Glaucoma, Cataracts and Diabetic Retinopathy (DR) are three forms of diabetic eye conditions that could potentially manifest in diabetic patients. Diabetes is a worldwide epidemic; Singapore has the second-highest proportion of diabetics among developed nations. About 440,000 Singapore residents who were 18 years and above had diabetes in 2014 and the number is estimated to grow to 1,000,000 in 2050. So how does diabetes eventually lead to blindness? How do the two connect?
Diabetic Retinopathy Signs & Symptoms
You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, diabetic retinopathy symptoms may include:
- Spots or dark strings floating in your vision (floaters)
- Blurred vision
- Fluctuating vision
- Impaired color vision
- Dark or empty areas in your vision
- Vision loss
- Diabetic retinopathy usually affects both eyes.
Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don’t develop properly and can leak easily.
There are two types of diabetic retinopathy:
Early diabetic retinopathy. In this more common form — called nonproliferative diabetic retinopathy (NPDR) — new blood vessels aren’t growing (proliferating).
When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges (microaneurysms) protrude from the vessel walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter, as well. NPDR can progress from mild to severe, as more blood vessels become blocked.
Advanced diabetic retinopathy. Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina, and can leak into the clear, jelly-like substance that fills the center of your eye (vitreous).
Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure may build up in the eyeball. This can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma.
Diabetic retinopathy involves the abnormal growth of blood vessels in the retina. Complications can lead to serious vision problems:
Vitreous hemorrhage. The new blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision.
Retinal detachment. The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in your vision, flashes of light or severe vision loss.
Glaucoma. New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up (glaucoma). This pressure can damage the nerve that carries images from your eye to your brain (optic nerve).
Cataract. Several clinical studies have reported that cataract formation occurs more frequently and at an earlier age in diabetic patients than in nondiabetic patients. Some studies indicate that cataracts are three to four times more prevalent in patients with diabetes under the age of 65. In patients over 65, cataracts are twice as prevalent. The main risk factors are longer duration of diabetes and poor metabolic control.
Blindness. Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.
Introducing EyRIS SELENA+
Although these eye conditions are irreversible, they are not impossible to control.
To build a bridge between academia and the industry, a team comprising of the Singapore National Eye Centre, Singapore Eye Research Institute and NUS Computing, has brought forth a new AI technology, the EyRIS SELENA+. This tool enhances the current progress rate at which the time taken for diagnosis and detections of these diseases could be countered. The EyRIS SELENA+ can produce results and analysis of an eye scan to be produced in seconds.
Improving Efficiency with EyRIS SELENA+
So how was it done differently in the past and now that the technology is introduced? In the past, such analysis is done by trained readers in the SNEC Ocular Reading Centre (SORC) and at another centre in Tan Tock Seng Hospital.
The work is tedious, tiring and time-consuming.
The centre receives more than 4,000 images a day – all of which need to be processed by 8 to 10 staff who grade eye conditions. These graders sit in a darkened room staring at retinal images on a screen, which they need to scan for abnormalities. They are typically not allowed to work for more than half a day as the job is too strenuous. The images currently go through up to three levels of checks. If the primary and secondary graders disagree in their analysis of an image, it will be sent to an ophthalmologist.
SELENA+ is set to replace the role of the primary graders. The system will address the need for increased manpower to tackle diabetes, the world’s fastest-growing chronic disease. Preliminary tests have shown SELENA+ can cut the time that it takes for a report to return to a patient with “normal” results to just 10 seconds, down from one hour.
Memorandum of Understanding Ceremony between Singapore Optometric Association and EyRIS Private Limited
Founder of Eyesight.SG, Ken Tong signs the Memorandum of Understanding between Singapore Optometric Association and EyRIS Private Limited (Photo: Singapore Optometric Association)
With the recently signed memorandum between Singapore Optometric Association and EyRIS Private Limited, the EyRIS SELENA+ has been widely utilised in at least 21 of our homegrown optometric practices, with the objective of bringing a more efficient eyecare to our community, much more accessible to the neighborhoods. We are proud to announce that Eyesight.sg is one of such honoured practises to have carried EyRIS SELENA+ with us.
The Future of Diabetic Retinopathy
Many lose their vision to preventable eye conditions, but this is avoidable through early detection and early treatment. This is our story, our purpose and our why to who we are.
At Eyesight.sg, our vision is dedicated to improve lives with primary eye care to help you eradicate preventable eye diseases and let you have control over your health and vision because your health is our top priority.
We hope that with EyRIS SELENA+, we could close the gap between the community and our optometrists and counter this preventable blindness together.
WhatsApp Eyesight.Sg at 9824 1607 to book an appointment with us today.