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Diabetes mellitus arises when the body does not produce enough of the hormone insulin, or when insulin is produced but cannot get into cells to help the body get energy from food. Diabetes occurs in different forms:

  • Type 1 diabetes is usually diagnosed in young people – children or teenagers. It may be due to an autoimmune process that destroys the beta cells in the pancreas, stopping insulin production. People with type I diabetes usually have to treat themselves with insulin injections.
  • Type 2 diabetes is common in people over 40 but younger people are developing it due to the rise in obesity. It occurs when the cells of the body become resistant to the effects of insulin. Initially, type 2 diabetes may be treated by lifestyle changes and drugs such as metformin. As the disease progresses, many patients need to take insulin.
  • Gestational diabetes occurs during pregnancy but disappears once the baby is born. A woman who has gestational diabetes is more likely to develop type 2 diabetes within 15 years.

Impact of diabetes on the eyes

The better diabetes is controlled and the more stable blood sugar, the less the impact on the eyes and other organs. Even so, over time, having diabetes does increase the risk of several eye conditions:

  • Cataract: people with diabetes are more likely to develop cataracts at an earlier age compared with people who don’t have the disease.
  • Diabetic retinopathy: fluctuating blood sugar levels affect the blood vessels at the back of the eye. These provide nutrients to the light sensitive nerve cells in the retina. If the blood vessels are damaged, they can leak or bulge and don’t carry nutrients as efficiently. Parts of the retina can lose nerve cells and sight can become impaired. In its early stages diabetic retinopathy is in the background – it produces no symptoms but gets worse over time.
  • Diabetic maculopathy: if the retina is damaged in the region of the macula, the zone responsible for fine vision in the centre of the field of view, even small changes can cause vision problems.
  • Diabetic macular oedema: this is one of the early events in the process that leads to diabetic maculopathy and drugs have been developed to reduce the fluid build up to slow down vision loss.
  • Proliferative diabetic retinopathy: this is the most serious form of diabetic eye disease. The blood vessels in the retina become so damaged they disintegrate or get blocked up. The retina is starved of oxygen so the body stimulates new blood vessel growth to make up for the deficiency. These blood vessels sprout randomly, some damaging the retina in the process. The new capillaries are also very liable to break down and bleed, causing further fluid build up.

Preventing diabetic eye disease

Keeping diabetes well controlled is the best way to prevent diabetic eye disease. Regular eye checks are also important to detect the early signs so that treatment can be more effective.

Surgery for diabetic eye disease

Proliferative diabetic retinopathy and diabetic macular oedema can be treated using laser surgery. A fine laser beam is used to seal off blood vessels that have started to leak, preventing them releasing more fluid into the retina.

If the problem with blood vessels is extensive, the entire retina is treated using pan retinal laser therapy.

The aim of laser surgery is to prevent further deterioration and to maintain the vision at the highest level possible for the longest time. No therapies currently available can reverse the damage caused by diabetic eye disease.

The type of laser surgery used is advancing and the latest option, only available privately in the UK at the London Eye Hospital, involves non-thermal laser treatment (the Ellex 2RT system), which stimulates healing without causing further damage to the delicate tissues of the eye. If this is able to reduce fluid build up early enough, it may even improve vision as well as slow further progression of the underlying disease.

Moorfields Private

Interested in getting private eye surgery?

Download our free 48 page PDF guide

Sponsored by Moorfields Private Eye Hospital

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Moorfields Private is the London-based private division of the world-renowned Moorfields Eye Hospital NHS Foundation Trust, with a reputation as a centre of excellence for providing ophthalmic care to private patients from the UK and across the world.

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