KOCHI: 68-year-old Thankamma (name changed) from Ernakulam has been a diabetic patient for 15 years. As she did not manage her disease properly, she lost vision in one of her eye 10 years ago. However, worried about financial burden and other difficulties, she opted to skip treatment.
Two years back, she lost vision in the other eye too. At this point, being an elderly woman and staying alone, she had no option and decided to take treatment to improve her vision. “However, a day after the procedure, her vision improved, and she could see at least people and things around,” said Dr Thomas Cherian, senior consultant in vitreo retinal at Little Flower Eye Hospital, Angamaly, who treated the patient.
Thankamma’s is a severe case of diabetic retinopathy, and surgery was the only option. People, when diagnosed with diabetes, often tend to avoid proper treatment and try to manage blood sugar levels themselves. If the disease is left untreated for a prolonged period, among other issues, it can lead to diabetic retinopathy - vision loss or blindness caused by diabetes. Diabetes along with hypertension, diabetes affecting the kidneys, high cholesterol levels, and anaemia, can worsen the condition.
Regular screening
According to experts, diabetic patients should undergo regular screening to identify any underlying conditions to prevent vision loss. “Because the condition is asymptomatic, people may miss it in the first 20 years of diabetes, where the retinopathy may worsen and the patient does not realise it. By the time the condition is diagnosed, it might have moved through mild, moderate, and severe diabetes retinopathy, moving to sight-threatening stages, making treatment difficult. Diabetes should be tightly controlled in the first 20 years to avoid complications in the next 20 years of life,” said Dr Gopal S Pillai, clinical professor and head of department of ophthalmology at Amrita Hospital, Kochi.
He added that the presence of retinopathy is usually diagnosed in many patients only when they present vision loss. By this time, the disease would have become quite advanced. “The condition is caused when microvessels in the eyes are affected, resulting in the growth of new vessels that are called proliferative diabetic retinopathy. Many may not experience blindness even with significant retinopathy. Thus, creating awareness on the condition and its early diagnosis is important,” said Dr Mahesh G, consultant and HOD, vitreo retina, Giridhar Eye Institute, Kochi.
“Diabetic retinopathy is the most commonly seen retinal vascular disease. Retinal vein occlusion, radiation retinopathy, and hypertensive retinopathy are the other conditions,” said Dr Thomas.
Stay in control
The treatment depends on the stage at which the condition is diagnosed. “If diabetes and other metabolic factors are not controlled, it can worsen the condition. Other metabolic conditions, like hypertension, etc., should also be controlled. Here we need the help of other departments. The patients should be motivated to follow up and treat lifestyle diseases,” he said, adding that every diabetic patient should undergo vision screening and should be diagnosed at the earliest possible to prevent vision loss. “Many patients take proper treatment for some time. But as management becomes longer and longer, patients get tired emotionally and financially, and may drop treatment, making the condition worse,” said Dr Gopal.
When people skip treatment, it affects their livelihood too. “I have seen many people, especially drivers, struggling owing to the condition. When they are diagnosed with diabetes, they tend to avoid treatment and diet. However, when it affects the eyes, it leads to financial trouble for the entire family,” said Dr Thomas.
Treatment
Laser treatment is used when retinopathy goes into the next stage of initial bleeding or proliferative diabetic retinopathy. Its efficacy has been proven since the 1960s.
“It is used to avoid leakage of vessels and to prevent the formation of new vessels in the eyes. In the advanced stages, surgical treatment is opted to remove and correct blood vessels. Along with these options, diabetes control is important,” added Dr Mahesh.
“When the patient has high sugar levels, we may ask them to control sugar levels and visit again. They may try to solve the issue with the help of home remedies or some other treatment options, leading to a delay in treatment and making the outcome poorer,” said Dr Gopal.
“People tend to give eye treatment less priority even when the first eye is involved, as diabetics have many different problems. Once the second eye is involved, they will desperately seek treatment. By this time the first eye is already blind, and the second eye too is on the verge of blindness, making the person completely incapacitated,” he added.
The aim is early management with laser treatment to prevent vision loss, and as diabetic retinopathy progresses, there will still be visual symptoms, and patients take this as a failure of treatment and may drop the treatment. “It is a lifelong battle—with diabetes and retinopathy, consistency plays a significant role in treating and reversing the condition,” emphasised Dr Gopal.