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Dr Dheeraj Kewlani

Dr Dheeraj Kewlani, Specialist Ophthalmology, Aster Clinic, Bur Dubai (AJMC)

What is the connection between diabetes mellitus and diabetic retinopathy?

Diabetes Mellitus is a disease, which cannot be ignored by anyone in today’s world. It affects people of all age groups, all races and is prevalent in the whole world. Let me explain what actually diabetes is. We all need glucose as energy currency in our body. Every single cell, tissue and organ of our body needs glucose and it is produced in our body with whatever food we eat or drink.

Now once glucose is generated, we need the insulin hormone to allow glucose molecule to enter the cells for utilisation, just like you need a key to unlock and enter your apartment. In diabetes the generation of insulin hormone is either less than required or totally absent. So the person may have ample glucose in blood but it cannot enter the cells for consumption. Here we should understand that if glucose is not utilised then there are two outcomes. (I) The body cells become starved as they don’t get glucose. (II) Blood glucose rises much more than normal (80-120mg) as it is not utilised.

We cannot stop eating food and the glucose levels keep on rising and we need tablets and injection insulin to control it. There are two main types of diabetes Type I, if occurs before age of 30 years and Type II, if occurs after age of 30. Once diabetes occurs, different organs of our body are affected including eyes, kidneys, heart and muscles. Diabetic retinopathy is when eyes are affected due to diabetes. It is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy might cause no symptoms or only mild vision problems. But it can lead to blindness.

Therefore it is very important for a diabetic to have a check-up with an ophthalmologist once he is diagnosed with diabetes. The ophthalmologist will examine the eyes and see if there is any problem related to diabetic retinopathy. The person may be diabetic but unaware of it (iceberg phenomenon) and he may have diabetic retinopathy as well without his knowledge as Type II diabetes starts well before the person’s knowledge and it may have been there for years even if it is discovered recently.

Dr K Janardhan

Dr K Janardhan, Specialist Ophthalmology, Aster Clinic, Al Karama (UMC)

What is lazy eye in children and how can one treat it?

Lazy eye also called amblyopia is reduced vision caused by abnormal visual development early in life. The symptoms include an eye

that wanders inward or outward, eyes that appear to not work together, squinting or shutting an eye, head tilting and abnormal results in a vision test.

It is advisable to consult an eye doctor if you notice the eye wandering after the first few weeks of life. A vision check is especially important if there’s a family history of crossed eyes, childhood cataracts or other eye conditions. Many a time, lazy eye is not evident without an eye exam.

Early diagnosis and treatment prevent long-term problems with the child’s vision. The eye with poorer vision can usually be corrected with glasses or contact lenses, and patching therapy.

For all children, a complete eye exam is recommended between ages three and five.

What are the common eye problems in children?

The common eye problems in kids include refractive errors, strabismus and digital eye strain.

Refractive errors: It includes myopia (near sightedness) hyperopia (far sightedness) and astigmatism. They are caused by variations in the eyeball length and curvature. Common symptoms include blurred vision, headache, squinting and eye strain. Refractive errors are detected by a comprehensive eye examination and effectively treated by spectacles.

Strabismus (squint): Squint is a misalignment of the eyes. If it’s not detected and corrected early on, it can lead to amblyopia or lazy eye. Presence of crossed eyes, uncoordinated eye movements and vision defects are the main features of strabismus.

A comprehensive eye exam is required and strabismus is often remedied with an eye patch over the eye that is properly aligned, which forces the misaligned eye to work in addition to prescribing correction glasses. Surgery or special glasses may also play a part in the treatment of squint.

What are the symptoms of digital eye strain?

Digital eye strain, is a condition that is caused by visual stress from extended screen time. Children are spending a good portion of their day on “screen time”, staring at the LED screens of computers, tablets, smart phones and other digital devices. This can lead to development and progression of myopia.

The symptoms include dry itchy eyes, fluctuations in vision, tired eyes , eye pain and headache. A detailed eye examination helps to identify any underlying refractive errors and other eye problems in children. When using digital devices, it is useful to follow the “20-20-20” rule: Every 20 minutes, take your eyes off your screen and look at something that’s at least 20 feet away for at least 20 seconds

Observing frequent visual breaks following the 20-20-20 rule, reducing non-essential screen time, maintaining adequate room lighting, proper screen position and healthy posture, regular eye check-ups and wearing corrective and protective glasses helps to control digital eye strain in the child.

Dr Benazir Ansari

Dr Benazir Ansari, Specialist Ophthalmology, Aster Clinic, Discovery Gardens

What do you think are the most important nutrients for eyes?

Research suggests that dietary antioxidants and anti-inflammatories may provide benefits to reduce risk of age-related eye disease.

Nutrients important for vision health include vitamins and minerals with antioxidant functions like vitamins C and E, lutein, zeaxanthin, β-carotene and zinc. Also important are compounds with anti-inflammatory properties like omega-3 fatty acids (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA]).

Good sources of vitamin C are orange, papaya, lemons, grapefruit, green peppers, broccoli, brussel sprouts, cauliflower and strawberries. Foods rich in vitamin E include sunflower seeds, almonds, peanuts, safflower oil, corn oil and soybean oil. β-Carotene is an orange pigment commonly found in fruits and vegetables. Good sources are sweet potato, pumpkin, carrots, spinach, kale and red peppers. Food rich in zinc are oysters, crabs, turkey, chicken, cashews, chickpea and yogurt.

Lutein and zeaxanthin are carotenoids found in high quantities in green leafy vegetables like kale, spinach, lettuce, broccoli, corn, peas and brussel sprouts. Fish and fish oils are the primary source of omega-3 fatty acids.

Hence awareness and patient education on the role and dietary sources of key nutrients is important for ocular health for both the patient and health-care provider.

How important is a regular eye exam in childen and adults to prevent eye problems and vision loss?

Normal vision and eye health is essential for development of a child and personal and economic productivity in adults. The economic burden of vision loss is significant. Comprehensive eye examinations prevent vision loss by screening for asymptomatic eye disease and modifying treatment of pre-existing disease.

Children should have at least one examination between the ages of three and five. This can check the vision and refractive errors (myopia/hypermetropia or astigmatism). It also detects lazy eye or amblyopia and its early management. Screening in children goes beyond vision to identify nasolacrimal duct obstructions, childhood allergies, ocular inflammation, squint, glaucoma and retinal diseases.

In adults with history of hypertension and diabetes mellitus routine screening plays a pivotal role as early retinopathy is usually asymptomatic. Glaucoma is another blinding disease where early detection and treatment goes a long way. Age-related cataract and age-related macular degeneration (ARMD) when detected early leads to good management outcomes.

Regular eye check-up is pivotal at any age. Routine eye exams should be done every year, and more frequently if there is a disease or risk factors. Any ocular complaints that were not there before need an ophthalmic consultation.

Dr Saleem Moopen

Dr Saleem Moopen, Specialist Ophthalmology, Aster Clinic, Al Muteena, Deira

How prevalent is dry eye disease and what are its causes?

The prevalence of dry eye disease (DED) in people in the UAE is estimated to be above 60 per cent. Various factors such as high screen time, use of contact lenses, eye surgeries and the weather make UAE residents more prone to mild to moderate dry eyes. Increase in online school time during the pandemic period has increased dry eye symptoms among children.

What are the common symptoms of dry eye disease?

Symptoms of dry eye disease are multiple, ranging from very minimal to severe symptoms, which affect the daily life of patients. One of the most common symptoms we encounter in the OPD is stinging or burning sensation of the eyes.

Other common symptoms include teary eyes, sandy sensation, discharge from eyes, episodes of blurry vision, heavy or tiredness of eyes, more severe symptoms such as redness and pain, photophobia associated with reduced tolerance for mobile, computer screens and contact lens use.

When would you recommend a patient come to the clinic for check-up?

Check-up and preventive measures early when the symptoms are minimal is always better and produce better results. In the early stages, the patient can make lifestyle modifications and use simple lubricant drops to get better results. Children should be examined for other associated factors like refractive errors, which make the dry eye symptoms and eye fatigue worse.

Dr Soni Soman

Dr Soni Soman, Specialist Ophthalmology, Aster Clinic, Bur Dubai (AJMC)

What are the factors that contribute to vision problems? And how can we correct them?

Eye health determines the quality of life of an individual, having its implications for their educational and employment opportunities.

* The factors that contribute to vision problems can be divided into avoidable/external and non-avoidable factors/internal (comorbidities) factors. The factors that we can avoid are uncontrolled screen time, inadequate intake of nutrients, uncorrected refractive errors leading to lazy eye/amblyopia, substance abuse (tobacco use, alcohol), unhygienic use of contact lens, over exposure to UV light, not using protective glasses at work place (construction site, while using chemicals).

These etiologies that can be corrected by controlling the screen time, taking balanced food, avoiding substance abuse, taking other adequate protective measures. Uncorrected refractive error is easily manageable with spectacles, contact lenses, or refractive surgery. Apart from these, less easily treatable conditions like cataract (age related/congenital), glaucoma, macular degenerations cause vision problems, making these diseases important targets for early detection and prevention.

Therapy for these conditions aim to arrest or slow its deterioration. Uncontrolled comorbidities like diabetes, hypertension, arthritis or immune related disorders can also take a toll on our vision resulting in total blindness.

* On a daily basis getting adequate rest for your eyes by keeping a regular healthy sleep pattern, avoiding unnecessary stress to your eyes and taking a balanced diet keeps your eyes and vision healthy.

It’s also important to avoid self-medication and avoid treatment delays in case of an ocular illness.

Pathological conditions regarding your eye and overall health needs to get checked by an expert, hence visiting your doctor regularly cannot be over emphasised.

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