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Poles know little about diabetes. Even less about diabetic retinopathy. Instead of prevention, we prefer to heal ourselves, as a rule, too late. With the ophthalmologist prof. Andrzej Grzybowski, we talk about why the patient, diabetologist and ophthalmologist must cooperate for the health of the eyes.
- The WHO predicts that by 2030 diabetes will become the 7th leading cause of death worldwide. Today one person dies every six seconds because of it
- Diabetic retinopathy is damage to the small blood vessels in the retina of the eye. Its consequence is progressive, irreversible loss of sight
- The basic form of fighting diabetes and its complications is education, which increases patients’ motivation for treatment
Zuzanna Opolska, MedTvoiLokony: Professor, like 2,23 million Poles, I am diabetic, am I at risk of diabetic retinopathy?
Prof. Andrzej Grzybowski, ophthalmologist: Everyone with diabetes is at risk. Epidemiological data show that diabetic retinopathy occurs in 90% of patients with type 1 diabetes and in 60 percent patients with type 2 diabetes for more than 20 years.
How does diabetes develop changes in the retina of the eye?
In people with diabetes, irregular, usually elevated blood sugar levels damage the tiny blood vessels in the retina, the light-sensitive tissue that lines the inner surface of the eyeball. Hypoxic and depleted tissue releases large amounts of VEGF (vascular endothelial growth factor) protein, which leads to neovascularization, i.e. the formation of new, abnormal blood vessels. The consequence of retinopathy is progressive, irreversible loss of vision.
What symptoms should worry us?
The problem is that diabetic retinopathy is completely asymptomatic in the early stages of development. It does not cause any deterioration of vision, let alone pain. That is why it is so important to undergo cyclic ophthalmological examinations that can detect early signs of the disease, e.g. micro aneurysms. In more advanced stages of retinopathy, visual acuity usually deteriorates gradually, the lines and shapes of objects become distorted, and blurred dark spots appear in the field of view.
Is there anything I can do to delay the deterioration of my vision?
Yes, the patient himself has the most important role to play in preventing the development of diabetic complications in the eye. First of all, it is necessary to counteract the risk factors. While we have no influence on the duration of diabetes, we can control hyperglycemia, dyslipidemia or hypertension. Therefore, we should strive to maintain the proper level of glucose and lipids (cholesterol and triglycerides in the blood), as well as control blood pressure. Previous studies have shown that keeping blood pressure within the normal range reduces the risk of complications from blood vessels by approximately 33%.
What about a hygienic lifestyle? Limiting carbohydrates, saturated fatty acids, 10 thousand. steps a day?
Certainly, following the recommendations regarding diet and physical activity is advisable. So does quitting smoking, which raises blood pressure and blood glucose levels, making it harder for us to control diabetes.
- Some preparations also support vision, eg VISIOBIANE Supplement for good eyesight PiLeJe Protection.
What kind of tests should I have for retinopathy?
Diagnostics includes a standard ophthalmological examination along with a fundus examination after pupil dilation. After the diagnosis of diabetic retinopathy, the ophthalmologist documents the patient’s treatment program – medication administration, laser treatments or referral to hospital procedures. Unfortunately, roughly half of the diabetic patients come in too late for the treatment to be effective.
Why is this happening? Do we avoid an ophthalmologist until we notice a deterioration in vision?
The reasons are different. On the one hand, there is no comprehensive healthcare for people with diabetes. Patients are not always referred to an ophthalmologist by a diabetologist or family doctor. On the other hand, patients who have referrals often do not come to the examination because of difficulties with signing up for an appointment reimbursed by the National Health Fund. On the other hand, the public’s knowledge of diabetes and its complications is insufficient. At the moment, there is no national program for the prevention of diabetic retinopathy in Poland. In previous years, the Foundation for the Development of Ophthalmology “Ophthalmology 21” implemented the project “Diabetic retinopathy – I know and prevent”, which involved educational and diagnostic activities among the residents of the city of Poznań suffering from diabetes.
How often should I be tested?
People with type 1 and type 2 diabetes should undergo an ophthalmological examination once a year. When diagnosed with retinopathy – once every six months, or even more often.
What is the treatment like?
In Poland, laser therapy is the standard method of treatment. During the procedure, areas of the damaged retina are exposed to small laser beams, which limit leakage from the lumen of the damaged vessels and stimulate the spontaneous absorption of fluid from the structures of the retina. Unfortunately, the weakness of laser therapy is the irreversible destruction of diseased areas of the retina, which may be associated with the formation of local defects in the field of view. The procedure is usually performed in four sessions and is financed by the National Health Fund.
Is there an alternative?
Yes, anti-VEGF therapy in the form of intravitreal injections. Anti-VEGF drugs block the vascular endothelial growth factor. VEGF protein through its uptake inside the eyeball. As a result, the concentration of this substance is lowered, which reduces vascular permeability and improves visual acuity. In most cases, repeated administration of the drug is necessary to maintain the therapeutic effect. The big advantage of anti-VEGF therapy is that it does not damage the retina, the downside is the high price. In the case of patients who do not respond to anti-VEGF injections, we can still use corticosteroid therapy.
Also in the form of injection?
Or by injecting the implant with a continuous release of the drug. Implants require less frequent administration than injections, but their price is high (cost of 4-5 thousand zlotys). Corticosteroid therapy, like anti-VEGF therapy, is currently not reimbursed by the National Health Fund.
And the operational methods?
An example of eye surgery is vitrectomy reserved primarily for very severe cases. During the procedure, e.g. an altered vitreous body, i.e. a jelly-like substance that fills the largest space of the eyeball – the vitreous chamber. In its place, a sterile fluid of the appropriate composition or a mixture of expansion gases is introduced, which over time is converted into a fluid produced by the secretory structures of the eye. In addition, altered tissues that damage the retina are removed. The procedure is reimbursed by the National Health Fund.
Prof. extra dr hab. med. Andrzej Grzybowski – Head of the Department of Ophthalmology at the University of Warmia and Mazury and President of the Foundation for the Development of Ophthalmology «Ophthalmology 21 ″ (http://okulistyka21.pl/). Laureate of prestigious domestic and foreign scientific awards. In 2017, in recognition of his scientific activities, he received the Achievement Award from the American Academy of Ophthalmology, and the Achievement Award from the Asia-Pacific Ophthalmology Academy. Member of many scientific societies, including the European Society for the Examination of the Eyesight (EVER), the European Society of Cataract and Refractive Surgery (ESCRS), the European Academy of Ophthalmology, the American Academy of Ophthalmology (AAO), board member of the European Retinology Society (Euretina). Author of over 350 scientific articles in peer-reviewed international scientific journals. Co-author of the books’ OCT in Central Nervous System Diseases. The Eye as a Window to the Brain »and« Endophthalmitis in Clinical Practice ».