Diabetes Mellitus is a disease caused by reduced insulin (Type I) or its decreased utility in the body (Type II)

Insulin dependent diabetes mellitus (Type I) is more common in younger individuals and Non - insulin dependent diabetes mellitus (Type II) is more common in older individuals and females.

World Health Organisation states that 2 % of Indians are diabetics and has projected 57.5 million diabetics by 2025.

Diabetic mellitus affects all organs - eyes, heart, kidneys, brain etc.

Diabetic eye disease: Diabetics are twice as likely to develop eye problems as non-diabetics and the risk of blindness is 25 times higher in diabetics as non - diabetics.
a) Diabetic Retinopathy (DR) - > 75% develop DR after 20 years.
b) Cataract - occurs earlier in diabetics.
c) Glaucoma - Increased eye pressure is commoner in diabetics than non - diabetics.

Diabetic Retinopathy :
Blood vessel walls become weak, bulge and bleed with deposition of fat and swelling of retina. Lack of blood supply to retina, deprives it of oxygen and nutrients, and weak new vessels start appearing which break easily and bleed profusely causing vitreous haemorrhage (VH) and drop or loss of vision.
Scar tissue, which grows from ruptured blood vessels, will pull the retina, detaching it and may cause permanent loss of vision.

Symptoms:
1) Usually symptomless, until a lot of damage has occurred.
2) Slight or intermittent blurring of vision.
3) Drop or loss of vision occurs, when :
    a) macula (central seeing portion) develops swelling or bleeding.
    b) new vessels bleed profusely (temporary)
    c) scar tissues pull on retina causing retinal detachment (almost permanent)

Types :
Non-Proliferative Diabetic Retinopathy (NPDR)
  * Mild
  * Moderate
  * Severe

Proliferative Diabetic Retinopathy (PDR)

Macular Edema
  * Clinically significant (CSME)
  * Not clinically significant

Fundus Fluorescein Angiography (FFA) is a diagnostic test where a dye is injected into the arm of the patient and photographs of retina are taken to show the areas of leakage and poor blood flow.

Treatment :
   A. Laser
   B. Surgery

Laser Treatment using Slit Lamp	Surgery

A. Laser is “Light amplification with stimulated emission of radiation”, where low energy, highly concentrated light beam is passed through the transparent structures of the eye and when stopped by the pigmented layer of retina, heat energy is produced coagulating the point, aimed at. ( Laser photocoagulation ).

At Jothi Eye Care Centre, Iris Green Laser which is one of the best lasers of its kind is available for the purpose of laser photocoagulation.

This stops further bleeding and weak new blood vessel formation, thereby preventing further loss of vision.

Laser may improve vision in some cases when the swelling subsides, after 6 weeks, but it is done mainly to prevent permanent loss of vision.

B. Vitrectomy is a surgical procedure, where the blood and scar tissue is removed from the centre of the eye and replaced by a clear, artificial solution.

Points to remember :
1. Diabetics need annual or more frequent eye check up, as advised.

2. Good control of diabetes by medication and diet.

3. Early detection and treatment with laser can prevent irreversible blindness due to diabetes.

4. Control of associated disorders like hypertension and cardiac problem is essential.

“Prevention is better than cure”.