What is diabetes?

 

Diabetes is a condition in which the body does not produce enough insulin or cannot use insulin properly. Insulin is a hormone that helps break down glucose (sugar) so that it can be used by the body’s cells as fuel.

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The body's problem with making or using insulin causes the level of glucose in the blood to rise. This can cause a wide range of complications, including diabetic retinopathy.

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There are two types of diabetes, which are described below.

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Type 1 diabetes

 

In type 1 diabetes, the body does not produce any insulin. The condition usually begins in people who are under 40 years of age and often develops during the teenage years. People with type 1 diabetes will need injections of insulin for the rest of their life.

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Type 2 diabetes

 

Type 2 diabetes is where the body does not produce enough insulin to function properly or where the body’s cells do not react to insulin.

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Being overweight or obese is a major risk factor for type 2 diabetes. Type 2 diabetes can develop at any age, but usually affects people who are 45 years of age or over. Some people with type 2 diabetes can control their symptoms using a combination of diet and exercise. More serious cases require insulin injections.

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Type 2 diabetes is the most common type of diabetes, accounting for 95% of all cases.

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How common is diabetic retinopathy?

 

Diabetic retinopathy is a common complication of diabetes. It is the leading cause of blindness in adults under the age of 65.

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It is estimated that 25% of people with type 1 diabetes will have some degree of diabetic retinopathy five years after their symptoms first develop.

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In the case of type 2 diabetes, 25% of people who do not require insulin will have some degree of diabetic retinopathy five years after the onset of symptoms. The figure is higher for people who require insulin (an estimated 40%).

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Outlook

 

If diabetic retinopathy is diagnosed and treated at an early stage, the outlook for the condition is good. Research has found that treatment can prevent severe vision loss in 90% of cases of diabetic retinopathy.

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Early stage diabetic retinopathy can usually be treated by bringing your diabetes under better control. More advanced diabetic retinopathy will require laser surgery to prevent further damage to the eyes.

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National screening programme

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The Department of Health has set up a national screening (testing) programme for diabetic retinopathy. If you are 12 years of age or over and you have diabetes, you should be offered annual screening.

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The screening programme was introduced because, if diabetic retinopathy is detected early enough, it can be treated effectively using laser treatment.

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By the time diabetic retinopathy begins to cause noticeable symptoms, it is often much harder to treat.

You should receive a letter from your GP or healthcare professional inviting you to attend a screening appointment.

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Contact your GP if you think that you are overdue for a screening appointment.

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The screening procedure

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During screening, eyedrops are used to make your pupils large and photographs of your retina are taken. As the photographs are being taken, you will see flashes of bright light, but usually it is not uncomfortable.

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The eyedrops may cause your eyes to sting slightly and your vision may become blurred about 15 minutes after the procedure ends. The blurring can last between two and six hours, depending on what sort of eyedrops were used.

The blurring will affect your ability to drive, so you will not be able to drive home from your screening appointment. You will also find that everything looks very bright, so you may want to take sunglasses to your appointment.

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In very rare cases, the eyedrops can cause a sudden rise in pressure within your eye. However, this only occurs in people who are already at risk of developing the condition. If it occurs, prompt treatment in an eye unit will be required.

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In rare cases, the screening procedure may cause:

• pain or severe discomfort in your eye

• redness of the white of your eye, or

• constant blurred sight, sometimes with rainbow haloes around lights

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If, after screening, you experience any of the symptoms above, contact your screening centre or go to an accident and emergency (A&E) department.

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Results

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You will not receive the results immediately after the procedure because the pictures will need to be studied by a team of healthcare professionals. The screening staff should tell you how long this will take.

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You will be called back for a further assessment if:

• staff find sight-threatening retinopathy that requires follow-up treatment

• the degree of retinopathy needs checking more than once a year

• the photographs are not clear enough to give an accurate result, or

• other eye conditions, such as glaucoma or cataracts, are detected by chance (screening for retinopathy will not always detect other eye conditions)

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The screening programme is not compulsory, but if you have diabetes it is the single best way to prevent sight loss.

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Stages of diabetic retinopathy

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If diabetic retinopathy is detected during screening, you will be given information about how far the condition has progressed. This will determine the type of treatment you will receive.

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The stages of diabetic retinopathy are described below.

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Background retinopathy

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Background retinopathy is the first stage of diabetic retinopathy. There is evidence of microaneurysms (tiny bulges in blood vessels) and some mild bleeding.

 

Pre-proliferative retinopathy

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Pre-proliferative retinopathy is the second stage. By this stage, new blood vessels have started to form in the retina and there are multiple points of bleeding.

 

Maculopathy

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Maculopathy is the third stage. By this time, the macula (the most sensitive part of the retina) has been damaged.

 

Proliferative retinopathy

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Proliferative retinopathy is the most advanced stage. The formation of new blood vessels has increased, there is evidence of scar tissue and there may be some degree of retinal detachment.

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(Source/Further information:: www.nhs.co.uk, http://www.nei.nih.gov)