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Diabetic Eye Screening in Singapore

Diabetes is a common disease that may result in complications in the eyes. One of the most common diabetic eye diseases is diabetic retinopathy. This is because changes occur mainly in the retina, the light-sensitive layer at the back of the eye responsible for vision. When you are experiencing signs of diabetic retinopathy, it’s essential that you undergo a diabetic eye check-up. That way, the specialist in Singapore can provide you with solutions on how to manage your condition and avoid severe vision issues.

What is Diabetic Retinopathy?

Diabetic retinopathy happens as a result of prolonged elevated sugar levels in the blood, the delicate blood vessels in the retina become fragile and start to leak fluid and proteins into the retinal tissue. This causes swelling of the retina (see Fig 1), especially in the centre area (macula) where vision is most detailed, resulting in blurred vision. Other changes in the retinal blood vessels lead to the narrowing and closure of some of the smaller blood vessels, causing insufficient blood supply and resulting in parts of the retina being starved of oxygen and nutrition. When they lack oxygen, these areas of the retina can be detected by the eye surgeon during routine eye screening tests (see Fig 2), but will not be noticed by the patient until it is too late.

This is why when you have diabetes, you must undergo regular diabetic retinal screenings in Singapore to detect earlier signs of diabetic retinopathy, even when there are no changes in vision yet. Additionally, diabetics are also more highly susceptible to cataracts and glaucoma. These can then be addressed at an earlier stage.

Types of Diabetic Retinopathy

There are two main stages of diabetic retinopathy:

Non-Proliferative Diabetic Retinopathy (NPDR)

Non-proliferative diabetic retinopathy (NPDR) marks the initial phase of diabetic ocular disease. It occurs when minuscule blood vessels experience leakage, resulting in the swelling of the retina. In cases where the swelling affects the macula, it is termed macular oedema. This condition predominantly contributes to vision loss in diabetic patients. When left unchecked and more blood vessels become blocked, this can progress from mild to severe.

Proliferative Diabetic Retinopathy (PDR)

Proliferative diabetic retinopathy (PDR) is the more serious stage of diabetic retinopathy. It arises when the damaged blood cells close off, resulting in the growth of novel blood vessels in the retina. These new blood vessels are fragile and can leak into the clear, jellylike substance that fills the centre of your eye. Over time, the scar tissue from the growth of new blood vessels can cause the retina to detach from the back of your eye. Should the new blood vessels disrupt the normal flow of liquid out of your eye, this can add pressure to the eyeball. This added pressure can damage the optic nerve, causing glaucoma. When experiencing symptoms of glaucoma, consult a glaucoma specialist in Singapore.

Symptoms of Diabetic Retinopathy

Signs that diabetes may be affecting your eyes include having blurry or wavy vision, dark areas or loss of vision, poor colour vision, flashes of light, and spots or dark strings. When this happens, make sure to get your eyes checked by undergoing regular diabetic eye screening.

Causes of Diabetic Retinopathy

Excessive sugar in the bloodstream can potentially cause the obstruction of minute blood vessels that are responsible for providing nutrients to the retina. This leads the eye to attempt to generate new blood vessels, but these new blood vessels are unable to develop properly and leak easily. As a result, it progresses into diabetic retinopathy.

Other risk factors of diabetic retinopathy include:

  • High blood pressure
  • High cholesterol
  • Pregnancy
  • Tobacco use

As such, regular diabetic eye screenings and check ups in Singapore are not enough to prevent diabetic retinopathy. It’s also essential to maintain a healthy lifestyle to avoid developing the condition or promote its progression.

Diabetic Eye Screening

The diabetic eye screening process is a non-invasive and relatively quick procedure that is essential for individuals with diabetes, particularly those who have had the condition for an extended period. The examination primarily focuses on assessing the health of the retina—the light-sensitive tissue located at the back of the eye. By closely examining the retina, the professional diabetic screener can identify any anomalies or abnormalities, such as the presence of microaneurysms, haemorrhages, or the formation of new blood vessels.

Early detection through regular diabetic eye screening tests enables healthcare providers to intervene promptly and effectively. Maintaining regular appointments for screening ensures that any changes in the eyes are identified at the earliest possible stage. That way, your eye specialist can adjust your treatment plan accordingly.

Treatment for Diabetic Retinopathy in Singapore

If your diabetic retinopathy test indicates that your disease has progressed to a later stage, then you will be given treatment, and our eye specialist will inform you. Treatment usually involves the laser and is mainly of 2 types: Central (macular) laser and Peripheral laser (what surgeons call PRP or pan-retinal photocoagulation).

Central Laser

Central laser is for vessel leakage around the area of detailed vision (macula) and is designed to reduce the amount of fluid leakage, thus, leading to improvement in the retinal swelling. This will require a few sessions on separate appointments to complete.

Peripheral Laser

Peripheral laser is designed to reduce the amount of retinal tissue that is not receiving adequate oxygen. It does this by reducing the oxygen usage of parts of the peripheral retina that are less important for vision. Similar to a macular laser, this will also take numerous sessions to complete.

Pattern Scanning Laser

Our eye care clinic has access to and uses a pattern scanning laser from OptiMedica, which completes the treatment in much less time and with NO PAIN, compared to conventional Argon or standard treatment lasers. If you have been treated with a conventional laser for diabetic eye disease before, this is a completely different experience.

Pre Diabetic Retinopathy Surgery Preparation

Before undergoing diabetic retinopathy surgery, thorough preparation is necessary. This phase typically involves comprehensive eye check-ups to assess the severity of the retinopathy and determine a suitable surgical approach. Patients may need to provide their medical history, undergo diagnostic tests, and follow specific guidelines to prepare for the surgery. These preparations help the medical team tailor the surgery to the patient’s individual needs and health condition.

Post Diabetic Retinopathy Surgery Guidelines and Recovery

After diabetic retinopathy surgery, adhering to post-operative guidelines is crucial. Patients may receive instructions regarding medication usage, eye care practices, and activity restrictions during the healing process. Regular follow-up check-ups allow the medical team to monitor progress, address concerns, and make any necessary adjustments to the recovery plan.

Possible Risks and Side Effects of Diabetic Eye Surgery

Like any medical procedure, diabetic eye surgery carries potential risks and side effects. Stay informed of these potential complications and have open discussions with your eye specialist during check-ups to understand the likelihood and management of such risks. However, during the procedure, they will take great measures to mitigate risks and ensure patient safety throughout the surgical process.

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About Dr Christopher Khng

Dr. Christopher Khng specialises in Complex Cataract and Anterior Segment Reconstruction Surgery, in particular, Iris Reconstruction and Surgery for Aniridia. His other areas of expertise include Complex Lens surgery, New Lens and Phacoemulsification technologies, Refractive surgery, Phakic IOLs (the Implantable Collamer Lens, ICL), and small-incision, topical anaesthesia phacoemulsification cataract surgery.

He completed his first two years of medical undergraduate studies at Aberdeen University, Scotland (UK). Because of cost, he completed his medical degree of MBBS at the National University of Singapore (NUS).

Dr. Khng served as Registrar, then Associate Consultant Ophthalmic Surgeon at the Singapore National Eye Centre (SNEC). Following his stint in SNEC, Dr. Khng was a Consultant at The Eye Institute, Tan Tock Seng Hospital, Singapore.

Over the years, he has worked with numerous diabetes patients during his years of practice, providing them the care they need to manage and prevent diabetic retinopathy. He has also volunteered at Community Centres to perform eye screening services, including diabetic eye screenings.

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Dr Christopher Khng

MBBS, M.Med(Ophth), FRCS(Edin), AMS(Ophth 2003) Consultant Ophthalmologist

Frequently Asked Questions About Diabetic Retinopathy

It’s recommended that people with diabetes regularly see an eye doctor, so they can assess if they’re at risk of diabetic retinopathy. That way, they can take proactive measures to prevent its progression and affect their vision.

Diabetic eye screenings and general eye screenings are similar in a lot of ways, but the big difference is that diabetic eye check-ups focus more on the condition of your retina and how the blood vessels are in your eyes. Our diabetic eye screener will use fluorescein angiography to identify if you have any damaged blood cells in your eyes, as well as check your pupil dilation.

If left untreated, diabetic retinopathy can advance to more severe stages due to prolonged damage to blood vessels in the retina. Elevated blood sugar levels can cause blood vessels to leak, leading to swelling and impairing vision. As the disease progresses, abnormal blood vessel growth occurs, potentially causing retinal detachment or glaucoma. Without intervention, these complications can impact vision and even lead to blindness.

Diabetics face a higher risk of cataracts and glaucoma due to metabolic changes and prolonged exposure to high blood sugar levels. Cataracts, clouding the eye’s lens, occur earlier in diabetics. High blood sugar can lead to structural changes in the lens of the eyes over time and promote the development of cataracts. Glaucoma is characterised by optic nerve damage, which can develop due to altered blood flow and increased eye pressure from diabetic retinopathy.

Central (macular) laser treatment targets the central part of the retina (macula) to reduce swelling and leakage from abnormal blood vessels. This approach aims to preserve central vision critical for reading and recognising faces. Peripheral laser treatment, on the other hand, is focused on the outer areas of the retina to slow down the progression of abnormal vessel growth. The distinction lies in the specific areas of the retina targeted, reflecting different goals in managing diabetic retinopathy.

Individuals with diabetes should undergo diabetic eye screening tests at least once a year. However, the frequency might increase if signs of retinopathy or other eye issues are detected. Regular screenings enable early detection and intervention, significantly reducing the risk of severe vision problems. Timely adjustments to treatment plans can be made based on the progression of the disease and individual risk factors.

Lifestyle changes that can lower the risk of diabetic retinopathy include maintaining stable blood sugar levels through proper diabetes management. This involves following a balanced diet, engaging in regular physical activity, managing weight, and taking prescribed medications. Avoiding smoking and controlling blood pressure is also crucial. Consistent eye care, including regular check-ups, aids in timely detection and treatment.

While complete prevention may not be guaranteed, the risk and impact of diabetic retinopathy can be reduced through proactive measures. Optimal diabetes management is key, along with regular eye screenings and prompt treatment when necessary. Monitoring blood sugar levels, blood pressure, and cholesterol contributes to overall eye health and reduces the risk and severity of diabetic retinopathy.