World Sight Day is on Thursday 12^th October 2023. This year the focus is on the importance of eye care in the workplace. The campaign encourages employers to make eye health initiatives standard practice in the workplace, and to promote eye health habits that will benefit the wellbeing, safety and productivity of millions of employees.

But of course, the first step is for individuals to prioritise their own eye health.

Our vision is one of the most precious gifts we have, it is a part of who we are. However, the importance of our eyes is often underappreciated until we experience a problem. So, what can you do to prevent eye problems?

A window to the world

Your eyes are at work from the moment you wake up to the moment you close them to go to sleep. Your eyes take in an abundance of information about the world around you — shapes, colours, movements, and more. Our vision allows us to be aware of our surroundings and 80% of everything we learn is through our sight. As we get older, changes to our eyes mean our sight becomes more vulnerable.

Risk factors for eye problems

A number of factors can cause eye disease. Other than diabetes, the most common factors are:

• Smoking
• Alcohol
• Ageing
• Excess screen time and in particular near-work such as reading, watching TV or looking at a computer screen
• High blood pressure
• High cholesterol
• Being overweight

Diabetes and eye health

People with diabetes have an increased risk of developing eye problems relating to high blood glucose levels.

For people living with diabetes vision loss is a major complication, so it is even more important to stay on top of eye health.

Short-term eye problems to be on the look out for

Short term eye problems can include:

• Blurred vision
• Infections
• Conjunctivitis (inflammation and redness of the lining of the whites of the eyes and the membranes surrounding the inner eyelids)
• Uveitis (inflammation of the middle portion of the eye, the uvea)
• Stye (a painful eye infection along the lash line due to blocked oil glands on the eyelid)

Long-term eye problems to watch out for

The risk of serious, more permanent eye problems increases when you have high blood glucose levels over a long period of time, or if your blood pressure or cholesterol levels are high. Long-term eye problems include:

• Cataracts, which can happen when protein from the lens clumps together and makes the lens cloudy, this can reduce vision. Although sun damage and ageing are the main risk factors, people with diabetes tend to develop cataracts faster and at a younger age than others. Without treatment cataracts will continue to develop until eventually vision loss is complete. Cataract surgery is often required if the cataracts affect your vision significantly.
• Glaucoma occurs when there is damage to the optic nerve, causing a build-up of pressure inside the eye. It can affect anyone, but again, it’s more common in people with diabetes. There are no warning signs of glaucoma, as it does not produce symptoms in the early stages. Early identification of glaucoma is important, as by the time you notice any vision changes, treatment may stop but cannot reverse any existing vision loss. Glaucoma is usually treated with prescription eye drops, though occasionally, laser and surgical procedures may be needed.
• Diabetic retinopathy can be the result of high blood glucose levels which, over time, can damage the small blood vessels in the retina of the eye, causing them to leak fluid. New blood vessels will grow to replace the damaged ones, but these new vessels are weak and rupture easily can cause a haemorrhage (bleed). New blood vessels can also leak protein or fluid into the macula and this can lead to macular oedema. In the early stages, there may be no symptoms or changes to your vision, but an eye check can identify the onset of problems. Diabetic retinopathy has five stages ranging from (1) no retinopathy to (2) mild, then (3) moderate to (4) severe non-proliferative diabetic retinopathy up to (5) proliferative retinopathy.
• Diabetic macular oedema is an additional and important complication of diabetes that can be found with any stage of diabetic retinopathy and that can run an independent course. When the macula is affected, you can lose your central vision.
• Retinal detachment can develop when the retina separates from the tissue that it is normally attached to, like wallpaper peeling off a damp wall. It can occur at any age, but it most commonly occurs in Caucasian males over the age of 40. Please be assured that retinal detachment is quite rare, occurring in just 1 in 10,000 people each year. If your retina is detached, you can lose some or all your vision permanently, if not treated urgently. Hence it is a medical emergency, that needs to be assessed as soon as possible, so that your ophthalmologist can start the treatment you may need to preserve any vision.

Eye health checks

You can greatly reduce your risk of serious vision loss from diabetes through regular eye examinations and timely treatment. The sooner eye problems are detected and treated, the better the result.

It is recommended that you have your eyes checked at least every two years – by an optometrist or an eye specialist (ophthalmologist). Have your eyes checked more often if your eye care professional advises, especially if you already have eye problems or if you are planning a pregnancy. Discuss any changes in your vision that develop in between your routine eye checks with your optometrist, eye specialist or your GP.

Your eyes can be checked by an optometrist without the need for a medical referral. Medicare provides a full rebate on most optometry appointments, but does not reimburse you if glasses are needed.  Most private health funds will at least partially reimburse you for your prescription glasses, depending on your level of cover.

A referral from a general practitioner, optometrist or other medical specialist is required to obtain the Medicare rebate for an ophthalmology consultation. Appointments are prioritised according to medical need.

KeepSight

KeepSight is a program developed by Diabetes Australia to make it easier for people with diabetes to get their eyes checked. KeepSight provides electronic alerts and reminders to help you remember your diabetes eye checks. When it’s time for a diabetes eye check you get a reminder. It’s that simple. KeepSight can also help you find an optometrist if you don’t know one.

Take an active role

There are a number of things you can actively do to reduce your risk of developing eye problems and these include:

• Aim for blood glucose levels and blood pressure as close to your target ranges as possible and aiming to avoid large glucose excursions (jumps from low to really high and vice versa)
• Keep your cholesterol level within the recommended range. Regular appointments with your health professionals can help you with this.
• Don’t smoke. If you do smoke, try and quit. If you feel you can’t give up smoking on your own, ask for help – talk to your doctor or call the Quitline on 13 78 48.
• See your optometrist or ophthalmologist for an eye check as soon as you notice any changes in your vision, though better still, see them annually.
• Speak to a psychologist or social worker if the health of your eyes is causing you to feel worried or anxious.

In summary

In Australia 90% of blindness and vision loss is preventable or treatable; however, this rises to 94% for Aboriginal and Torres Strait Islander people. It is estimated that in Australia over 500,000 people are affected by blindness or vision loss and that 80% of blindness and vision impairment is caused by five common eye conditions (listed alphabetically):

• age-related macular degeneration (AMD)
• cataracts
• diabetic retinopathy
• glaucoma
• uncorrected or under-corrected refractive error.

In most cases, the earlier eye problems are treated, the better the result. Your eye specialist can advise what treatments are available. But as always, prevention is better than trying to cure.

By Credentialled Diabetes Educator, Carolien Koreneff