diabetic retinopathy treatment melbourne

Diabetic Retinopathy Treatment – Everything You Need To Know

Diabetes mellitus is a metabolic disease arising from a deficiency in the production or function of a hormone known as insulin. As insulin is responsible for the absorption of glucose from the bloodstream into the tissues of the body, problems with this hormone results in elevated blood glucose, which then damages blood vessels. Other organs and tissues reliant on receiving this blood supply also suffer, resulting in a myriad of diabetes-related complications, including:

  • Diabetic retinopathy and other diabetic eye diseases
  • Kidney disease
  • Dental disease
  • Nerve damage, also called neuropathy, typically in the legs and feet
  • Reduced blood circulation to the legs and feet
  • Increased risk of heart attack and stroke

While diabetes is present in the Australian population at a prevalence of around 5%, experts estimate a significant number of people are living with undiagnosed diabetes; it is thought that for every 4 diagnosed diabetics, there is 1 adult with undiagnosed disease. As the risk of experiencing diabetic retinopathy increases with longer duration of diabetes and poorer blood glucose control, it’s important to be aware of your risk factors for developing diabetes, such as obesity or a family history, and what can retinal surgery do to treat this condition, and to keep on top of your general health. 

 

Diabetic Retinopathy

A retinopathy is any disease affecting the sensory tissue lining the back of the eyeball, known as the retina. The retina is responsible for receiving incoming light into the eye and sending neural signals onward to the brain to form vision. Because the cells of the retina are constantly working to process light into neural impulses, they are supported by a branching network of tiny blood vessels in order to meet this energy demand. Increased blood glucose levels from diabetes mellitus can damage these retinal blood vessels, resulting in diabetic retinopathy

Diabetic retinopathy is divided into two broad categories, proliferative and non-proliferative disease. Non-proliferative retinopathy can be further classed from minimal to severe. In the mild stages of non-proliferative retinopathy you may experience no symptoms and be entirely unaware of you have any ocular complications, however, an eyecare practitioner examining your retina may notice signs such as haemorrhages, yellowish deposits called exudate, areas of swelling, and white patches caused by restricted blood supply. If any of these signs occur close to the macula, the part of the retina responsible for central vision, you may be aware of a distortion or blur to your vision even if you only have mild retinopathy.  

Proliferative retinopathy is defined by the development of new blood vessels in the retina, which occur in response to compromised blood circulation from the diabetes. These new vessels are fragile and poorly formed, and are at risk of causing a large haemorrhage in the eye. Depending on the size and location of the bleed in the eye, your sight may be partially or fully obscured until the blood clears away. Although vision loss directly from a haemorrhage is temporary, the proliferation of these leaky new blood vessels can lead to other complications, including permanent scarring and distortion of the retinal layers, a retinal detachment, or glaucoma.

Diabetic retinopathy usually occurs in both eyes, though may be asymmetrical in its severity. 

 

Diabetic Retinopathy Treatment

If you have mild to even moderate non-proliferative diabetic retinopathy, treatment is not always necessary and your eyes and vision can simply be monitored, particularly if you are asymptomatic. The early signs of diabetic eye disease can often be managed by improving blood glucose control, whether through diet and exercise or medications as directed by your endocrinologist or diabetes educator. Conversely, diabetic retinopathy treatment is always required for proliferative disease, usually in the form of retinal surgery

Patients with either proliferative or non-proliferative retinopathy may experience swelling around the macula known as macular oedema. This is often readily noticeable and can interfere with your daily activities by causing blurred vision or even distortions to your sight such as objects appearing smaller than compared to the unaffected eye or altered colour vision. Macular oedema can be observed until it self-resolves under the care of an experienced eyecare clinician if the impact to your vision is low; alternatively, you may be recommended diabetic retinopathy treatment in the form of either a laser retinal surgery procedure or eye injections to help the eye to heal more quickly. 

Photocoagulation is a type of laser retinal surgery used to seal damaged blood vessels that are leaking blood and fluid into the retina. The application of the laser to these affected vessels effectively seals the leak. Laser retinal surgery may also be used in the proliferative stage of the disease to reduce the oxygen demand of select areas of the retina, thereby removing the stimulus for the growth of those new fragile blood vessels. This procedure effectively burns and scars parts of the retina to achieve this and so is usually performed as far into the periphery of the retina as possible to avoid damaging your important central vision. 

Macular oedema and proliferative retinopathy can also be managed using diabetic retinopathy treatment in the form of eye injections. A drug class known as anti-vascular endothelial growth factor (anti-VEGF) blocks the chemicals released by oxygen-deprived tissues that trigger new vessel growth. 

 

Keeping your diabetes under good control is the ideal way to avoid needing diabetic retinopathy treatment. Patients with diabetes are recommended to maintain regular eye tests with their optometrist or ophthalmologist, even if they haven’t noticed any changes to their vision. Call us today at (03) 9070 3580.

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

explained difference between long and short sightedness melbourne

The Difference Between Long and Short Sightedness

Many people believe long sightedness to be the straightforward opposite of short sightedness. While to a certain extent this is true, the difference between long and short sightedness is a little more complex than long sightedness simply being able to see in the distance and not up close, and short sightedness being vice versa. To further complicate things, an additional condition known as presbyopia is often confused for long sightedness as people with presbyopia find an increasing difficulty with their near vision. 

 

Refractive Error and Eye Anatomy

In simple terms, refractive error refers to the mismatch of the eye’s focusing power to the length of the eyeball. Refractive error includes both long and short sightedness, as well as another condition known as astigmatism, and the previously mentioned presbyopia.

There are several points in the eye that light must pass through in order for us to see. These anatomical points serve as surfaces to bend light rays such that the rays come to a sharp point on the retina at the back of the eye, thereby providing a clear image. It’s when the refractive (focusing) power of these anatomical components doesn’t quite manage to bring the rays of light to a sharp focus on the right spot that we experience blurry vision. 

Light first passes through the tear film, which covers the cornea, before then passing through the cornea itself. The cornea is the transparent dome at the front of the eye; together with the tear film it accounts for about two-thirds of the focusing power of the eye. The crystalline lens, which sits behind the coloured iris, is responsible for the remaining one-third. The lens is suspended in place with fibres attached to a ring of muscle and can adjust its shape to bring forward the focal point of the eye to focus on closer objects in an action known as accommodation – this is particularly important for understanding long sightedness

The length of the eyeball, known as the axial length, plays a significant role in the presence of refractive error. As mentioned earlier, light must be refracted, or focused, through the tear film, cornea, and crystalline lens, to come to a sharp point right on the retina in order for us to perceive clear vision. If this focal point of light falls short of the retina, or falls behind the retina, we end up with blurred sight. 

explained difference between long and short sightedness melbourneThe main difference between long and short sightedness, and the only straightforward part of this explanation, is that long sightedness, also known as hyperopia or hypermetropia, occurs when the eyeball is too short for the focusing power of the eye – that is, the focal point of light falls behind the retina. Short sightedness, also called myopia or nearsightedness, occurs when the length of the eyeball is too long for its focusing power, and the focal point of light falls short of the retina. Both long and short sightedness may occur in conjunction with astigmatism, which is commonly caused by an uneven cornea.

Presbyopia refers to the age-related decline in the flexibility of the crystalline lens and reduced accommodative ability, resulting in an increasing difficulty at focusing up close such as during reading. Many people confuse this with long sightedness, believing both to simply refer to an inability to see at near, but these are two different conditions. Presbyopia occurs to everyone with age, and can occur alongside both long and short sightedness

 

The Difference Between the Long and Short Sightedness Experience 

Here we come to the complicated part. 

People with long sightedness, can be quite content at both far and near distance viewing without the need for glasses or conversely, experience blurred sight for both distant and near objects, and require corrective lenses all the time. This is typically dependent on two factors – the age of the person (and therefore their ability to accommodate) and the magnitude of their hyperopia. In a young person with a flexible crystalline lens and active accommodation, a hyperopic refractive error may be compensated through accommodation, meaning the lens is able to change its shape enough to provide clear vision at both distance and near. However, the nature of hyperopia is such that the crystalline lens is working to focus even far distance objects. This means a young person who is very long sighted may find the effort to see clearly even in the distance is too great, with this effort increasing as the viewing distance comes closer, and will therefore need glasses for both long and short distances. 

On the other hand, people with short sightedness, or myopia, will always find their long-distance vision to be clearer through their corrective lenses, regardless of age. A young person with short sightedness will also be able to read clearly at near through their glasses for myopia, due to active accommodation, but may find that removing their spectacles for reading is just as clear and possibly more comfortable. An older patient with myopia and reduced accommodative ability will find they will have difficulty seeing at near unless they remove their distance optical correction or wear lenses such as multifocals or bifocals with an integrated reading prescription.  

 

Refractive error can be a complicated topic but the good news is that there are a multitude of options for correcting both long and short sightedness, including glasses, contacts, and laser eye surgery. Call us today at (03) 9070 3580.