What is Diabetic Retinopathy?
People who have diabetes are at risk of developing diabetic retinopathy. Elevated blood glucose levels cause damage throughout the entire body, including the small blood vessels in the eyes, producing microangiopathy. This vascular damage leads over time to gradual vision loss, through fluid and blood accumulation in the retina, vitreous hemorrhages, retinal detachment, etc.
How Does Diabetes Develop?
There are three types of diabetes:
Type 1 DM – usually present in children and young adults, in which the body does not produce insulin (the hormone that facilitates glucose entry into cells);
Type 2 DM – the most common form of diabetes in which either the body does not produce enough insulin, or the cells "ignore" insulin (don't recognize it); in this situation, glucose remains in the blood, unutilized (hyperglycemia occurs);
Gestational Diabetes – blood glucose levels increase during pregnancy, even if the mother did not have diabetes before pregnancy.
Over time, diabetes can affect the kidneys, eyes, and blood vessels. It has been found that 80% of those with Type 1 DM develop diabetic retinopathy in approximately 15 years, and that 84% of those with Type 2 DM develop diabetic retinopathy in approximately 19 years.
What are the Risk Factors for Diabetes?
Important associations have been found between the appearance of DM and the following situations:
- elevated blood glucose level (glycosylated Hb A1 level), maintaining blood glucose at a normal constant level is the "key" factor in delaying the onset of diabetic retinopathy;
- heredity;
- arterial hypertension;
- pregnancy;
- obesity;
- hypercholesterolemia;
- sedentary lifestyle.
How Does Diabetic Retinopathy Manifest?
Diabetic retinopathy can be: non-proliferative and proliferative.
Non-proliferative diabetic retinopathy – is the first stage of diabetic retinopathy. In this stage, damage to the blood vessels in the eye leads to the accumulation of fluid and small amounts of blood in the retina. Most often, deposits of cholesterol or other types of blood fats can accumulate in the retina. Non-proliferative diabetic retinopathy can produce the following retinal changes: microaneurysms, retinal hemorrhages, hard exudates, macular edema.
Proliferative diabetic retinopathy – is accompanied by the appearance of new, abnormal vessels and fibrous tissue. In advanced stages, the following may occur: vitreous hemorrhages (through rupture of fragile neovessels), neovascular glaucoma (through growth of neovessels in the chamber angle), tractional retinal detachment (through traction exerted by fibrous tissue forming between vessels and retina).
How is Vision Affected?
Symptoms can be varied: from a slight progressive decrease in visual acuity, accompanied by altered perception of object shapes, colors, visual field changes, to sudden vision loss (in case of retinal detachment or vitreous hemorrhage).
Is Diabetic Retinopathy Difficult to Diagnose?
For any patient with diabetes mellitus, it is important to have a complete examination, including fundus examination with pupil dilation every 6 months, following which the ophthalmologist determines the disease stage and develops a treatment plan. Very useful in confirming the diagnosis and precisely determining the stage of retinopathy are a series of detailed investigations such as: fluorescein angiography and optical coherence retinal tomography, ocular ultrasound.
What Does Retinopathy Treatment Consist Of?
Treatment is specific depending on the stage. Apart from specific therapy (oral antidiabetic medications or insulin), vascular trophic medications may be administered (to improve microangiopathy), retinal laser applications are performed, intravitreal injections with substances that inhibit neovascularization, vitreo-retinal surgery.
What is the Disease Progression?
Diabetic retinopathy usually affects both eyes. Patients with retinopathy often do not notice changes in visual acuity in the early stages of the disease, but as the retinopathy progresses, it can cause irreversible vision loss. It is important to know that the most important role in disease progression is blood glucose control; other specific ocular treatment methods serve to try to slow, stop, or regress retinopathy.
