FAQ’s on Eye Screening

What is diabetic Retinopathy?

When the network of tiny blood vessels in the retina leak or become blocked due to high blood glucose levels, it is called Retinopathy. Diabetic Retinopathy is generally a progressive disease and begins with minor changes such as micro aneurysms formed on tiny capillaries and dot and blot haemorrhages. At this stage the vision might not be affected. However, if retinopathy is spotted early enough it can be managed well to prevent loss of eye sight.

Why should people with diabetes get their eyes screened regularly?

In its early stages, retinopathy does not cause noticeable symptoms so people may not realize their retina is damaged until the later stages when their vision is already affected. This is why screening is very important for people with diabetes. It will pick up at an early stage changes  that need not necessarily affect vision at first but that could progress to more serious diabetic eye disease.

What is the difference between a diabetes annual eye check and regular eye exams?

Annual diabetes eye screening focuses on examination of the retina while regular eye check- up does not necessarily involve retinal examination.

Is retinal screening recommended for all diabetic patients?

Yes. It is recommended for all patients with Type 1 and Type 2 diabetes at all ages. Retinopathy screening is strongly recommended for children diagnosed with Type 1 Diabetes Mellitus because of its severity when compared to Type 2 Diabetes Mellitus. However patients diagnosed with Type 1 diabetes or Type 2 diabetes  should start as soon as possible because diabetes may have been present already for some time. Pregnant women with diabetes should be checked at 3 month intervals.

What does a retinal screen actually involve?

The complete screening process takes about 30 minutes. First the medical details are checked to see if there were any previous eye problems or treatments and whether or not they are seeing an ophthalmologist currently.
Visual acuity and intra ocular pressure are tested as a routine. Eye dilating drops are administered which sometimes has a stinging sensation. Dilation takes about 20 minutes after drops are put. Fund us photo is taken with a digital camera and patient is examined by a trained ophthalmologist.Grading is done according to National Grading Protocol and patient is advised accordingly. Patients are advised not to drive back home after appointment as pupils will be still dilated and near vision temporarily impaired. This condition usually resolves in the next 3 to 4 hours during which they may experience some blurriness and sensitivity to light.

How does retinopathy cause loss of vision?

As retinopathy progresses, there are more serious signs such as multiple haemorrhages and leakage  of lipoproteins  from capillaries into the tissue which can cause swelling in the retinal tissue.As a result there will be deterioration in vision if left untreated and with poor diabetes control.The retina can then deteriorate further with blockages in fine capillaries which result in growth of new blood vessels which are unstable and grow into the vitreous gel of the eye. They can break and bleed easily causing vitreous haemorrhage. It may also lead to tractional retinal detachment resulting in scarring and permanent loss of vision.

What are the common eye problems in people with diabetes?

The main problems are maculopathy and proliferative retinopathy. In addition, cataract or a combination of cataract and retinal problems is also common among people with diabetes. A small number have glaucoma, age- related macular degeneration and other problems that are not related to their diabetes.

Are some groups more at risk?

Yes. Those who have poorer control of blood glucose levels and other problems such as high blood pressure, nephropathy and high cholesterol are at greater risk.  Duration of diabetes is another issue where diabetes for a long period and poor control can lead to advanced eye disease. Pregnancy can cause retinopathy to worsen very rapidly.

How common is visual loss in diabetes?

There is 5 -6 % moderate loss of vision and  1 – 2.5 % severe loss of vision.

How can people with diabetes help themselves?

The most important thing to do is to be responsible for one’s own health and vision, follow a healthy lifestyle and diet, and take regular medication to control blood glucose, blood pressure and lipid levels.Make annual eye screening a priority.

Nutrition Therapy

For most people with diabetes what to eat is the most challenging part of managing their condition. The American Diabetes Association suggests there is no ‘one size fits all ’eating pattern for them.

Adults diagnosed with diabetes should

• Eat a variety of nutrient dense foods in appropriate portions as part of an eating plan that takes into account individual preferences, culture, religious beliefs, traditions and metabolic goals.
• Consider individual metabolic goals such as glucose and lipid levels and blood pressure while choosing foods.

• Take into consideration eating patterns since people eat combinations of foods and not just single nutrients such as carbohydrates, protein fats. Whether a Mediterranean diet, vegetarian diet or low carbohydrate diet, the important thing is finding an eating pattern that fits food preferences and lifestyle  and that can be consistently followed and provides the nutrition for good health.
• Go to a registered dietitian or participate in a diabetes self- management education program soon after diagnosis.
• Choose carbohydrates from vegetables, whole grain, fruits, legumes, and dairy products over other sources that contain added fats, sugar or sodium.
• Eat monounsaturated fats and polyunsaturated fats and avoid trans fats and saturated fats . Individuals who are trying to manage their weight should still eat good fats in moderation.
• Limit  or avoid intake of sugar sweetened beverages  from any caloric sweetener including high fructose corn syrup & sucrose to reduce risk of weight gain and worsening of cardio vascular risk profile.
• Adhere to the  general recommendation to reduce  sodium to less than 2.300 mg/day with added reductions for those who have high blood pressure.
• Adhere to the general recommendation to eat fatty fish at least 2 times a week instead of  using omega 3 EPA/DHA supplements for the prevention of or treatment of  cardio vascular disease .  

There is no clear evidence of benefit from vitamin or mineral supplements for people with diabetes who do not have underlying vitamin or mineral deficiencies.

The key components of diabetes management are healthy eating habits, regular physical exercise and timely medication. 

These recommendations are based on review of relevant literature by a group of highly trained clinicians and researchers. 
Diabetes Pro Quarterly - American Diabetes Association.