A Pandora's Box called Diabetes
Mr. V. S. Shukla*, a 54 years old gentleman came with sudden reduction of vision in his right eye since 2 days. He had no significant past history. Mr. Shukla’s eyes were checked to assess his best possible vision with glasses. His vision was normal in his left eye for near as well as distant vision. However, when it came to his right eye, the vision was so poor that he could only count fingers at a distance of 2 meters, while it was poor for near vision too (<N36). The front chamber of his eye was examined; however this did not turn up anything positive. His eye pressures were checked and found to be normal.
It was only when his light sensitive layer at the back of the eye/ retina was examined (Fundus Examination), did the culprit come to light.
Fundoscopy Examination Findings:
Mr Shukla’s right eye showed bleeding inside the eye (subhyaloid hemorrhage). Because of the dispersed hemorrhage in the vitreous (the jelly like transparent fluid inside the middle eye), the other details of his fundus could not be seen clearly. When it came to his left eye (which had seemed apparently normal until then), it showed the growth of abnormal new blood vessels at the optic disc (a region in the retina). Even other than the optic disc, Mr Shukla had multiple superficial bleeds in the retina.
Dr Yogesh Patil, the consulting Retina Specialist at Advanced Eye Hospital in Navi Mumbai, immediately asked for Random blood sugar levels to be done. These turned out to be alarmingly high: 460 mg% (It is considered normal if it is 140 mg%). HbA1C is a test which gives an average reading of the last three months blood sugar levels. The normal range for the hemoglobin A1c test is between 4% and 5.6%. Levels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher indicate diabetes. Mr Shukla’s levels turned out to be an alarming 11! Once his kidney functioning was ascertained to be normal, Fundus fluorescein angiography was done, which helps assess the blood vessels in the retina, which grow abnormally in diabetic eye diseases.
Fundus Flourescein Angiography showed:
All findings suggested a diagnosis of Proliferative diabetic retinopathy. Subsequently Pan-retinal photocoagulation (PRP) which is a laser treatment for diabetic retinopathy was done for both the eyes.
Dr Patil, then referred Mr Shukla to a physician for diabetes treatment, and advised him to avoid strenuous activities and follow-up again after 2 weeks for his diabetic retinopathy.
Take Home Message:
It is quite common to have Diabetic Eye Disease and not have any symptoms at all. A regular eye examination with an eye doctor is a must, even if you do not have any complaints. Eye examinations can give a glimpse into diseases affecting your body too!
*Not his real name