Dr Karobi Lahiri on Diabetic Retinopathy & Eye Care for Diabetic Seniors

On March 13, 2021, Seniors Today hosted its weekly Health Live webinar Dr Karobi Rani Lahiri, a leading eye specialist with over three decades of experience, to talk about and answer questions regarding diabetes and its effects on the eye, focusing largely on diabetic retinopathy and eye care for diabetic senior citizens. Here are the takeaways from the session, as captured by Dr Noor Gill.

Dr Lahiri is a consultant at the Bombay Hospital Institute of Medical Sciences in Mumbai. She is also an Associate Professor of Ophthalmology, a Consultant- VR Surgeon and a Paediatric Ophthalmologist at the Bombay Hospital. An awardwinning doctor, she has written five book chapters and 10 publications and is a former President of the Bombay Ophthalmologists Association.

• Diabetes worldwide is now estimated to affect about 422 million individuals with an estimated rise of 629 million by the year 2045. This escalation is partly due to our lifestyle and how we lead our lives, hence, changing our lifestyle plays a major role and can help in bringing these numbers down.
• Diabetes damages the blood vessels all over the body, which by extent causes damage and affects all parts and organs of the body.

Thus and so, it also blocks the small blood vessels of the eyes, in the retina and causes them to leak fluid and bleed. So, to make up for these blocked vessel, your eye as a response to take care of the circulation starts growing new blood vessels (which is called neovascularisation). But these new blood vessels do not have the integrity of the old blood vessels and so, on least provocation, these tend to break down and bleed.

• Diabetic retinopathy is the most common cause of blindness between 20-70 years of age.
• There are three main types of diabetes mellitus:

1. Juvenile diabetes or Diabetes Mellitus Type 1: this is the most ferocious type and occurs between the ages of 10-20 years. Here the individual is not able to produce insulin. The risk of development of diabetic retinopathy is 70%
2. Diabetes Mellitus Type 2: in this type, there is insulin production but the body and the cells are incapable of processing the insulin which leads to the rise in the sugar levels. This is the more common type of diabetes and occurs in people between the ages of 50-70 years of age. The risk of development of diabetic retinopathy is 39% and type 2 patients on insulin- 70%
3. Gestational diabetes: as the name suggests is associated with pregnancy. This tends to settle once the patient is not pregnant anymore.

• Diabetic retinopathy does not appear for at least 5 years after the diagnosis of DM type1. It may be present when DM type 2 is diagnosed. The probability of diabetic retinopathy goes up by 98% after 15 years of diagnosis of DM type 1 and diabetes like disease and 78% of patients with DM type 2 have some degree of retinal damage.
• Diabetic age is the number of years you’ve had diabetes; whether it is 5 years, 10 years, 15 years. As the diabetic age advances, the retinopathy changes become possible. Hence, a strict glycemic control is very important.
• Symptoms that can indicate a diabetic eye disease:-
• Reduced night vision.
• Discharge or constant infections of the eye
• Frequent headaches
• Vision disruptions
• Chronic eye fatigue
• Light sensitivity
• Difficulty in focusing
• Blurred vision
• Seeing floaters or patches or streaks in the eye when there is a bleeder

In case you have any of these symptoms, you should go to your ophthalmologist to get your eye checkup and diabetic eye examination.

• Any effect to the macula, can cause whole lot of visual disturbances in the eye. Sometimes, when the macula is affected, you can get an empty spot or a black spot in the centre which is called a scotoma.
• In case of a bleed in the eye, there can be a sudden and total loss of vision.
• What to expect when you go to your ophthalmologist?
• They will check your vision
• They might also introduce some eye drops to dilate your pupil for examination
• They check the front of your eye and the back of your eye. They check for the anatomy of the blood vessels in the back of your eye, they check for any abnormalities in the optic nerve or the retina or if any new blood vessels are developing, or tractions, detachments, scar tissues, etc.
• They will check for presence or absence of cataracts
• Eye pressure is checked to look for glaucoma
• Effects of diabetes in the eye
• Cataracts- an opacity that hinders the homogeneity of the visual field
• Glaucoma- raised intraocular pressure in the eye
• Retinopathy- this can be of the

1. a) Proliferative type- proliferation of new blood vessels on the retina is seen or around the optic nerve
2. b) Non-proliferative type- this can further be segregated into mild, moderate and severe

• Maculoedema: swelling in the macula
• Vitreous haemorrhage: bleed in the vitreous cavity
• Traction retinal detachment
• Optic neuritis: inflammation of the optic nerve
• Diabetic patients are 2-4 times more likely to develop cataract than non- diabetics especially if the blood sugar levels go above 200mg% and are not controlled.
• Poor glycemic control and high HbA1c levels can hasten the process of diabetic retinopathy.
• The visual outcome/ prognosis after a cataract surgery for a diabetic cataract depends on the severity of the retinopathy before surgery. There is an escalation of the diabetic processes in the eye by 3 times of what it is, in case you don’t treat the retinopathy or maculopathy before your cataract surgery.
• Maculopathy is also associated with hyperlipidemia and hence the assessment of the blood sugar levels along with your cholesterol and triglyceride profile is required.
• Risk factors which can aggravate the diabetic processes in the eye:
• The amount of time you’ve had diabetes
• Poor control of the blood sugar levels
• Associated hypertension, obesity, hyperlipidemia, nephropathy
• Smoker
• Pregnancy

• Constant use of white screens, this can be your laptops, mobile phones, television for over 4 hours, can tend to give rise to dryness of the eye. This can get aggravated if the individual also has diabetes. Constant use of white screens also gives rise to eye strain, fatigue which is also called as digital eye strain and it manifest with greater amount of watering of the eyes, redness of the eyes, itching, irritation, foreign body sensation. If you go to an ophthalmologist, he’ll do a Schimmer’s Test to detect the level of wetting/ tear production your eye has and depending upon the severity he will prescribe you medication, a tear emollient or lubricant. Along with the eye drops, you also should restrict your screen time. Follow the 20-20 rule which says that eyes 20 minutes you should look away from your screen for 20 seconds at an object placed 20 feet away from you.
• The blue-cut lenses help in cutting out the blue rays that are emitted by your screens. It is not something that everyone needs to do. If you are following the 20-20 rule, keeping yourself well hydrated and your eyes hydrated, if you keep your screen at an adequate distance and take every measure to avoid the blue rays and dryness and strain in the eye, these measure are also equally helpful in cutting off the blue rays.
• Arcus senilis is a white ring around the cornea which is common and a benign condition in the elderly. It is caused due to the deposition of phospholipids and cholesterol as the age advances.