Diabetic retinopathy is a complication of diabetes that can lead to complete blindness. So if your doctor has diagnosed you with diabetes, keep your sugar in check and regularly check your eyesight, because diabetics are more likely than he althy people to suffer from other eye diseases, such as glaucoma and cataracts. What are the causes and symptoms of diabetic retinopathy? What is diagnosis and treatment?

Diabetic retinopathyis the most common complication of diabetes - after 20 years of struggling with this disease, retinopathy occurs in all patients with type 1 diabetes and in 60% of patients. People suffering from type 2 diabetes. 86 percent of people with type 1 diabetes and 33 percent of people with type 2 lose their eyesight. Unfortunately, the bad news doesn't end there. In diabetic patients, cataracts appear on average 10 years earlier than in he althy people.

The World He alth Organization (WHO) estimates that 4 percent of the population, or approximately 135 million people, suffer from diabetes. By the end of 2025, there will be 300 million patients, of which 100 million will have diabetic retinopathy. For comparison - kidney problems will occur in 44 million. Diabetes is still the leading cause of blindness.

Diabetic retinopathy - causes

Diabetic retinopathy is caused by microangiopathy, which is damage to the small blood vessels of the retina, which damages the retina itself. What is the mechanism of this disease? As a result of the increased level of sugar, the cells (pericytes) responsible for maintaining the proper shape of the vessel die. Under the influence of glucose, its wall becomes flaccid and bulges, forming micro aneurysms. Blood leaks through the weakened vessel wall and microcarcinomas occur. In people with diabetes, the blood is thick and more viscous than in he althy people. Vascular damage and increased blood density lead to retinal hypoxia. When it is significant, the body creates new blood vessels. Unfortunately, they are weak and improperly built, causing them to break easily and cause bloodshed to the center of the eye.

Diabetic retinopathy - symptoms

Symptoms that may indicate diabetic retinopathy:

  • gradual deterioration of vision
  • transient visual acuity disturbance
  • night vision impairment
  • sudden painless loss of vision
  • mrożki beforeeyes

- Very often patients with diabetes do not experience vision problems in the initial stage, they are not aware of the progressive diabetic retinopathy. Meanwhile, diabetic changes on the fundus can be found 3 years after the diagnosis of diabetes in 12% of patients. In patients with type I diabetes, retinopathy develops in direct proportion to the course of diabetes. 15 years of its duration are enough for complications in the retina of the eye. However, the situation is different in patients with type II diabetes. Here, diabetic retinopathy develops early, even 7 years before diagnosis. Regardless of the type of diabetes, every patient with this disease should systematically undergo fundus checkups annually, even if they have no vision problems. - says prof. Krystyna Czechowicz-Janicka.

Diabetic retinopathy - diagnosis. 3 degrees of diabetic retinopathy

Currently, ophthalmologists can use the most modern diagnostic and therapeutic methods. In addition to the examination of the fundus and visual acuity, additional specialist examinations illustrating the state of the retina in the course of diabetic retinopathy include optical OCT coherence tomography and fluorescein angiography, which allows for the precise localization of leakage sites of pathologically changed vessels. Depending on the type of lesions, there are 3 degrees of diabetic retinopathy:

  • Non-proliferative straight line- develops when a blood vessel wall loses its elasticity. Then it deforms easily. In some places it stretches excessively and this is where micro aneurysms are formed. This type of retinopathy does not lead to blindness yet, but to vision deterioration as perceived images become increasingly blurry.
  • Pre-proliferative- apart from microtenomas, dead areas of the retina can be seen at the bottom of the eye, because they were not supplied with blood. In both cases, saving visual acuity consists in lasering the retina, i.e. destroying damaged blood vessels with laser light. This allows you to maintain a balance between the eye's need for oxygen and the capacity of the blood vessels.
  • Proliferative- is the most dangerous form of ailment. Large blood vessels close, which stimulates the growth of capillaries that appear above the retina of the eye, and even their growth into the vitreous body. This process is called neoplasm, which is the formation of new blood vessels to supply blood to the hypoxic parts of the eye. The problem is that the new vessels are not properly constructed, they only have one layercells, which promotes bleeding inside the eye, i.e. the vitreous body. Frequent strokes are responsible for the formation of adhesions between the retina and the vitreous. Over time, the vitreous constricts and stretches the retina, causing it to detach.
According to an expertprof. Krystyna Czechowicz-Janicka, ophthalmologist

How do I avoid retinopathy?

Patients with diagnosed diabetic retinopathy, depending on the severity of diabetic changes in the eye, should visit an ophthalmologist more often, at least twice a year, and in the case of advanced retinopathy - every 3 months. Also, pregnant and puerperal women suffering from diabetes should be under the supervision of an ophthalmologist and have their eyesight checked regularly (at least once a month). The earlier we detect changes in the retina of the eye, the greater the chance of their successful treatment.

Diabetic retinopathy - treatment

In advanced proliferative retinopathy, the only salvation is a vitrectomy, which is an operation to remove the vitreous together with the hemorrhage, separate the adhesions between the vitreous and the retina, and then laser lasering the entire retina. If the doctor suspects that bleeding may occur after the operation, the eye is filled with silicone oil, which stops the bleeding inward. Vision depends on the degree of damage to the retina. If the changes in the retina are minor, your vision is very good after the procedure. In case of larger damage, it is limited to recognizing large objects.

Worth knowing

Diabetic retinopathy often occurs in the extremely dangerous form of DME (Diabetic Macular Edema), i.e. diabetic maculopathy, which, if left untreated or diagnosed too late, can lead to permanent loss of vision. This form develops in approximately 14% -25% of patients with type II diabetes and is caused by the presence of fluid in the central part of the retina, i.e. in the macula.

Worth knowing

Glaucoma and cataracts - diseases that can lead to blindness

Many diabetics develop glaucoma. The risk of developing the disease is related to the age and duration of the disease. Glaucoma develops when pressure rises in the eyeball. If it is high, the blood vessels that nourish the retina and the optic nerve close, causing them to die and therefore gradually lose vision. By using medications, the progression of glaucoma can be stopped. Cataract is an extravascular complication of diabetes. The disease is clouding of the lens. Fortunately, it can be remedied by surgically removing the damaged lens and implanting an artificial one in its place. Diabetic eyesthey give out too little tears, making the eyeball constantly irritated. The eyes are sore, they sting, the patient has the impression that something is stuck under the eyelid. All you have to do is supplement the number of tears with moisturizing drops.

Laser therapy - an effective method of treating diabetic vision problems

The only effective tool in the hand of an ophthalmologist is a laser. Laser photocoagulation, as this method is called, should be used at every stage of the disease development. Treatment is carried out through special contact lenses that limit the laser's effect only to a selected part of the eye. Lenses are placed on the cornea after local anesthesia. During the procedure, you need to sit still and not move your head so that the laser light does not damage he althy parts of the eye's retina. Blinding flashes of light, sometimes stinging and sometimes pain are an unpleasant experience for the patient.

Diabetes complications

Complications of diabetes are related, among others, to with the functioning of the circulatory system: can lead to stroke, heart attack and lower limb ischemia. What are the other possible complications of diabetes? This question is answered by prof. dr. hab. n. med. Grzegorz Dzida from the Department of Internal Medicine, Medical University of Lublin.

The article uses the materials of the Eye Institute.

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Diabetes