Diabetes is a silent killer that slowly attacks tissues and organs throughout the body, and the eyes are no exception. Despite this, most people still lack the necessary understanding and awareness of diabetes and its ocular complications, and many patients do not visit the ophthalmology department until they have severe vision loss or even blindness, delaying valuable treatment. Therefore, it is important to raise the awareness of diabetic patients and their families about the eye complications of diabetes, especially diabetic retinopathy, so that early detection and timely treatment are the key to avoiding blindness. What is diabetic retinopathy? The retina in the eye, like the negative of a camera, is an important tissue structure that receives light from the human eye, and once the retina is severely damaged, it can lead to significant vision loss and blindness. The retina is rich in blood vessels, and when diabetes is present, high blood sugar can damage these blood vessels and the retinal nerve layer that senses light and transmits nerve impulses, causing a series of vascular damage to the retina, which is known as diabetic retinopathy, and its occurrence and development is related to poor blood sugar control and long duration of the disease. Diabetic retinopathy is characterized by retinal hemorrhage, macular edema, vitreous hemorrhage, etc. In severe cases, it leads to retinal detachment and neovascular glaucoma, which can range from no change in vision in the early stage to large black shadows in front of the eyes and complete loss of vision. Symptoms of diabetic retinopathy In the early stage when the fundus lesion does not affect the macula, vision is not affected and patients have no conscious symptoms. Sometimes patients feel that their vision is diminished or there are black shadows flying or floating in front of their eyes. If the lesion develops for 3 to 5 years or if the blood sugar is not well controlled, it may cause different degrees of hemangioma, fundus hemorrhage, exudation and edema. If the macula of the fundus is involved, symptoms such as loss of vision, black shadows in front of the eyes, dark spots in the center of the visual field and distortion of visual objects may occur. If the retina repeatedly hemorrhages into the vitreous, patients feel a black shadow floating in front of their eyes. When the blood vessels or neovascularization bleed heavily into the vitreous cavity, vision will be seriously affected and even blindness will occur. How to prevent diabetic retinopathy? Good blood sugar control under the guidance of a diabetic specialist is the most fundamental means. This is because retinopathy is extremely closely related to how well diabetes is controlled. Second, early detection and treatment can stop or delay the progression of the disease. Patients with diabetes should receive regular eye examinations, regardless of whether they have vision changes or not. In general, vision and fundus should be checked once a year, and those with disease duration of more than 5 years should have their vision and fundus checked every six months, and fundus photography and fundus fluorescence angiography should be done if necessary to accurately observe the retinal vessels in the fundus. Fundus laser treatment – a heavy handed attack on diabetic retinopathy Fundus laser is currently the most effective and fundamental method to interrupt the blindness caused by diabetic retinopathy. Results from the Early Treatment Diabetic Retinopathy Study (ETDRS) in the United States have shown that timely and appropriate laser treatment can reduce the risk of vision loss by 50% in patients with diabetic retinopathy. Depending on the condition, fundus laser modalities used for diabetic retinopathy can be classified as total retinal photocoagulation, localized photocoagulation, and lattice photocoagulation, which are used to treat proliferative retinopathy and macular edema, respectively, in order to control the condition and reduce the risk of vision loss. When do I need fundus laser treatment? Diabetic macular edema, severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy, combined with iris neovascularization, and moderate non-proliferative diabetic retinopathy combined with cataract, cataract or vitreous, etc. The above lesions are detected by fundus fluorescence angiography after surgery. For patients who need laser treatment, a wait-and-see and hesitant attitude will often delay the best time for laser treatment, leading to further progression of the disease and even blindness! In this case, although vitreoretinal surgery is still available, fundus laser also remains a necessary option during or after surgery, and the treatment is very costly, but the efficacy is far less than that of timely laser treatment. Can you rest easy after laser treatment? The answer is no. Because there are many risk factors associated with the progression of diabetic retinopathy, including disease duration, blood glucose, lipids, and blood pressure levels. Therefore, patients should also pay attention to the control of these risk factors after receiving laser treatment, which on the one hand helps to control the disease and reduce the risk of further progression of retinopathy, and on the other hand also helps to promote the recovery of vision after laser treatment. In addition, it is important to review the fundus regularly after laser treatment according to medical advice in order to detect new lesions and provide timely and appropriate treatment. Surgery When serious lesions such as vitreous hemorrhage and retinal detachment occur, vitreoretinal surgery is required. However, the results of treatment during this period are often unsatisfactory, and it is difficult to restore better vision even if all efforts are made to resuscitate the patient. Advice for diabetics Diabetic retinopathy is preventable and treatable! The incidence of retinopathy is as high as 40% to 50% in people who have had diabetes for 10 years, and more than 90% of people who have had diabetes for more than 20 years have some degree of retinopathy. While controlling blood glucose, lowering cholesterol, participating in physical exercise appropriately, not doing strenuous activities, paying attention to eye hygiene, combining work and rest, having regular fundus examinations, early treatment, preserving vision, avoiding blindness, and improving your quality of life.