Diabetes is a condition where the body does not produce enough insulin to convert sugar to energy, leading to a build up of sugar in the blood. This leads to a number of problems, including diabetic retinopathy -- which is one of the leading causes of adult blindness in Singapore.

About 60% of patients with diabetes for 15 years or more will have some blood vessel damage in their eyes. Some of these patients are at risk of developing blindness.

Are you worried that you are at risk? Find out what is the preventive measure that you can take to reduce the risk of diabetic retinopathy.

Adj Assoc Prof Lee Shu Yen, Senior Consultant from the Department of Cataract and Comprehensive Ophthalmology Service ​at Singapore National Eye Centre,​ gives detailed answers to your questions.

Question by kp

Dear Prof Lee,

I will be 57 next month. I am considering Lasik but am wondering if there would be any problem should I get cataracts within the next 5 to 10 years. What do you advise?

Thank you.

Answered by Adjunct Assoc Prof Lee Shu Yen Senior Consultant Cataract and Comprehensive Ophthalmology service Singapore National Eye Centre

I would suggest that you see an ophthalmologist for a full eye examination before you make any decision regarding LASIK surgery.

At 57 years old, it is highly possible that you may already have early stages of cataracts. If that is the case and if you find that you are not getting as good visual function as in the past, you may want to consider early cataract surgery instead. Disturbed visual function does not just include the acuity but is also present if you colours appear darker or washed out, or if you have difficulty with contrast sensitivity, or if you have glare when looking at bright lights.

If you really do not have any evidence of lens opacities (cataracts) and if you have a significant refractive error, LASIK would be a possible option, provided your corneal assessment fulfill the treatment requirements. However, you would be right to plan in advance and consider options for cataract surgery in the future.

In the presence of prior laser refractive surgery, calculation of the lens power suitable for your eye is more challenging and there is a risk of inaccuracy and you may not be able to achieve emmetropia, ie “zero degree” for distance vision. This means that you have to be prepared to accept the inaccuracy and wear glasses, or undergo a lens exchange.

As you may know, there are two parts to cataract surgery. The first involves removing the cataract using high frequency ultrasound power to liquefy the lens (phacoemulsification). This is followed by a lens implant to restore the focusing power of the eye. Nowadays, there are various lens implant types to choose from. There is the standard monofocal lens which will enable good distance vision without glasses; however, you will still need reading glasses. This lens does not correct for significant astigmatism. The toric intraocular lens will. The third lens type corrects for distance vision as well as near vision, ie a multifocal lens. In general, individuals who have undergone laser refractive surgery are not suitable for multifocal lens implantation. Monofocal lenses are recommended instead.

So if you undergo LASIK now, and undergo cataract surgery later, you will still be able to see far without glasses, but, very likely, you will nee​d reading glasses.

Question by oxxmann

Hi, I had a problem with my right eye, initially it look very redish and watery, local clinics treated me for sore eyes, after a few days my right eye vision became very cloudy.

Visited a specialist, the said the eye had inflammation and possibly caused my pressure to shoot to 40. Was treated with

1. TRUSOPT - dorzolamide hydrochloride
2. XALACOM - Latanoprost & Timolol
3. MAXIDEX

The inflammation and cloudy vision slowly disappeared and was recommended to stop using all eye drops in stages, but from this episode now my right eye cannot focus, I see shadows around the alphabets.

I stop using all the drops about three weeks ago. A few day back I had the cloudy vision again and the spectacles just made did not help either.

​Visited the specialist, they did see some cloudy patches and recommended to use a drop of Maxidex every four hours, and to visit him again in a week.

Before all this problems I had very good eyesight and never had vision problems. My dad did not have glaucoma, but some of his siblings had it, and I'm now 42 years old.

What do you think is wrong or have you any advice for me?

Regards Lienad

Answered by Adjunct Assoc Prof Lee Shu Yen Senior Consultant Cataract and Comprehensive Ophthalmology service Singapore National Eye Centre

It sounds like you may have an inflammatory eye condition which manifests with increased intraocular pressure. This is called Posner-Schlossman syndrome (PSS).

During an attack of PSS, there is some inflammatory reaction in the front part of the eye and the intraocular pressure is elevated. When the pressure is high, the cornea, which is normally transparent, reacts by becoming water-logged and becomes cloudy. Vision then becomes hazy. In addition, there will be redness, eye pain and sometimes nausea and vomiting.

Treatment for this condition would be to reduce the pressure with tablets and eye drops (such as Trusopt and Xalacom) as quickly as possible and control the inflammation with steroid eyedrops. If the eye pressure is too high for too long, the optic nerve can become damaged and there may be permanent visual loss.

If this condition recurs, you should be further investigated to exclude any underlying viral infection which may need further treatment.

Question by littlelow

Hi Prof Lee, I start to see floaters and getting more floaters in months. I also see a black dot on my left eye and it's moving ard. One incident where I see flash and last for 5mins and vision was disturbed and I'm worry. My job needs me to look at pc screen and all these floaters are a disturb to me. Is there a cure? Thanks. Littlelow

Answered by Adjunct Assoc Prof Lee Shu Yen Senior Consultant Cataract and Comprehensive Ophthalmology service Singapore National Eye Centre

Seeing floaters is usually a normal manifestation but occasionally it can also be a sign of an abnormality. Floaters and flashes are very common complaints in the 40-50 year olds. This is largely due to benign age-related degenerative changes in the jelly of the eye, called the vitreous.

When young, the vitreous has the consistency of a solid gel, but with age, it undergoes liquefaction. The greater water content makes the gel more likely to swirl about and to collapse away from the inner wall of the eyeball. This is called posterior vitreous detachment (PVD) and it occurs in everyone.

It may occur earlier if there is high myopia or in presence of previous eye injury. Most of the time PVDs are harmless and the floaters gradually reduce over months. Occasionally, as the vitreous collapses from the eye wall, it can pull on a blood vessel and cause a haemorrhage or it can pull on the retina and cause a retinal tear. In the presence of a vitreous haemorrhage, the vision will become very blurry with many floaters seen.

If there is a retinal tear, there will be a sudden release of floaters. Should these occur, one should consult an ophthalmologist as soon as possible. The retinal tear needs laser treatment to seal it and prevent progression to a retinal detachment.

As PVD is a normal process of ageing, there is no treatment for it. The floaters will gradually reduce but you will see them again if you move your eyes left and right quickly or if you look at a bright surface like a white wall.

Question by huilian

Dear Professor Lee I just underwent laser treatment for DR. After 2 weeks, the vision is still very glaring when there is white light and things look hazy and also because of the glare - it is difficult to read - is this normal and will it get better ? Can we take supplements for eye ? Are there any workshops conducted in SNEC for eye care and education?

Laser for diabetic retinopathy aims to stabilize vision and prevent further loss of vision. In the presence of DR, it is likely that there is already some retinal damage from the abnormal blood supply caused by diabetes.

I am not sure if you had laser treatment to the peripheral retina, ie a panretinal photocoagulation (PRP), or if you focal laser treatment for diabetic macula oedema.

If you had PRP done, the vision may not be clear for the first few days but this should settle. If you had focal laser for diabetic macula oedema, the effect of the laser can take more than 3 months to settle, however further laser may be necessary. Vision may not improve. The aim of focal laser is to stabilize vision and prevent further visual loss.

In general, diabetic retinopathy does not cause glare. However, patients with diabetes very often early cataracts, and the type of cataract does cause difficulty looking at things in bright light (glare).

There are no eye supplements for diabetic eye disease. The best thing to do is to keep the sugar well controlled (ie HbA1c <7%), blood pressure controlled and high cholesterol levels treated.

SNEC does conduct regular patient education talks. You can find details at www.snec.com.sg.

Question by Magan

Dear Prof Lee

I am 49 years old and suffering from diabetes. There is leakage in my right eye. The Ophthamologist has recomended laser treatment. Is there any other treatment to stop this leakage and is this treatment safe. And after this treatment will the leakage be stopped permanently.

Answered by Adjunct Assoc Prof Lee Shu Yen Senior Consultant Cataract and Comprehensive Ophthalmology service Singapore National Eye Centre

Diabetes can cause eye complications in the form of diabetic retinopathy and macula oedema. In the presence of macula oedema, there is fluid leakage into the macula (the central area of the retina). The gold standard method of treatment is to treat with laser. The effect of the laser can take up to 3 months to settle, sometimes longer if the area involved is greater and additional laser may be required. The aim is to stabilize vision and prevent further visual loss.

Now there is an injection with an anti-VEGF agent to help reduce the swelling and usually this is done together with laser in the more severely affected cases.

There will always be a chance the macula oedema can recur. This depends on the level of control of diabetes, blood pressure and cholesterol. If these are well controlled, the chance of diabetic retinopathy and macula oedema will be less.

Question by mango

Q. Dear Prof Lee

My grandma is suffering from diabetes for more than 10 years. All the while, she has no problem with her eye sight.

2 years ago, she started complaining about floaters on and off. The situation did not worsen, should we send her for treatment? What are the treatment options available for such conditions?

Hope to hear from you soon.

Thank You

mango

Answered by Adjunct Assoc Prof Lee Shu Yen Senior Consultant Cataract and Comprehensive Ophthalmology service Singapore National Eye Centre

Seeing floaters is usually a normal manifestation but occasionally it can also be a sign of an abnormality.

Floaters and flashes are very common complaints in the 40-50 year olds. This is largely due to benign age-related degenerative changes in the jelly of the eye, called the vitreous. When young, the vitreous has the consistency of a solid gel, but with age, it undergoes liquefaction. The greater water content makes the gel more likely to swirl about and to collapse away from the inner wall of the eyeball. This is called posterior vitreous detachment (PVD) and it occurs in everyone.

It may occur earlier if there is high myopia or in presence of previous eye injury. Most of the time PVDs are harmless and the floaters gradually reduce over months. Occasionally, as the vitreous collapses from the eye wall, it can pull on a blood vessel and cause a haemorrhage or it can pull on the retina and cause a retinal tear.

In the presence of a vitreous haemorrhage, the vision will become very blurry with many floaters seen. If there is a retinal tear, there will be a sudden release of floaters. Should these occur, one should consult an ophthalmologist as soon as possible. The retinal tear needs laser treatment to seal it and prevent progression to a retinal detachment.

As PVD is a normal process of ageing, there is no treatment for it. The floaters will gradually reduce but you will see them again if you move your eyes left and right quickly or if you look at a bright surface like a white wall.

If there are only a few floaters present, it is unlikely that this is due to diabetes related bleeding. Diabetic vitreous haemorrhage will cause significant blurring of vision. However, as a diabetic, your grandma should have regular eye check ups to exclude any diabetic eye complications.

Ref: U11