birth or during childhood & may or may not be associated with other systemic diseases.

Cataract affects normal vision to a great extent depending upon its grade. All parameters of vision like clarity, colour perception, depth perception, sharpness, contrast are affected badly. This in turn causes lot of disturbances in day to day life of an individual. The only treatment available for this condition is surgery. It can’t be cured by medicines or glasses or any other therapy.

Cataract surgery is most commonly performed surgery all over the world. It has undergone drastic revolutions in last 10-15 years. At present surgery is done by most advanced technique called Phacoemulsification by using a machine (Phaco Machine) through a small 2.8 mm incision. Cataractous lens material is removed with the machine & replaced by artificial high quality foldable Intra Ocular Lens (IOL).Surgery takes hardly half an hour & patient can go home immediately after surgery. No hospitalisation is required. Patient can resume office work after 5 days.

In terms of availability of most modern equipments & advanced surgical techniques, Indian surgeons are at par with Western World. Thanks to advances in Indian Ophthalmology, because of which cataract is no longer a doom for human vision.

Ashwini Eye Care Clinic located at Baner is the centre where this advanced Cataract Surgery is done on routine basis by Dr. Kaushik Shah who is well experienced in this type of surgery. This clinic is well equipped with all the infrastructure & equipments required for modern cataract surgery & provides high quality Cataract & Squint Surgeries on day care basis at affordable rates. All the facilities required for diagnosis & treatment of all the eye diseases are available under one roof including state of the art Operation Theatre & Glass Counter. This centre has become a great help for the patients with eye problems in & around Baner.

Cataract

Change in vision due to cataract

Cataract removal by most advanced technique – Phacoemulsification

Cataract replaced by artificial lens