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Diabetes & Eyes
An Article by Dr. Mohammad Malak
Ophthalmologist @ KKES Hospital Riyadh KSA

Another article on same subject
Diabetes is recognized as the leading cause of Blindness for individuals between the ages of 24 and 74 years even in advanced countries such as the United States of America. Diabetes causes changes in all the organs of the body but mainly affects the Nervous system, the Kidneys, Retinas and blood vessels.
Most of the organs fortunately do compensate and maintain a reasonable functionality for a normal life, but on the other hand there are few very sensitive organs that start to de-compensate after a while and starts to produce symptoms
The organs that are mostly affected are the Kidneys (Diabetic Nephropathy), The Retina (Diabetic Retinopathy) & the Nervous system (Diabetic Neuropathy).
The Retina is the inner most part of the eye, which conveys the image to the Brain where it is processed & is perceived as a logical Identifiable object.
It is just like the Film inside the Camera which captures the still Image as soon as it is exposed to it, the Retina is far much superior in the sense that it captures the Images continuously as long as the Eye is open and is receiving images projected on to it.
We can appreciate now that if this very important and very sensitive Part of the Eye is damaged, it will no further be able to convey the Images and hence the Eyesight will be greatly reduced either permanently or temporarily.
The Retina is composed of highly specialized cells, which sense color, movement, brightness, contrast and a lot of other optical properties, which are still poorly understood.
For this to occur it has a highly integrated environment which is kept constant for the optimum function of the Retina.
Diabetes in a way disturbs this Integrity and causes the malfunction of Retinal Tissue (Diabetic Retinopathy). 
Diabetes cause abnormal Leakage of Proteins from the Blood vessels of the Retina, which normally does not Leak, as the blood vessel walls becomes damaged by the abnormally high blood sugar it will allow this harmful Proteins to leak and destroy the otherwise healthy Retinal cells.
In an Advanced disease there is abnormal growth of very fragile vessels into the Retina that bleeds and causes sudden decrease in Vision.
Although Diabetes can affect the Eyes in different ways, there are few important things that should be kept in mind always: 

Basically the problem starts after certain duration of having an abnormally high level of blood sugar, the onset of reduced sight might be on the first symptoms the patient will experience.

Patients using INSULIN as treatment for Diabetes are at a higher risk of developing Diabetic Retinopathy earlier than patients using tablets for controlling blood sugar.

In an average, severe visual loss can occur in 60% of patients using Insulin within 5 years after the diagnosis is established compared to 25-30% of patients using tablets.

This risk further increases by other factors such as the presence of high blood pressure, pregnancy or high plasma cholesterol/Lipids or having kidney diseases.

It is Important to realize that everybody who is diagnosed to have Diabetes should be Examined Initially at the time when he is discovered to be a Diabetic and Annually onwards.

The Importance of Regular Eye Exam of all Diabetic patients is to identify the high-risk group and treat accordingly at an early stage to halt the progression of the disease.

The Treatment might be just simple observation and good sustained control of blood sugar levels by adequate Medications & Exercise, if this is not enough laser treatment to cauterize the Leaking blood vessels and destroying the dead Retinal cells might be required.

The treatments are directed towards preserving the present level of sight and one should be mentally prepared to accept the fact that most of the time, there is no room for further improvement of vision.

Guidelines for Diabetic Patients 

Diabetics should have a baseline Examination at the Time of Diagnosis of the Disease and Annually onwards by an Eye specialist.

According to your Eye examination the Eye specialist will decide if you need just observation or need treatment & accordingly will arrange the time of the next appointment.

Any change in Vision should be reported to the Eye specialist, as this might be the earlier sign of Retinal damage and early treatment will prevent further deterioration of vision.

It is of prime importance to keep a sustained & balanced level of Blood sugar, which will cause less damage to the Retina by Passage of time.

Having blood sugar measuring device is very effective & important, it gives you a clear idea about the level of blood sugar at any given time, keeping a record of the Readings of Random & Fasting blood sugars can help the Treating Physicians to have a better understanding of the individual requirements of patients and dose adjustments.

Doing a regular light Exercise in a form of brisk walking for 40-60 minutes daily will greatly reduce the high blood sugars leading to a better control.

Early recognition of Retinal changes secondary to Diabetes and the early treatment of such changes will contribute greatly in preserving the vision.