Myths and facts on diabetic retinopathy

Dr P Tandava Krishnan

Myth 1 We are a developing country. Diabetes is primarily a problem of developed countries.
Fact A recent study conducted by Indian Council of Medical Research (ICMR) has found that nearly one in every five Indian above 20 years is either a diabetic or at risk for diabetes. In fact, India has earned the dubious sobriquet of being “world’s diabetes capital”. So diabetes is a big problem here.

Myth 2 Diabetes is predominantly a problem of urban areas.
Fact A study conducted in South India has found that the prevalence of diabetes is similar in both urban and rural areas. So people in rural areas are also at risk of developing diabetes and its complications.

Myth 3 My recent sugar levels are normal. Hence, I am safe from any possible complications of diabetes.
Fact Complications due to diabetes are a net effect of the number of years of diabetes as well as the level of control of diabetes during the entire period of having diabetes. People who have had strict control of diabetes from the beginning have better outcomes as compared to those who have had poor control for long duration and have started control of diabetes only in the near past.

Myth 4 My sugar levels are largely under control. Hence, I will not have any complications like retinopathy (eyes), neuropathy (nerves) or nephropathy (kidney).
Fact Complications due to diabetes develop not only due to poor control of sugar levels but also due to associated factors like poor BP control, anaemia, impaired lipid control ( abnormal cholesterol levels), smoking, kidney problems and cardiovascular problems. So it is essential that all the associated factors are also kept under control.

Myth 5 I got my glasses checked recently. Hence, I don’t need further eye check-up.
Fact Checking of glass power (refraction) is just a small part of the total eye examination. Eye examination includes aspects like checking for eye pressure, angles, cornea, lens status, pupillary response and fundus examination. Many treatable conditions of the eyes may not get their due attention unless a thorough examination is done.

Myth 6 My vision is fine. I have no other symptoms. I don’t think I need a dilated retinal examination.
Fact A person’s vision is usually unaffected unless the central part of the retina called macula is affected. To elaborate, there may be many changes inside the eye (diabetic retinopathy) which may need urgent treatment without the patient’s vision being affected. And the condition may be too advanced by the time patient becomes symptomatic. Hence it is prudent for the patient to get a thorough eye evaluation done once he/she knows that they have diabetes.

Myth 7 I have had bleeding inside my eye, immediately after the doctor had treated my eyes with LASER. I think he/she treated me shoddily and the bleeding is a direct effect of the inefficient management.
Fact It takes about three months for the effect of LASER to set in. Rarely, bleeding may occur inside the eyes immediately after LASER. This bleeding is a consequence of the pre-existing damage and would have occurred even if the patient had not been treated and does not represent any poor management on the part of the doctor

Myth 8 I have had LASER treatment for diabetic retinopathy. My sugars are under control ever since the treatment had started. So I do not need to go back to my doctor.
Fact Diabetic retinopathy is an ongoing condition just like diabetes. While control of diabetes is a must to have the problem under control there is no guarantee that the disease will not progress just because diabetes is under control. Therefore it is essential that the patient gets himself/herself evaluated at regular intervals to ensure that the problem is under control

Myth 9 I have had two injections inside my eye with no response. I think the medicine is ineffective.
Fact The condition inside the eye maybe difficult to manage and may need multiple injections. The injection helps in creating a suitable environment inside the eye to ensure recovery from the damage caused due to diabetes. It improves oedema inside the eye which may sometimes also be associated with improvement in visual acuity. Some studies have also demonstrated that the administration of these injections results in improvement in the quality of vision and life. Needless to say, some damage might be beyond repair.

Dr Krishnan is senior consultant, Vitreo retinal services, Maxivision Super-speciality Eye Hospital, Madhapur