This has to be a matter of personal choice. I first had photocoagulation in the winter of 1978, when it was almost unheard of. The lasers were far more damaging than now, and even as I type this, I am aware of scarring. But, I am able to see and drive 39 years later, without any form of visual aids. Even though I had a pancreas transplant 52 months ago, thus stopping further damage from Type 1 diabetes over a period of 54 years, I choose to attend the East of England Retinal Screening Service. Not only is it possible for my eyes to deteriorate due to damage in the past (I last had photocoagulation in 1983), but also the DVLA would never renew my licence without the evidence. The biggest cause of blindness in diabetes is retinopathy, essentially because the capillaries that feed the eyes are at an extreme terminus of an already challenged circulation. To compensate, they proliferate and begin boring through the retinas. This excerpt, from Fifty Years of Malfunction, is a graphic description of my first experience:
It was at this time that King’s College Hospital noticed the first signs of retinopathy, a word I had not yet encountered. I was well aware that many elderly diabetics were blind and I was reminded of this every time we drove past the iconic 1930s St Dunstan’s Home in Ovingdean, a little East of Brighton. Their Website has a section on diabetes. With this in mind it is remarkable that I am writing these words some thirty years later (now thirty-six). One evening, in my first year at King’s, I was sitting at my desk, amazingly doing some work, when I was suddenly unable to see out of my right eye. It was as if a bottle of drawing ink had been poured into the eyeball. Various ideas flooded into my imagination, almost as rapidly as the real substance into my sight. Blind panic took control. I ran down Champion Hill and across Denmark Hill, straight into the Hospital, I would guess in under sixty seconds. Arriving at Accident and Emergency, I was greeted by the ubiquitous unsympathetic gaze of a receptionist:
“What’s your problem?”
“I can’t see out of my right eye.”
“Who sent you here?”
“I did.”
“Did you contact your GP?”
“Listen, I’m an outpatient here and I’m diabetic” (magic words).
“Oh, I see, do you know your Hospital Number by any chance?”
“Yes, A153034.”
“Fantastic. Ah, Mr Vicat. I see from your notes that retinopathy has been noted. I’ll get someone to attend to you.”
A doctor duly appeared and informed me that I had had a haemorrhage and that nothing could be done until it had cleared enough to see what damage had occurred. I was put under the care of Mr E.W.G. Davies, a short, wire-rimmed-bepectacled man with whispy grey hair, twinkly beaming eyes and an everlasting supply of Fox’s Glacier Mints stuffed into his white coat. I found this ironic, seeing that the majority of his patients were diabetic! During one of his consultations in my second year he asked me about my life. I told him that I was living in Kensal Rise; that I cycled into King’s College in the Strand every day; that I played squash; and that I drank moderately (I’m sure he didn’t fall for this). His response was that I should stop burn-ups on the Edgeware Road, that I should avoid squash, moderate my alcohol intake, and that I should shun aerobic exercise or anything that would make me red in the face. If I did not heed his words, I would be blind by the time I reached twenty-three.
I have had my eyes screened every year since.
Of course diabetics can suffer all kinds of eye problems, but several of my acquaintances who have varying degrees of macular degeneration do not have diabetes of any description.
Please do not dismantle the Eye Screening Service!
