Being diabetic, one is at risk of getting complications resulting from the uncontrolled level of blood sugar in their body. For instance, heart, kidney, legs, eye and brain complications, just to name a few. But the crucial one and what most of the diabetic patients normally forget is the disease caused by the damage of  the eye especially the retina , commonly known as diabetic retinopathy.

According to Sonia Sebuseruka, an ophthalmologist at Polyclinique la Medicale, diabetic  retinopathy is the most serious, irreversible eye complications leading to blindness.

"The condition is common in type 1 (young people) and type 2 (adults), this ocular manifestation of diabetes affects up to 80 % of all patients who have had diabetes for 20 years or more,” she says.

What is diabetic retinopathy?

Rachna Pande, a medic at Butaro Hospital, says diabetic retinopathy is the damage to the retina (part of the eye where rays are focused and impulse is carried via optic nerve to brain for interpretation of image).

She says this occurs due to damage to blood vessels and nerves of eyes.

"Initially, there is damage to blood vessels with small swellings forming in them. Later on there is edema, of surrounding parts. New blood vessels form which bleed. A person may suffer from blurred vision, reduced field of vision, seeing spots in front of eyes,” she says.

Pande notes that 70 per cent of people who have had diabetes for over 20 years do develop retinopathy. 

"The risk is higher and can occur and in more severe form with uncontrolled diabetes. High blood pressure, if co-existing, adds to eye damage,” she says.

Retinopathy can also be due to hypertension, severe anaemia and systemic lupus, but changes due to diabetes are unique. It is diagnosed by fundus examination and fluorescin angiography.

How it comes about

Dr Sebuseruka explains that the glycemic index of diabetic patients is supposed to be between 70-110mg/dl, and when it exceeds that, for example at 300-400mg/dl, the patient is at risk of getting other complications including diabetic retinopathy.

"All this happens when the level of sugar is high or not well-controlled because it damages the micro vessels in the retina, leading to swelling of the retina as well as leading to leakage,” he says, adding that when the level of sugar is high, there is occlusion, a process where the blood becomes blocked in veins of the retina leading to ischemia.

Pande says the condition may also be aggravated during pregnancy and with those with high blood pressure. 

She explains that if one experiences alarming signs such as dark spots, blurred vision, sudden loss of vision in one eye and flashing lights, there is a need to consult an ophthalmologist for proper examination.

"When one has been diagnosed with type 2 diabetes, their first move should be to see ophthalmologist, because 20 per cent of them will always have diabetic retinopathy. After 7 years of being diagnosed with diabetes, 50 per cent will definitely develop the diabetic retinopathy and 85 per cent will get the condition after 15 years,” she says.

According to Pande, this alone shows how dangerous the condition is and how important it is to do check-ups in order to get the correct medication at the right time.

Treatment

"Losing your sight due to diabetic retinopathy can’t be reversed, therefore, getting frequent check-ups and starting medication early are the best options for preventing loss of vision,” says Francis Kazungu, a general practitioner in Kigali.

"First of all, the condition may not often show signs and symptoms early enough to alarm you, and they might show in advanced stages when nothing can be done to correct the condition,” he says.

Kazungu adds that anyone diagnosed with diabetes should go for immediate check-up from opthamologist, and that general consultations should be done to check for high cholesterol level, obesity, high blood pressure and other complications that come with one being diabetic.

"One should also be able to control their blood sugar and blood pressure levels. This is because it reduces the risk of further complications that may occur and it can be achieved by improving one’s lifestyle. For example, maintaining a healthy weight through exercising or consuming a healthy diet with little or no salt at all,” he adds.

Pande points out prevention lies in avoiding diabetes, while treatment may include laser therapy, depending on the stage of the condition. 

"Consuming foods rich in antioxidants like carrots, greens and vegetables is useful because they do help in treatment of diabetic retinopathy,” she says.