What is Diabetic Retinopathy?

Diabetic retinopathy is a common complication of diabetes that affects the small blood vessels in the lining at the back of the eye. It is estimated that there are approx. 225,000 people living with diabetes in Ireland and 10% of those are at risk of developing sight threatening retinopathy. The condition causes damage to the blood vessels in the retina, the tissue lining the back of the eye that allows us to see, and affects up to eight out of 10 patients who have had diabetes for 10 years or more. The retina helps to change what you see into messages that travel along the sight nerve to the brain. A healthy retina is necessary for good eyesight. Diabetic retinopathy can cause the blood vessels in the retina to leak or become blocked and damage your sight.

In the early stages, diabetic retinopathy will not affect the sight, but if the changes get worse, eventually the sight will be affected. When the condition is caught early, treatment is effective at reducing or preventing damage to sight. The Irish College of Ophthalmologists (ICO), the training and professional body for eye doctors in Ireland, explain diabetic retinopathy, the symptoms and treatment options.

Diabetic retinopathy is one of the five main causes of sight loss in Ireland and the leading cause of blindness among the working age population. This is despite the fact that 70-75% of blindness is preventable with early diagnosis and treatment.

Anybody with diabetes, either Type 1 or Type 2, is at risk of developing diabetic retinopathy. The longer you have diabetes, the more likely you are to develop diabetic retinopathy.

What causes Diabetic Retinopathy? Diabetes is a condition where the body can’t use and store sugar properly and this can cause many health problems. Too much sugar in the blood can cause damage to blood vessels throughout the body, including the blood vessels in the eye. When someone has diabetes, over time the blood vessels in the

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Catoca Fine Food and Giftware Great food, great service, great location. Catering for all your special occasions and corporate events. Free car parking available on site 044 9338960 Contact: Belvedere House Gardens & Park, Mullingar, Co. Westmeath. Tel: 044-9349060 info@belvedere-house.ie www.belvedere-house.ie www.facebook.com/Belvedere-House-Gardens-Park isit Location: 5km south of Mullingar on N52 1hour from Dublin, M4/N4 Exit 15 Sat Nav: Latitude/Longitude 53.4761, - 7.3552 Opening Times 7days a week all year round from 9.30am Seasonal closing times apply Admission Rates Adult €8. Student/Senior €6. Child €4. Family Ticket (2 adults + 2 children) €23. Each additional child €3. Catoca Fine Food and Giftware Great food, great service, great location. 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Tel: 044-9349060 info@belvedere-house.ie www.belvedere-house.ie www.facebook.com/Belvedere-House-Gardens-Park tate to Visit Location: 5km south of Mullingar on N52 1hour from Dublin, M4/N4 Exit 15 Sat Nav: Latitude/Longitude 53.4761, - 7.3552 Opening Times 7days a week all year round from 9.30am Seasonal closing times apply Admission Rates Adult €8. Student/Senior €6. Child €4. Family Ticket (2 adults + 2 children) €23. Each additional child €3. Catoca Fine Food and Giftware Great food, great service, great location. Catering for all your special occasions and corporate events. www.catocafinefood.com Parking Free car parking available on site This magnificent 160 acre Lakeside estate boasts a fully restored Georgian Villa built in 1740 by the famous Architect Richard Castles for Robert Rochfort –later Lord Belvedere. The estate has a fascinating Victorian Walled Garden, with one of Ireland's finest collections of naturalistic designed 18 th century parkland, punctuated with Romantic Follies includes the largest in Ireland; “The Jealous Wall”. Licensed Restaurant and Gift Shop and there are also 4 outdoor children’s play areas & many picnic areas on the estate. Whether you are part of a gardening group, historical society, school tour, active retirement Contact: Belvedere House Gardens & Park, Mullingar, Co. Westmeath. Tel: 044-9349060 info@belvedere-house.ie www.belvedere-house.ie www.facebook.com/Belvedere-House-Gardens-Park Estate to Visit Location: 5km south of Mullingar on N52 1hour from Dublin, M4/N4 Exit 15 Sat Nav: Latitude/Longitude 53.4761, - 7.3552 Opening Times 7days a week all year round from 9.30am Seasonal closing times apply Admission Rates Adult €8. Student/Senior €6. Child €4. Family Ticket (2 adults + 2 children) €23. Each additional child €3. 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retina become thicker and the blood flowing in the blood vessels slows down. These eye changes are called diabetic retinopathy. Diabetic retinopathy is the name for two different changes in the retina which can affect the sight:

Diabetic macular oedema is where leaky blood vessels affect the part of the retina called the macula. If fluid leaks from these vessels and affects the centre of the macula, the sight will be affected. This is the more common eye change

Proliferative diabetic retinopathy is where fragile new blood vessels form on the surface of the retina over time. These abnormal vessels can bleed or develop scar tissue causing severe loss of sight. Both diabetic macular oedema and proliferative diabetic retinopathy can be treated and managed if they are detected early enough. If they are left untreated, sight problems will develop.

What are the risk factors for diabetic retinopathy? • Poor blood glucose control • High blood pressure • Raised fats (triglycerides) in the blood • Pregnancy (not gestational diabetes). During pregnancy, diabetes can worsen diabetic retinopathy.

What can I do to take care of my eye health if I have diabetes? The best protection against the progression of Diabetic Retinopathy is good diabetic control, awareness of the risks of developing sight disturbances and participating in the National Diabetic Retina Screening Programme or having regular eye examinations by an eye doctor. If left untreated a person with diabetic retinopathy could lose vision or find they develop other eye complications including cataracts or glaucoma so regular monitoring of your eyes is crucial if you are diabetic.

The following measures can help prevent or slow the development of diabetic retinopathy: • taking your prescribed medication • sticking to your recommended diet as best you can • exercising regularly and sensibly • controlling high blood pressure – this keeps your eye’s blood vessels healthy. • limiting your alcohol intake • avoiding smoking • Having regular eye examinations

Diabetic RetinaScreen - The National Diabetic Retinal Screening Programme

Diabetic RetinaScreen is the National Diabetic Retinal Screening Programme which was introduced in 2013. It is a government-funded screening programme that offers free, regular diabetic retinopathy screening to people with diabetes aged 12 years and older.

Diabetic RetinaScreen uses specialised digital photography to look for changes that could affect sight. All people in this country who have been diagnosed with diabetes should be on the register for screening. If a patient is diabetic, they need to check if they are on the national diabetic register. If not, they can self-register on the website www. diabeticretinascreen.ie or by calling 1800 454 555 or they can ask their GP or diabetic nurse to register them. This is very important as it is the people who are on the register who will receive the invitation to be screened for free in this national HSE service.

Diabetic retinopathy may not have any symptoms or may not affect sight in the early stages. The national screening programme will reduce sight loss among people with diabetes as a result of early detection and effective treatment. Eye doctors urge people to make the follow up call when they receive their letter of invitation so an appointment for screening can be arranged. Treatment for Diabetic Retinopathy

Medical control Controlling blood sugar and blood pressure can help prevent vision loss. Carefully follow the diet your doctor or nutritionist has recommended. Take the medicine your diabetes doctor prescribed for you. Sometimes, good sugar control can even bring some of your vision back. Controlling your blood pressure keeps your eye’s blood vessels healthy.

Anti-VEGF Injections Anti-VEGF injections help to reduce swelling of the macula, slowing vision loss and perhaps improving vision. This drug is given by injections (shots) in the eye by an Ophthalmologist. Steroid medicine is another option to reduce macular swelling. This is also given as injections in the eye. Your ophthalmologist will recommend how many medication injections you will need over time.

Laser Surgery Laser surgery might be used to help seal off leaking blood vessels. This can reduce swelling of the retina. Laser surgery can also help shrink blood vessels and prevent them from growing again. Sometimes more than one treatment is needed.

Vitrectomy If you have advanced Proliferative Diabetic Retinopathy (PDR) your ophthalmologist may recommend surgery called vitrectomy. This is where the eye doctor removes vitreous gel and blood from leaking vessels in the back of your eye. This allows light rays to focus properly on the retina again. Scar tissue also might be removed from the retina.

How to make an appointment with an eye doctor For an appointment to see any medical specialist working in the HSE, including eye doctors, you need to get a referral from your General Practitioner (GP). A GP has knowledge of the specialists in his/her area and can ensure that any important information relating to your medical history is passed to the eye doctor.

Can I make an appointment directly with an eye doctor? While it is advisable to seek a referral from your GP many eye doctors working in the community will give you an appointment directly - you can find contact details for eye doctors on the ICO website at www. eyedoctors.ie

How to take care of your eye health The ICO places a priority on raising the public’s awareness of eye health and the significance of eye health as an indicator of general health and wellbeing.

The eye is not an isolated unit and has complicated relationships with numerous other bodily functions including that of the brain and nervous system. Often when an eye problem presents, it can be an indicator of another underlying medical condition. Many eye diseases are associated with general medical conditions and many general systemic conditions affect eye health (diabetes, sleep apnoea, various tumour’s,

hypertension, sickle cell disease, lupus, and many others can affect the eyes and threaten vision).

It is important for people to be aware of the positive impact of a healthy lifestyle on eye health and the importance of reacting to any change they notice to their sight.

After ageing, smoking is the biggest risk factor for developing Age related-Macular Degeneration and also increases your risk of developing cataracts.

Simple lifestyle changes can have a big impact and help to slow the progression or onset of eye conditions, like giving up smoking, eating a healthy diet rich in leafy greens, exercise, sensible use of sunglasses and having regular eye exams.

It is important to make an appointment to see an eye doctor or a health care professional if you notice a change, however slight in your vision. For more helpful advice and information on eye health, visit the ICO website at www.eyedoctors.ie

The importance of keeping eye appointments

ICO President and Consultant Ophthalmologist, Dr Patricia Quinlan advises

These are very challenging times for patients and we understand patients may be reluctant to attend their doctor or hospital at the present moment to both avoid contracting the coronavirus, but also not to put added pressure on the health service at this time.

However, the ICO wants to stress to patients the importance of attending their ophthalmology appointments as directed by their eye doctor or health care professional as non-COVID services resume in hospitals and the community. Many ophthalmology treatments are time sensitive, such as wet macular degeneration and glaucoma. Early diagnosis and ongoing treatment is crucial to preserve and protect vision.” Patients with emergencies are and will continue to be cared for. Measures are in place in ophthalmology hospital departments to ensure that urgent ophthalmic care patients can be seen. Community ophthalmology services are also available to offer advice and triage patients, and are liaising with GPs and the eye care team in primary care.

If you or any of your family members experience sudden vision loss or significant pain in your eye, it is important that you contact your eye doctor, GP or A&E and seek medical advice.

The ICO is also reminding the public of the significance lifestyle factors can have on our eye health - a good diet rich in antioxidants, regular exercise and avoiding smoking all have a positive impact on our eye health. Among the recommendations from eye doctors for healthy vision are:

Consider eye health as part of overall good health - Understand the impact of other diseases on the eyes. The eyes are extraordinarily complex. Many systemic diseases such as diabetes, various tumours, hypertension, sickle cell disease, lupus, and many others can affect the eyes and threaten vision. Anyone with concerns should visit their GP who can refer you to an eye doctor for medical examination.

Diet - yat the right foods - Studies show that what we eat can affect our vision. Certain foods are particularly high in antioxidants which can help to prevent retinal damage and certain eye conditions like cataracts and age-related Macular Degeneration (AMD). An anti-oxidant which hugely beneficial is lutein, found in many fruit and vegetables. Foods recommended for eye health include: • Broad leaf greens such as kale and spinach • Brightly coloured fruit and veg such as corn, carrots, orange sweet peppers and oranges • Oily fish like salmon, tuna and mackerel • Broccoli • Eggs

Exercise – Our eyes need good blood circulation and oxygen intake, and both are stimulated by regular exercise. Lack of exercise contributes significantly to several eye conditions, particularly amongst people aged 60 and over. Being physically active also helps in maintaining weight in a normal range, which reduces the risk of diabetes and diabetic retinopathy, which is a serious eye complication related to that disease.

Don’t smoke – Avoiding smoking or quitting altogether is one of the best investments a person can make in their long-term health. Smoking increases the risks of a variety of diseases, including those that affect the eye such as cataracts and diabetic-related conditions. After ageing, smoking is the biggest factor for developing Age-related macular degeneration (AMD).

Know your family eye health history – Certain eye conditions can be hereditary, such as glaucoma. When detected early, it can be treated and controlled and therefore it would be very beneficial to know if this condition has been in your family so you can be tested.

Protect protect your eyes at aork and at play – One of the best investments in eye health is to be sure to protect them with proper eye wear, whether it’s enjoying a day in the sun, playing sports or in your profession, be safe with your eyes at all times.

Get regular eye exams – Healthy adults who do not notice anything obviously wrong with their eyes should still have their eyes tested every two years. Eye Doctors recommend that adults with no signs or risk factors for eye disease get a baseline eye disease screening at age 40, which is typically the approximate time when early signs of disease and changes in vision may start to occur. Individuals at any age with symptoms or who are at risk for eye disease, such as those with a family history of eye disease, diabetes or high blood pressure should see an eye health care professional to determine how frequently their eyes should be examined.