Dr André Burger

OPHTHALMOLOGIST • OFTALMOLOOG

PIETERMARITZBURG

Diabetic Eye Disease

Diabetes may affect the eye in several ways and severities. Patients with diabetes, may be unaware that they have eye complications.

Please make an appointment to see Dr. Burger immediately if you are diabetic with one or more of the following symptoms:

  1. Sudden worsening of vision
  2. Sudden sensation of floaters – may indicate a recent bleed from proliferative diabetic retinopathy.
  3. Pain, redness, severe vision loss, halos around lights – may indicate raised intra ocular pressure from neovascular glaucoma.

How does Diabetes affect the eye?

Over time, high blood sugar levels, lead to damage to the small retinal blood vessels.

Several complications may develop due to this, including macular edema (swelling in the central retina which affects the quality of central vision) and retinal ischemia (poor blood flow with resultant tissue loss and other complications which may adversely affect vision).

Retinal ischemia if untreated, will lead to permanent and irreversible visual loss. Early intervention and monitoring can prevent this from occurring.

Depending on the severity of your diabetic eye disease, Dr. Burger will classify your type according to international guidelines.

This classification will assist Dr. Burger in guiding you on the frequency of your follow up appointments and/or the need for a therapeutic intervention.

Who needs eye screening?

All newly diagnosed diabetics needs screening at the time of diagnosis to obtain a baseline eye assessment

Do diabetics need regular follow up visits?

Yes, all diabetics need annual follow ups to look for diabetic eye complications. The frequency of eye visits, depends on the grading or severity of the diabetic eye disease.

Management of diabetic eye disease:

Adequate medical control of diabetes mellitus(i.e. good glucose, blood level control) is very important to prevent target organ involvement and complications.

Diabetes may adversely affect the following target organs: the eyes, brain, kidneys, heart and nerve tissue.
Aim for glucose levels at or below 8.
Avoid smoking
Control blood pressure and cholesterol levels.

Diabetic macular edema:

This may be treated by applying laser to leaking blood vessels (microaneurysms) as well as other areas where the retina is swollen.

Other options include ocular injections with bevacizumab (Avastin) and/or steroids with or without subsequent laser.

Surgical treatment for diabetic macular edema is rarely used, and only used in a select few individuals with specific features.You will be guided by Dr. Burger if treatment is indicated.

Proliferative diabetic retinopathy is a serious, sight threatening condition which only can be diagnosed by an ophthalmologist. The patient with diabetes may be unaware of this.

An Argon laser procedure in the rooms, is the main treatment for proliferative diabetic retinopathy. In this approach, wide areas of the peripheral retina are treated with laser spots.

The aim of this treatment is to reduce the risk of permanent visual loss. One or more sessions of laser may be needed to complete this treatment. This type of laser may permanently and adversely affect the patient’s peripheral vision and night time vision. This will make night time driving unsafe. It takes several weeks for the regression of the neovascularization to occur. This therapy has saved the vision of millions of patients with diabetes.

Another option in a very select few, would be Avastin intra ocular injections, which would be given in Dr. Burger’s rooms.In some patients with very severe proliferative diabetic eye disease, surgery by way of a Pars plana vitrectomy (PPV), is the only intervention which could hopefully improve and preserve vision.

Dr. Burger has received training within South Africa and the United Kingdom to perform such delicate and highly advanced surgery.

A small percentage of patients have such poor blood flow that vision is lost despite excellent treatment.