Diabetic retinopathy – causes, symptoms, treatment, prevention

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Diabetic retinopathy is a complication of diabetes that damages the blood vessels in the retina of the eye. Most people with diabetes are affected. Risk factors include pregnancy and cataracts.

Definition of diabetic retinopathy

Diabetic retinopathy is a very common complication of diabetes, it damages the blood vessels in the eye’s retina. This disease occurs in patients with type 1 diabetes and approximately 60% of type 2 diabetics. Patients with diabetes develop cataracts much earlier than in healthy subjects. The WHO estimates that 4% of the population is affected by diabetes.

Diabetic retinopathy – causes

The cause of diabetic retinopathy is diabetes. High blood glucose and high blood pressure can increase blood flow. As a result of these processes, the eyeball membrane thickens. This results in blockage of fluid flow to and from the retina. Damaged cells in the retina begin to secrete special chemicals that cause new blood vessels to form. They are more likely to break and bleed. This causes the already described visual disturbances. In the course of diabetes mellitus, blood vessels are damaged, which may cause haemorrhage. There may also be new blood vessels forming on the surface of the retina and bleeding frequently.

There are three types of diabetic retinopathy:

1. non-proliferative retinopathy – associated with the fewest complications, does not greatly affect vision; however, it must be carefully monitored as it can develop into a proliferative retinopathy over time;
2. preproliferative retinopathy – retinal swelling and bleeding appear; consequently, there are visual disturbances;
3. proliferative retinopathy – the patient’s vision is blurred; if you experience rapid retinal bleeding, you can even suddenly lose your eyesight!

Diabetic retinopathy – symptoms

Diabetic retinopathy is often asymptomatic – there are no vision problems or pain symptoms. However, it does appear in the field of view dark spot. After some time (weeks or months), the extravasated blood can finally be absorbed and normal vision returns. Diabetic retinopathy is a condition that severely affects your vision and, if ignored, can even cause blindness.

However, it happens that patients complain of:

1. poor vision in the dark;
2. blurred vision;
3. longer time for the eye to adapt to vision in bright rooms;
4. neoplasm of blood vessels on the surface of the retina or iris;
5. swelling of the retina (around the macula at the back of the eye).

Diabetic retinopathy – diagnosis

Patients who see a doctor with symptoms of diabetic retinopathy are referred to an ophthalmologist, who then sends them for further diagnosis. In diagnosing the disease, I use fluorescein angiography, which shows how advanced the disease is. OCT, on the other hand, helps determine whether the patient has macular edema. In addition, of course, a basic ophthalmological examination is performed, which involves checking visual acuity and assessing the anterior and posterior segments in a clinical examination.

Treatment of diabetic retinopathy

For patients with proliferative retinopathy, laser treatment may be a rescue. Due to the “burnout” of the pathological blood vessels, further visual impairment is prevented.

Patients with a mild form of diabetic retinopathy must be monitored frequently. It should be monitored whether diabetes is well treated, whether glycemia and glycosylated hemoglobin are at an appropriate level, and whether other lipid disorders have occurred. Sometimes, retinal photocoagulation or laser therapy (mentioned above) is necessary. Laser therapy is most commonly used for proliferative retinopathy. With regard to diabetic macular edema, laser photocoagulation is less frequently used as there are newer methods of injecting intravitreal anti-VEGF drugs that inhibit vascular endothelial growth factor responsible for the development of edema and proliferative retinopathy.

Laser and injections are not invasive methods. However, uncomplicated proliferative retinopathy requires a very large number of peripheral retinal burns, which leads to a narrowing of the visual field. It is possible that in the future the side effects of such aggressive photocoagulation can be partially reduced using modern lasers working at subliminal parameters.

Complications of diabetic retinopathy

Diabetic retinopathy is itself a complication of diabetes. However, it can lead to other diseases that, in combination with diabetes, turn out to be very difficult to treat. Complications are mainly related to blood vessels growing inside the retina, which can exudate or rupture.

The main complications of diabetic retinopathy include:

1. a vitreous hemorrhage which causes spots to appear in our field of view. It happens that the blood takes up the entire eyeball – then we completely lose the ability to see;
2. neovascular glaucoma, which can completely damage your eyesight or cause blindness;
3. retinal detachment caused by scar tissue that forms at the back of the eye.

For complicated proliferative retinopathy (vitreous haemorrhage or traction retinal detachment), the only treatment method is vitrectomy, which involves excision of the vitreous humor together with the haemorrhage. Of course, people with severe retinopathy usually have a worse prognosis for improved vision because their disease is very advanced.

Diabetic retinopathy – prevention

If you have diabetes, see an ophthalmologist at least once a year. A visit to this specialist does not require a referral. The doctor will look at the fundus of the eye with an ophthalmoscope (an instrument with a small bulb) and will see if any changes are present. This is important because early detection of diabetic retinopathy increases the effectiveness of treatment. The ophthalmologist may also perform another test – fluorescein angiography. It involves putting a dye into the eyeball, which makes it easier to see the retinal blood vessels and check for rupture and fluid leakage.