Articles on diabetic retinopathy

Diabetic Retinopathy, Don't Let It Blind You

Dr. Ritesh Gupta, Ophthalmologist
Diabetic retinopathy (DR) is one of the most frequent causes of blindness worldwide. Twenty years ago in India, DR was the 17th most common cause of blindness, but it ranks now as the sixth leading cause. The World Health Organization (WHO), under its VISION 2020 initiative, aims to control eye diseases, and DR is among target diseases.There is low level of awareness of the disease and of its treatment modalities among communities and physicians.According to the WHO, 31.7 million people were affected by diabetes in India in 2000. This figure is estimated to rise to 79.4 million by 2030, the largest diabetic population of any nation in the world. It is estimated that 15% to 25% of the population with diabetes have DR, and other peoplewith the disease have the potential  to develop DR over a period of time.Symptoms- At first, Patient does not notice any change in the vision, but don't let diabetic retinopathy fool you. The condition could get worse over the years and threaten your vision. With timely treatment, 90% of those with advanced diabetic retinopathy can be saved from blindness.Symptoms of diabetic retinopathy and its complications may include:Blurry or distorted visionDifficulty readingEye floatersPartial or total vision loss or what feels like a permanent shadow cast across your field of visionExaminationPatient may have decrease vision because of Macular Oedema (swelling in the central part of the retina),Vitreous hemorrhage( bleeding inside the eyes) & /or Retinal detachment (Traction on the retina). TreatmentThe best treatment for early-stage diabetic retinopathy is a preventative one. Monitor the blood sugar levels and schedule a yearly eye exam. Often, effectively managing diabetes greatly slows the development of retinopathy. In advanced stages of the disease, common treatments include:- Focal laser treatment During the procedure, abnormal blood vessels are treated with laser burns. This treatment is completed in one session and normal vision usually returns within a day or two.- Scatter laser treatment This procedure typically takes two or more sessions, completed in a clinic. Scatter laser treatment utilizes lasers to shrink and scar the abnormal blood vessels in the retina. Vision usually returns within a day or two. The procedure may cause marginal damage to peripheral vision and/or night vision.Intraocular injection – Intraocular injection of AntiVEGF drugs and/or steroids help in selected patients.- Vitrectomy A vitrectomy is completed in a surgery centre and often takes a week or more to recover. This procedure removes blood and scar tissue from the eye and is frequently performed to reattach the retina if the disease causes the detachment of the retina. The operation may be executed in joint with laser treatments.

Bad Breath? Chances Are That You Could Be Diabetic

Dr. Yashwanth Kumar Venkataraman, Dentist
Bad Breath?Chances are that you could be Diabetic.Breath odour is the scent of the air you breathe out of your mouth. Unpleasant breath odour is commonly called bad breath orhalitosis; this is something you should not ignore. Those close to you would certainly agree.Bad breath can originate from the most common causes like, poor dental or oral hygiene, the cook's heavy hand with garlic or an underlying serious health problem? Regardless, you can take steps to prevent bad breath at home and treat halitosis with the help of your dentist.Your breath has an interesting ability to provide clues to your overall health. ·   Bad breath related to poor oral hygiene is most common and caused by release of sulphur compounds by bacteria in the mouth ·   Fruity odour in the breath is a sign of ketoacidosis, which may occur in diabetes. It is a potentially life-threatening condition·   Breath that smells like feces can occur with prolonged vomiting,especially when there is a bowel obstruction·   Bad breath having an ammonia-like odor (also described as urine-like or"fishy") occurs in people with chronic kidney disease·   Similarly, a very foul fruit odor may be a sign of anorexia nervosa·   Other diseases, such as asthma, lung and liver disease also can cause distinct odors on the breath. Bad breath, also called halitosis, can be so intense that doctors may even be able to use it to identify diabetes. Recently, researchers have found that infrared breath analyzers can be effective in identifying if you have pre-diabetes or early-stage diabetes. And researchers are testing a breath analyzer that even measures blood glucose levels. What Causes Diabetes Breath?Diabetes induced halitosis has two main causes: Gum disease High levels of ketones in the blood.Gum Diseases (Periodontitis)Gum diseases which is also called periodontal disease, include gingivitis, mild to moderate Periodontitis, and advanced Periodontitis. In these diseases, bacteria attack the tissues and bone that support your teeth. This may lead to inflammation that can affect metabolism and increase your blood sugar, which worsens diabetes. A person with Diabetes having periodontal disease may be more severely affected and will take longer to heal than in a person without diabetes.Diabetes and gum disease is like a double-edged sword. While diabetes can lead to periodontal diseases, these diseases can also create further problems for people with diabetes. According to a report in IOSR Journal of Dental and Medical Sciences, an estimated one in three people with diabetes will also experience periodontal diseases. Heart disease and stroke, which can be complications of diabetes, are also linked to Gum disease.Diabetes can reduce blood flow throughout your body, including your gums. If your gums and teeth aren’t receiving a proper supply of blood, they may become weak and more prone to infection. Diabetes may also raise glucose levels in your mouth, promoting bacteria growth thereby causing infection, and bad breath. To make matters worse, when your blood sugars are high it becomes hard for the body to fight infection, which makes healing in the area of the gums difficult.Bad breath is acommonest sign of periodontal disease. Other signs include:·  Red or tender gums· Bleeding gums· Sensitive teeth· Receding gumsKetonesWhen your body can’t make insulin, your cells don’t receive the glucose they need for fuel. To compensate this, your body burns fat. Burning fat instead of sugar produces ketones, which build up in your blood and urine. Ketones can also be produced when you are fasting or you are on a high-protein, low-carbohydrate diet.High ketones levels often cause bad breath. One of the ketones, acetone (also the chemical found in nail polish) can cause a nail polish-like odor on your breath.When ketones rise to unsafe levels, you’re at risk of a dangerous condition called diabetic ketoacidosis (DKA). Symptoms of DKA include:·  A sweet and fruity odor on your breath· More frequent urination than normal· Abdominal pain, nausea, or vomiting· High blood glucose levels· Shortness of breath or difficulty breathing· ConfusionDKA is a dangerous condition, mostly limited to people with type 1 diabetes whose blood sugars are uncontrolled. If you have these symptoms, seek medical help immediately.What You Can Do to Prevent Gum Disease?Along with neuropathy, cardiovascular disease, and others, Periodontitis is a common complication of diabetes. You can, however, take steps to stave off gum diseases or to lessen their severity.Take control with these daily tips:The most important step is to try to control blood sugar levels. Brush your teeth at least twice a day and floss daily.· Don’t forget to brush or scrape your tongue, a prime breeding place for foul-smelling bacteria· Drinking lots of water every single day will flush out toxins from the body and enhance the saliva production, making it a less conducive environment for bacteria to grow· Use sugar-free mints or gum to stimulate saliva· Your doctor or dentist may prescribe a medication to stimulate the production of saliva· It is also advised to avoid using mouthwashes that contain alcohol as to this will only dry the insides of the mouth causing bad breath· Visit your dentist regularly and follow treatment recommendations. Make sure the dentist knows you have diabetes· If you wear dentures, make sure they fit well and change them at regular intervals· Avoid smokingThereforeDiabetes along with Periodontist or gum disease causing bad breath, is a deadly combination if untreated. However, this will cause no or very little damage to your teeth, gums and body, if you are well informed about the effects and follow good oral hygiene practices regularly.Visit your dentist for further advice on your specific condition

3 Symptoms of Diabetic Eye That You Must Know

Dr. Charu Tyagi, Ophthalmologist
India  has a huge population of  diabetics, and recently we were named as the diabetic capital of the world with the highest number of diabetics!Yet, only a few people are aware of its impact on eyes. Raised blood sugar levels have multi-fold impacts on eyes and can lead to progressive and permanent visual loss. It is very important for all diabetics to have a regular detailed eye check-up and dilated retina examination at least once a year with your eye specialist.BLURRING OF VISION Frequent change of glasses or blurring of vision with your recently corrected glasses is very common in diabetics, it is an indicator of fluctuating blood sugar levels leading to diabetic lens changes or damage to the retina. Vision in one eye may appear slightly blurred and distorted more for reading than at distance, or sudden black spots may be seen, these are all an indicator of retinal problems.WATERING- Mild watering in both eyes, one more than other is a common finding in diabetics. The tear film in eye is unstable in diabetics and they are also prone to higher and longer incidences of eye (conjunctivitis, meibomianitis) infections.REDNESS-Eyes may appear red and congested due to chronic dryness and infection. At times one of the eye may appear bright red, noticed by others without much discomfort. This is due to fragility of blood vessels seen in long-standing diabetics who may also have hypertension.

Diabetic Foot, A Frightening Complication Of Diabetes

Dr. Anamay K. Bidwai, General Physician
Diabetic foot, after all it is your foot!Diabetic foot is a very common complication of diabetes, particularly in long standing diabetes or untreated kinds.Amputation of legs due to diabetes related complication is the second most common cause for amputations after traffic accidents.Diabetic foot infections can be limb threatening and/ or life threatening.You can prevent this dreaded complication by taking some simple measures every day.If you are a smoker stop now. If you have high cholesterol control it now.Always maintain good control of blood sugar level and be regular with your medicines and insulin.Walking is a MUST, if you want to prevent diabetic foot complication, please walk, walk, walk, at least 3-5 km in day. Please make sure you wear good quality sports foot wear while going for walk.Never walk bare foot, even inside house wear comfortable sandals, while going out wear shoes. No chappals please.Wear cotton socks, every day a freshly washed pair socks must be used. Wash your feet twice a day with normal soap and water, pay special attention to space between toes, dry feet with towel, and apply any moisturiser, even liquid paraffin or coconut oil is good enough.At bed time gently massage your feet for about 10-15 minute, it helps to improve circulation in the small blood vessels. Take vitamins B complex and omega 3 fatty acid supplements every day, it prevents degeneration of small nerves, a major contributor to diabetic foot.Take care while cutting toe nails, do not try to cut the nails too short or you may end up injuring the skin, sometimes it is better to use a nail file.If you notice an injury, scratch or crack on the foot, sole or any where on foot, immediately see a doctor, no matter how small the injury is.These simple measures can save your limbs from dreaded diabetic foot, you need to do it every day, life long.

Preserving Vision in Diabetics

Dr. Atheeshwar Das, Ophthalmologist
Simulation of Vision defects in patients with Diabteic Retinopathy How can diabetes affect eyes?Diabetes can affect different parts of the eye. Diabetic Retinopathy is the most common manifestation of diabetic eye disease followed by Diabetic cataract (snowflake cataract). Recurrent eyelid infections called Stye or "Hordeolum” are also the early presenting signs of diabetes. Advanced diabetic eye disease may lead to intractable glaucoma (neovascular glaucoma) where in the eye pressure progressively increases to cause damage of optic nerve. Diabetic eye disease is now increasingly becoming a major cause of preventable blindness in India.What are the different types of eye problems that one can face?Redness of eyes with swelling of eyelids is encountered in infection of oil secreting glands (meibomian) present in eyelidsBlurry vision and seeing multiple black spots in front of the eye are the early symptoms of Diabetic retinopathy. Distorted vision or” metamorphosia” is also a common complaint wherein a straight line may appear wavy; this is frequently encountered in type 2 diabetics. Type 1 Diabetics are prone for bleeding inside the eye called vitreous haemorrhage. If this is not treated promptly this can lead to detachment of retina.Diabetic retinopathy is broadly classified into 2 types Non proliferative and Proliferative. The latter needs immediate attention and treatment.Cloudy or foggy vision is a manifestation of cataract or clouding of the crystalline lens in the eye.Glaucoma or eye pressure related vision loss is also seen in diabetics, is initially devoid of symptoms but can lead to progressive contraction of field of vision and irreversible blindness.When should one visit an eye doctor (ophthalmologist)?If you were 30yrs and younger when your diabetes was detected, then eye exam by an ophthalmologist should be done within 5 yrs of the diagnoses. However if you are above 30 yrs when your diabetes is first detected then you need to be examined by an ophthalmologist within few months.If you are a diabetic and become pregnant then schedule an eye exam in the first trimester.If you have already experienced high risk Diabetic complications like diabetic kidney disease or diabetic foot leading to amputation then you need an eye exam immediately by an ophthalmologist.If you have been examined by an ophthalmologist and found to have non proliferative diabetic retinopathy then yearly review as per the discretion of the ophthalmologist is required. If you have been diagnosed with proliferative retinopathy then monthly review and treatment as per the ophthalmologist advice is necessary to prevent vision loss.How are diabetic eye problems treated?Diabetic retinopathy once diagnosed is then graded and assessed by the Retina specialist and treated. Initially you need to undergo a retinal scan called SD OCT to asses the extent of diabetic macular edema followed by an Angiogram to grade the severity of your diabetic eye disease.There are different types of treatment modalities for diabetic eye disease which include:Laser photo coagulation of retinaIntravitreal injections ( injections given in the eye)Intravitreal implants( drug eluting capsule implanted in eye)Surgery ( vitrectomy) for non clearing bleed inside the eye and retinal detachmentPattern scan and navigated laser treatment of diabetic maculopathy.Micro incision cataract surgery for diabetic cataractEye drops to control your elevated eye pressuresCryotherapy for advanced diabetic eye disease.The treatment strategy would be discussed by your retina specialist based on the severity and grade of your diabetic eye disease. All the above treatments are done as day care procedures and don't require admission.What can one do to prevent damage to eyes?Optimal control of your blood sugar levels is known to prevent progression of diabetic retinopathy . HbA1C levels which is indicative of 3 month glycemic control should be below 7.You should also be aware that hypertension (High BP), anemia (low hemoglobin ) and kidney disease can worsen diabetic retinopathy and should consult your physician regularly.The old adage “Prevention is always better than cure”  is very true for diabetic retinopathy.  Hence regular exercise, diet ( as prescribed by nutritionist) and periodic eye check up by an ophthalmologist can help you preserve your vision.

Retinopathy of Prematurity - Childhood Blindness

Dr. Atheeshwar Das, Ophthalmologist
The World Health Organization says that India and other middle-income countries are facing the third epidemic of ROP. Extrapolating the government data (primarily from northern India) every two hours in India, three babies have reached the threshold for ROP treatment. Up to 24% of childhood blindness in India is due to retinal pathology and ROP is one of the most important cause. Prevention was never so better than cure when it comes to treating ROP. There are multifactorial reasons for terming ROP as a pending epidemic. With the advent of improved facilities in Neonatal Intensive Care Units (NICU), preterm low/very low birth weight neonates now survive and are exposed to the risk of developing ROP. These babies who would not have survived otherwise in the past two decades, in small towns, are now surviving in greater numbers and many develop ROP.The awareness of ROP among the medical fraternity is very low as a result of which the babies are referred to a retina specialist only late in the course of ROP. There are many myths among the paediatricians regarding ROP. One among them is that, babies who have never received supplemental oxygen therapy do not develop ROP. This myth has been busted now and it has been proved that supplemental oxygen therapy is not the only causative factor for ROP, though it plays some role. 20% of babies who never received oxygen in postnatal period still develop ROP.As per the Western data, ROP occurs in babies who weigh less then 1500 gms. However in India, we tend to see ROP in babies who weigh more than 1500 grams. If we had applied the western criteria for screening babies, we would have missed 20% of the ROP cases. Western developed countries guidelines do not apply to Indian context as the neonatal and postnatal care vastly vary. There is a tendency to see a large number of ROP cases in the rural areas in India,probably due to neonatal care practices prevalent there. Gestational age or post conceptional age as a screening tool is ineffective in rural area as it is almost impossible to date the pregnancy. ROP once diagnosed early is graded according to the set guidelines and treatment initiated as per protocol. Early treatment of ROP can go a long way in preventing blindness. ROP can be effectively managed with laser photocoagulation. The immature retina in a pre-term neonate when exposed to very high concentration of ambient oxygen is susceptible to develop new blood vessels, which have a tendency to bleed. If the treatment is initiated early, these new blood vessels regress and the retina attains maturity subsequently. On an average for every 10 preterm neonates I screen, 4 would have ROP and among them 2 or 3 require treatment.All this, calls for a clarion call among pediatricians; neonatologists and ophthalmologists who need to counsel the parents, screen for ROP more aggressively and to frame guidelines for screening Indian babies.  Already there has been initiative in this context in the form of tele-ROP screening with help of Ret-cams, which can be transported to remote rural areas in Karnataka.We need more such initiatives targeting the rural areas in particular, as ROP blindness is definitely preventive.

5 Foods Need to Be Avoided if You Are Diabetic

Ms. Swati Kapoor, Dietitian/Nutritionist
People with diabetes are required to manage their blood sugar levels. So, many diabetic patients watch out for sugar in their diet. But is that enough? We have a list of foods besides sugar that could be equally harmful for diabetics, because they have a high Glycemic Index(how carbohydrate containing food raises blood sugar). Foods with high Glycemic Index increase blood glucose levels. Also,  an impact on testosterone level in diabetes can be seen. For non-diabetic people, when your blood glucose level rises, your body produces insulin to reduce the increased blood glucose levels. People with diabetes are not able to produce enough insulin to reduce blood sugar levels. As a result of this, its important for them to avoid foods with high Glycemic Index. So, what are the foods that diabetics must watch out for, besides sugar and sugar based foods? Let’s find out. 1. DatesIt sounds like a healthy fruit, but it has a Glycemic Index of 103 (sugar has a glycemic index of 68!). 2. Corn FlakesMistaken to be healthy, this breakfast cereal has a high Glycemic Index of 87. Often, HFCS is used in corn flakes, that has been linked to obesity. 3. White breadWe’ve warned you before about how white bread is your weight loss enemy. Besides having a high Glycemic Index of 73, this food has truly no nutrition besides empty calories. 4. Biscuits/Cookies Another food that is often mistaken to be healthy, besides the fact that biscuits can promote weight gain, the primary ingredients are refined flour and sugar, both of which have a high Glycemic Index, so it raises your blood sugar significantly. Definitely a no-no food for diabetics. 5. Packaged fruit juicesThe Glycemic Index of most fruits fall into the low or medium category, which is acceptable, but packaged fruit juices are not good for diabetics. Most packaged fruit juices have added sugar. Even without the added sugar, many fruit juices have a high Glycemic Index.

Though Healthy, but Taking Health for Granted?

Dr. Vaibhev Mittal, Ophthalmologist
Yes, most of people have a propinquity to do it and I, too, followed the same course, but alas, I was made to pay dearly for my effrontery. My inveterate habit of taking everything casually has brought my life to such a fine pass. Anyhow, it is of no use to crying over split milk but I don’t want that such a harrowing and traumatic thing ever happen to anyone of you. My tale is a horrendous account of my errors. I am Rahul, 35 years old, young cheering person like all of you at this age, enjoying family life and aspiring for an exciting career ahead. But everything went to pieces when I was diagnosed with diabetes seven years back. Following the common Indian psyche, I didn’t pay any attention to valuable advice of my ophthalmologist. I was under a mendacious impression that it can at the most affect my kidneys but EYES, Oh My GOD, who can ever imagine that it would seriously damage my vision but my dear friends, it did and did in unrepairable manner. Now I stand before you as a person undone by my own negligence.My horrendous tale: I am young cheering male, known diabetic for last 7 years but I really never cared  for it till one very fine morning, I noticed black spots moving in front of my right eye. I did not take serious note of it and thought these will fade away with time but on the contrary these increased over a week’s time. I was time for me to visit an ophthalmologist.After thorough retinal examination, he diagnosed me with proliferative diabetic retinopathy and advised me retinal lasers. As per the doctor, this may cause blindness if left untreated. Diabetes Mellitus is a metabolic disorder characterized by sustained hyperglycaemia of variable severity secondary to lack, diminished efficacy or both of endogenous insulin. Diabetes has a predilection to affect all parts of body mainly kidney, heart, eyes, nerves and blood vessels. Most of us though  know adverse effects of diabetes on kidney and heart, but very few ever dream that diabetes can impair eyes leading to  permanent blindness.Eyes has got two segments: Anterior and Posterior segment.Diabetes mostly affects retina which is the most sensitive layer of posterior segment of eye. This condition of damage of retina due to diabetes is known as diabetic retinopathy.The severe symptoms of diabetes only appear after a considerable time, hoodwinking you completely at initial stage. Duration of diabetes is just a matter of imagination but, later on, paralyzing your whole life bit by bit, inch by inch.There are two stages of diabetic retinopathy:Non proliferative Diabetic Retinopathy (NPDR): Intraretinal bleeding along with blockage of vessels is seen but new vessels are not formed.Proliferative diabetic retinopathy (PDR): New vessels formation (neovascularisation) is the hallmark of this stageTo my view, treatment of diabetic retinopathy is both costly and time consuming and most important, prognosis is poor in severe cases. It is open to you whether you would chose to be misfortunate like me or a normal person havingproper vision or vision both to achieve what one aspires.Best is to change our daily life a bit which may includeStrict control of diabetes : It not only delays the onset of Diabetic Retinopathy but also slows the progression ofdiabetic retinopathyControl lipid profile and blood pressureRegular follow up as advised by doctor My message to you:As we know that life is a precious gift of God which needs to be nurtured with utmost love and care. In this journey of life, ailments are natural guests of human body which no one can circumvent. Let us be more practical, instead of getting scared or developing fallacious notions, we must consult a doctor, trust him and see what a tremendous effect he can make on your life. Most of the diseases are curable, provided we care for ourselves. Eyes come at top, love them and see how life will love you in return.