ဆီးချိုနဲ့ပတ်သက်ပြီး မျက်စိနဲ့ပြဿနာဖြစ်ခြင်း (Diabetic retinopathy)

Symptoms

You will not usually notice diabetic retinopathy in the early stages, as it does not tend to have any obvious symptoms until it's more advanced.

However, early signs of the condition can be picked up by taking photographs of the eyes during diabetic eye screening.

Risk Factors

Anyone with type 1 diabetes or type 2 diabetes is potentially at risk of developing diabetic retinopathy.

You're at a greater risk if you:

• have had diabetes for a long time
• have a persistently high blood sugar (blood glucose) level
• have high blood pressure
• have high cholesterol
• are pregnant
• are of Asian or Afro-Caribbean background

By keeping your blood sugar, blood pressure and cholesterol levels under control, you can reduce your chances of developing diabetic retinopathy.

Diagnosis

Diabetic eye screening

Everyone with diabetes who is 12 years old or over is invited for eye screening. How often you're invited depends on your last 2 screening results. If diabetic retinopathy was not found at your last 2 tests, you'll be invited every 2 years.

Screening is offered because:

• diabetic retinopathy does not tend to cause any symptoms in the early stages
• the condition can cause permanent blindness if not diagnosed and treated promptly
• screening can detect problems in your eyes before they start to affect your vision
• if problems are caught early, treatment can help prevent or reduce vision loss

The screening test involves examining the back of the eyes and taking photographs.

Depending on your result, you may be advised to attend more regular appointments or discuss treatment options with a specialist.

Treatment Options

Diabetic retinopathy usually only requires specific treatment when it reaches an advanced stage and there's a risk to your vision.

It's typically offered if diabetic eye screening detects stage 3 (proliferative) retinopathy, or if you have symptoms caused by diabetic maculopathy.

At all stages, managing your diabetes is crucial.

Managing your diabetes

The most important part of your treatment is to keep your diabetes under control.

In the early stages of diabetic retinopathy, controlling your diabetes can help prevent vision problems developing.

In the more advanced stages, when your vision is affected or at risk, keeping your diabetes under control can help stop the condition getting worse.

Treatments for advanced diabetic retinopathy

For diabetic retinopathy that is threatening or affecting your sight, the main treatments are:

• laser treatment – to treat the growth of new blood vessels at the back of the eye (retina) in cases of proliferative diabetic retinopathy, and to stabilise some cases of maculopathy
• eye injections – to treat severe maculopathy that's threatening your sight
• steroid eye implants – to treat severe maculopathy if eye injections are not suitable or have not worked for you
• eye surgery – to remove blood or scar tissue from the eye if laser treatment is not possible because retinopathy is too advanced

Laser treatment

Laser treatment is used to treat new blood vessels at the back of the eyes in the advanced stages of diabetic retinopathy.

This is done because the new blood vessels tend to be very weak and often cause bleeding into the eye.

Treatment can help stabilise the changes in your eyes caused by your diabetes and stop your vision getting any worse, although it will not usually improve your sight.

Laser treatment:

• involves shining a laser into your eyes – you'll be given local anaesthetic drops to numb your eyes; eye drops are used to widen your pupils and special contact lenses are used to hold your eyelids open and focus the laser onto your retina
• normally takes around 20 to 40 minutes
• is usually carried out on an outpatient basis, which means you will not need to stay in hospital overnight
• may require more than 1 visit to a laser treatment clinic
• is not usually painful, although you may feel a sharp pricking sensation when certain areas of your eye are being treated

Side effects

After treatment, you may have some side effects for a few hours.

These can include:

• blurred vision – you will not be able to drive until this passes, so you'll need to arrange for a friend or relative to drive you home, or take public transport
• increased sensitivity to light – it might help to wear sunglasses until your eyes have adjusted
• aching or discomfort – over-the-counter painkillers, such as paracetamol, should help

Possible complications

You should be told about the risks of treatment in advance.

Potential complications include:

• reduced night or peripheral (side) vision – some people may have to stop driving as a result of this
• bleeding into the eye or objects floating in your vision (floaters)
• being able to "see" the pattern made by the laser on the back of your eye for a few months
• a small, but permanent, blind spot close to the centre of your vision

Get medical advice if you notice that your sight gets worse after treatment.

Eye injections

In some cases of diabetic maculopathy, injections of a medicine called anti-VEGF may be given directly into your eyes to prevent new blood vessels forming at the back of the eyes.

The main medicines used are called ranibizumab (Lucentis) and aflibercept (Eylea).

These can help stop the problems in your eyes getting worse, and may also lead to an improvement in your vision.

During treatment:

• the skin around your eyes will be cleaned and covered with a sheet
• small clips will be used to keep your eyes open
• you'll be given local anaesthetic drops to numb your eyes
• a very fine needle is carefully guided into your eyeball and the injection is given

The injections are usually given once a month to begin with. Once your vision starts to stabilise, they'll be stopped or given less frequently.

Injections of steroid medication may sometimes be given instead of anti-VEGF injections, or if the anti-VEGF injections do not help.

Risks and side effects

Possible risks and side effects of anti-VEGF injections include:

• eye irritation or discomfort
• bleeding inside the eye
• floaters or a feeling of having something in your eye
• watery or dry, itchy eyes

There's also a risk that the injections could cause blood clots to form, which could lead to a heart attack or stroke.

This risk is small, but it should be discussed with you before you give your consent to treatment.

The main risk with steroid injections is increased pressure inside the eye.

Steroid implants

If you cannot have anti-VEGF injections or they have not worked for you, you may be offered an eye implant called an intravitreal implant (brand name Ozurdex) containing a steroid medicine called dexamethasone.

This is a tiny implant that's injected into your eye using a special applicator. You'll be given a local anaesthetic first to numb your eye.

The implant slowly releases dexamethasone over a few months. This reduces swelling in your eye, and can help to improve your eyesight.

The implant eventually dissolves so it does not need to be removed.

Risks and side effects

Possible risks and side effects of having the implant include:

• headaches
• increased pressure inside the eye
• cataracts
• bleeding in your eye
• eye pain
• problems with your eyesight

Side effects usually get better after a few days. Speak to your treatment team if you have eye pain or changes to your eyesight.

Eye surgery

Surgery may be carried out to remove some of the vitreous humour from the eye. This is the transparent, jelly-like substance that fills the space behind the lens of the eye.

The operation, known as vitreoretinal surgery, may be needed if:

• a large amount of blood has collected in your eye
• there's extensive scar tissue that's likely to cause, or has already caused, retinal detachment

During the procedure, the surgeon will make a small incision in your eye before removing some of the vitreous humour, removing any scar tissue and using a laser to prevent a further deterioration in your vision.

Vitreoretinal surgery is usually carried out under local anaesthetic and sedation. This means you will not experience any pain or have any awareness of the surgery being performed.

After the procedure

You should be able to go home on the same day or the day after your surgery.

For the first few days, you may need to wear a patch over your eye. This is because activities such as reading and watching television can quickly tire your eye to begin with.

You will probably have blurred vision after the operation. This should improve gradually, although it may take several months for your vision to fully return to normal.

Your surgeon will advise you about any activities you should avoid during your recovery.

Risks and side effects

Possible risks of vitreoretinal surgery include:

• developing a cataract
• further bleeding into the eye
• retinal detachment
• fluid build-up in the cornea (outer layer at the front of the eye)
• infection in the eye

There's also a small chance that you will need further retinal surgery afterwards. Your surgeon will explain the risks to you.

Prevention Tips

You can reduce your risk of developing diabetic retinopathy, or help stop it getting worse, by keeping your blood sugar levels, blood pressure and cholesterol levels under control.

This can often be done by making healthy lifestyle choices, although some people will also need to take medication.

Healthy lifestyle

Adopting a few lifestyle changes can improve your general health and reduce your risk of developing retinopathy.

These include:

• eating a healthy, balanced diet – in particular, try to cut down on salt, fat and sugar
• losing weight if you're overweight – you should aim for a BMI of 18.5-24.9; use the BMI calculator to work out your BMI
• exercising regularly – aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week; doing 10,000 steps a day can be a good way to reach this target
• stopping smoking if you smoke
• not exceeding the recommended alcohol limits – men and women are advised not to regularly drink more than 14 alcohol units a week

You may also be prescribed medication to help control your blood sugar level (such as insulin or metformin), blood pressure (such as ACE inhibitors) and cholesterol level (such as statins).

Know your blood sugar, blood pressure and cholesterol levels

It can be easier to keep your blood sugar levels, blood pressure and cholesterol levels under control if you monitor them regularly and know what level they are.

The lower you can keep them, the lower your chances of developing retinopathy are.

Your diabetes care team can let you know what your target levels should be.

Blood sugar

If you check your blood sugar level at home, it should be 4 to 7mmol/l. The level can vary throughout the day, so try to check it at different times.

The check done at your GP surgery is a measure of your average blood sugar level over the past few weeks. You should know this number, as it is the most important measure of your diabetes control. 

It's called HbA1c, and for most people with diabetes it should be around 48mmol/mol or 6.5%.

Blood pressure

You can ask for a blood pressure test at your GP surgery, or you can buy a blood pressure monitor to use at home. Blood pressure is measured in millimetres of mercury (mmHg) and is given as 2 figures.

If you have diabetes, you'll normally be advised to aim for a blood pressure reading of no more than 140/80mmHg, or less than 130/80mmHg if you have diabetes complications, such as eye damage.

Cholesterol

Your cholesterol level can be measured with a simple blood test carried out at your GP surgery. The result is given in millimoles per litre of blood (mmol/l).

A healthy total cholesterol level is below 4mmol/l.

Regular screening

Even if you think your diabetes is well controlled, it's still important to attend your diabetic eye screening appointments when invited, as this can detect signs of a problem before you notice anything is wrong.

Early detection of retinopathy increases the chances of treatment being effective and stopping it getting worse.

You should also contact your GP or diabetes care team immediately if you develop any problems with your eyes or vision, such as:

• gradually worsening vision
• sudden vision loss
• shapes floating in your field of vision (floaters)
• blurred vision
• eye pain or redness
• difficulty seeing in the dark

These symptoms do not necessarily mean you have diabetic retinopathy, but it's important to get them checked out straight away.

When To See A Doctor

Contact your GP or diabetes care team immediately if you experience:

• gradually worsening vision
• sudden vision loss
• shapes floating in your field of vision (floaters)
• blurred or patchy vision
• eye pain or redness
• difficulty seeing in the dark

These symptoms do not necessarily mean you have diabetic retinopathy, but it's important to get them checked out. 

Do not wait until your next screening appointment.