Diabetes (Sugar) is a disease that is protean in its manifestations. It potentially affects each and every cell of the body. Damage to the microscopic blood vessels of the body-capillaries is the hall mark of this disease process. Eye happens to be the only organ in the body where blood vessels of every size can be seen and observed for diabetes induced changes. Eye is the mirror of the body. Changes in the eye reflect changes in the other organs and systems to a fair extent.
In the initial years an annual check up may be sufficient, but as the duration increases a more frequent follow up may be required.
Diabetes can affect eyes in many ways-starting with frequent lid infections and sty formation. Dry Eye Disease may be an association. Cataract formation at younger age and Glaucoma (kala motia) are other well known associations. Diabetic Retinopathy is probably the most important complication that needs to be managed by the eye surgeons. Hemorrhagic spots, small vessel aneurysms, deposition of fat residues in layers of retina, formation of cob web like new vessels on the retina that have a tendency to bleed (due to poor wall strength), retinal oedema, even frank bleeding into the eye can be seen at different stages. Saving vision becomes a priority in diabetic retinopathy which is a progressive disorder and not completely reversible in many aspects.
Strict "parameter based" "metabolic control" of Diabetes is of prime importance.
1) Blood sugar profile (monthly); Target- Fasting <100 mg/dl and all readings < 180mg/dl
Involves taking 8 readings before and after major meals in a day
2) Hb a1C (quarterly); Target- 6.5%
3)Lipid Profile (annually): No hyper-lipidemia
4)Blood Pressure; Strict Target 130/80 (ACE inhibitor drugs to be added)
5) 24 hour urinary proteins (annually)
Retinal examination will require +90 D examination of the macula, Indirect Ophthalmoscopy. OCT (optical coherence tomography) and FFA (fundus fluoresceine angigraphy) may be required for evaluation, treatment and follow up.
Intra vitreal injections and green laser therapy may be required to tackle different situations in retinopathy.
Regular interaction with the diabetologist and ophthalmologist can lead to preservation of sight for a long time.