Waking up in the morning with blurred vision, dark spots or total loss of vision can be very scary, especially for people with preexisting medical conditions like diabetes and hypertension.
It is scarier for people who don’t even know that their blood sugar and blood pressure are elevated because there are no signs and symptoms like physical pain, headaches or dizzy spells.
Retinopathy happens when blood vessels in the retina become damaged because of uncontrolled blood glucose and blood pressure.
Dr. Noel Jusay Lacsamana, ophthalmologist-surgeon, in an interview on Radyo Klinika at Dwiz 882 AM, describes the retina as the tissue layer at the back of the eye. This particular layer transforms light into nerve signals that are sent to the brain for interpretation.
The retina’s blood vessel walls may thicken if the blood pressure is too high or consistently high. Lacsamana says that this results to narrowing of the blood vessels, restricting the blood from reaching the retina. The retina could swell because of this.
In diabetic patients, the blood vessels within the retinal tissue become damaged, which causes the fluid to leak and distort the vision.
Lacsamana explained that when the blood sugar is too high and uncontrolled for a long time, the lumen’s internal lining gets damaged, disrupting the smooth flow of the blood. “The blood carries oxygen and nutrients to the eyes. If the blood can’t reach the eyes because of the damaged small vessels, the eyes would demand for more oxygen and nutrients, leading to angiogenesis or the formation of new but abnormal blood vessels. These abnormal new blood vessels are very fragile. They break easily, so they bleed. It can cause obstruction to the vision, hence the floaters or sudden loss of vision.”
If the eyes are left untreated and the blood sugar uncontrolled, this could lead to retinal detachment. “Neovascular membrane forms, which could attach itself to the retina. If it becomes hard and contracts, it can pull the retina and lead to retinal detachment, and eventually to blindness,” warned Lacsamana.
He also adds that diabetic retinopathy could also lead to neovascular glaucoma. “The drainage apparatus of the eyes could become blocked, which could lead to the buildup of ocular pressure. Neovascular glaucoma is painful and usually sight threatening. We can operate on the eyes to relieve the pressure but usually, the damage is irreversible.”
Early detection of the problems related to elevated blood sugar and blood pressure can save the eyes. A funduscopy can check the arteries of the eyes for possible narrowing or even necrosis (death of the blood vessel).
A perimetry and visual field test will also be done to check if the patient’s scope of vision has been compromised. A B-scan Ultrasonography (brightness scan) will be performed to accurately view the lens, choroid, sclera, vitreous and retina.
These tests and latest machines are available at the International Eye Center in San Fernando, Pampanga, where Lacsama also operates on his patients.
“If the tests show that there are blocked blood vessels, hemorrhages and formation of new but abnormal blood vessels, I immediately perform PRP or pan retinal photocoagulation laser to save the eyes.” A special laser (in Lacsamana’s clinic, he uses Pascal Topcon) to make tiny burns that seal the retina and prevent the vessels from growing and leaking. It is a quick procedure (about six minutes) and the patient can go back to work or his normal activities after several hours.
If the retinopathy becomes severe and leads to macular edema, the ophthalmologist will start injecting antiVEGF, or antivascular endothelial growth factor drugs. This is injected directly to the white of the eye or sclera. This is quick and usually not painful.
The macula is at the center of the retina, which is responsible for the details and colors of the things that we see. When there are new and abnormal vessels that are forming and the macula gets swollen, it can cause problems in the central vision, making it hard for the patient to read, watch TV or gadgets and even to recognize faces.
Managing your blood sugar and blood pressure are the key to prevent retinopathy. “See your doctors regularly, take your medicines and have a healthy lifestyle,” concluded Lacsamana.
Lacsamana holds clinic and does eye operations in the International Eye Center at the second floor of Robinsons Star Mills, San Fernando, Pampanga every Monday to Friday, 10:00 a.m. to 2:00 p.m. For appointment, call (045) 636-0003 or 0920.909.9937
Radyo Klinika has been awarded Best Radio Magazine Program by the Kapisanan ng mga Brodkaster ng Pilipinas in 2016. It airs every Tuesday to Friday, 7 to 8 p.m., on Dwiz 882 KHZ AM and on Facebook page: Dwiz 882. Download the app: Dwiz 882 AM to listen to its live streaming on your mobile phones. For interview requests, email: email@example.com.
Image credits: Guniita | Dreamstime.com