Fact is, patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma but the main threat to vision is the disease’s effect on the retina. That effect is called diabetic retinopathy.
American Eye Center’s Dr. Arnold Salud, clinical associate professor, UP-PGH College of Medicine, explains it very clearly, "What happens basically is this: From the heart, there’s a major blood vessel that goes on to the brain as its main supply. But on its way to the brain, there’s a main branch that goes into the eye, which we call ophthalmic artery. It goes into the optic nerve, shoots into the eye and branches out into veins. In diabetics, what’s affected is the smallest branches or what you call capillaries. When you have high blood sugar, the end or long-term effect is those small blood vessels are clogged up so they cannot do their function, which is to distribute oxygen through the red blood cells. Now, when you don’t bring enough oxygen, the response of the retina would be to allow growth of additional blood vessels that can bring in more oxygen. But what happens is that those blood vessels that grow burst and eventually cause all those bleedings because they’re abnormal, weak wall structures. When they burst — the content of the eye is supposed to be a clear gel — light cannot reach the retina so you cannot see."
In medicalese, people develop a condition called macular edema. This occurs when the damaged blood vessels leak fluid and lipids into the macula, the part of the retina that lets us see detail, making it swell. As a result, vision is blurred.
Clear and simple fact, isn’t it? But sad to say, you could be suffering from diabetic retinopathy and not know it. "Your eyes may be clear, you may have 20-20 vision but you may already have blood in your retina," the good doctor warns.
He hastens to add, "You should not rely on signs because once you have some or most of the signs, it means you already have a problem. Once you’re diagnosed as diabetic, even if you have no eye problems, you should go for an eye checkup. Your best bet is what is called the well-baby checkup, you bring a baby for checkup even if the baby’s well."
Dr. Salud sees at least two patients a day with diabetic retinopathy at the state-of-the-art American Eye Center, located at Level 5 of Shangri-La Plaza, where he holds clinic twice a week. His patients are mostly over 50 years old. Consultation fee is reasonably priced at P400.
"Our referral system is not as sophisticated as the US’," he laments. "In the States, once you’re diagnosed, there’s automatic referral. If you’re diabetic, you shouldn’t only go to a diabetologist, you should also go to a general practitioner. If you have glaucoma, you should go to a glaucoma specialist."
Let’s take a closer look at diabetic retinopathy via this Q & A: