I. What is the dangerous situation of diabetic retina?
A: In a word: very serious! With the development of China’s national economy and lifestyle changes, people are living a better life, but the incidence of diabetes is increasing year by year.
According to statistics, the number of people suffering from diabetes in China is currently more than 40 million, of which about 30% may already have diabetic retinopathy, so that the number of patients with diabetic retinopathy, China should have 10 million, and the vision of this is seriously threatened may be about 3 million. Even in a developed country like the United States, diabetes-induced blindness is about 1,2000-2,4000 people per year.
As ophthalmologists, we see patients blinded by diabetes almost every day, so we feel a very heavy burden on our shoulders.
Second, if I have diabetes, is it certain that I will develop diabetic retinopathy?
A: No. Whether or not diabetic retinopathy occurs depends on: the duration of the disease; the control of blood sugar, blood pressure, blood lipids and individual differences.
Generally speaking, diabetic retinopathy does not occur after the onset of diabetes, but after 7-8 years, diabetic retinopathy will slowly begin to bleed, and it will get worse with time.
Of course, if your blood sugar, blood pressure and lipids are well controlled, your lifestyle is healthy, and you have a good attitude, you may have late onset of lesions, and we have seen people with diabetes for more than 50 years without lesions in the fundus. Individuals also vary greatly, and some individuals develop diabetic retinopathy despite good glycemic control.
In addition, diabetic retinopathy occurs early and severely in type 1 diabetes, while retinopathy occurs later in type 2 diabetes.
How can diabetic retinopathy be detected?
A: It is important to emphasize that diabetic retinopathy is the easiest to detect because the fundus can be seen directly by the ophthalmologist. However, many patients, who do not pay much attention to this point or have poor medical conditions, do not have the opportunity to see an ophthalmologist, thus delaying treatment is very unfortunate.
It is a good tradition at Concordia Hospital that all newly diagnosed diabetics must visit the ophthalmologist to see the fundus, which will help the diabetologist determine how long the patient has had diabetes. Diabetes is a painless disease in its early stages, and some people are careless and do not easily discover that they have diabetes, only to come to the ophthalmology department and see that the fundus has been bleeding profusely, and that the diabetes has been there for more than 5 years, and that there is no control at all, and they still eat and drink a lot.
We encountered many patients with vision loss in the clinic, and once they saw the typical diabetic retinopathy in the fundus, we said “you have diabetes”, many patients did not believe it, thinking that I am fine, how can I have diabetes? This is a case of being too insensitive to your own health condition.
It is recommended that everyone should have regular health checkups. In addition, it is recommended to alternate between the right and left eye frequently to detect the disease in one eye. If there is blurred vision, go to the eye examination as soon as possible.
In general, fundoscopy, or fundus color photography can confirm the diagnosis, but if there are hemorrhages in the fundus, it is better to have a fundus fluorescence angiography, which can see the extent of diabetic retinopathy more clearly.
4. Do I have to get a laser if I have diabetic retinopathy?
A: No. The most frequently asked questions about whether diabetic retinopathy should be lasered are indeed the most difficult to say. There are two conditions to be treated with laser. One is macular edema, and many studies have shown that careful weak dispersed laser photocoagulation of the macula can reduce the leakage of blood vessels, thus reducing edema and improving visual acuity. Secondly, when neovascularization is found in the retina, or there is a large area of retinal blood vessels without blood supply, then in order to make the neovascularization shrink or stop the growth of neovascularization, so-called whole retinal laser photocoagulation is performed.
The importance of laser photocoagulation in the treatment of diabetic retinopathy should be particularly emphasized. Without laser photocoagulation, there is no telling how many patients would have gone blind. Proper laser photocoagulation is the protector of vision for patients with diabetic retinopathy! And, laser is never just 1 or a few shots. For patients with diabetic retinopathy, laser treatment may be required at any time during the course of regular review. As for how to laser and when to laser this is really a matter for the physician and the patient himself does not need to know much about it. In general, whole retina laser photocoagulation will be done in 3-4 sessions, and it is not advocated that too much is done at once, which can cause increased edema.
Many patients, because of the lack of timely laser, vitreous hemorrhage, retinal neovascularization, formation of mechanized proliferative membrane, retinal detachment, falling to the point of blindness; on the contrary, if the laser is timely and appropriate, this situation can be completely avoided.
V. Why did my vision decrease after laser treatment?
A: Laser treatment is a thermal burn effect, the less important part of the destruction, throwing pawns to protect the car, not without harm, but based on the long-term, if not very good laser treatment, may be blind, and after the laser, there may be a little loss of vision, which is a contradiction, but not because of this is not laser, vision loss is better than blindness! In fact, not every patient’s vision must decrease after laser, there are also vision improvement, so there is no need to be afraid. Of course, there are some experience issues here, but the general direction of laser treatment for diabetic retinopathy is right.
Is there any other way to treat diabetic retinopathy besides laser?
A: In recent years, medical technology has advanced rapidly, especially the emergence of anti-angiogenic drugs, making more treatment options available for diabetic retinopathy.
For example, laser treatment combined with vitreous injection of anti-angiogenic drugs can have better effect on controlling macular edema; for example, for cases with neovascularization, vitreous injection of anti-angiogenic drugs can help the regression of neovascularization, especially when the neovascularization is not laserable on the optic nerve papilla; in some cases of advanced diabetic retinopathy where surgery is necessary, the drugs can be injected first and then operated. In some cases of advanced diabetic retinopathy where surgery is necessary, drugs can be injected first and then operated, which can reduce intraoperative bleeding.
How to deal with neovascular glaucoma caused by diabetes mellitus?
A: We have dealt with many such patients. If the IOP is very high and not controlled, the optic nerve will be atrophied and it will be too late. Therefore, measures must be taken without delay to retract the iris neovascularization and control the IOP.
VIII. What kind of conditions must be treated surgically for diabetic retinopathy?
A: If the diabetic blood glucose is not well controlled, nor is the correct laser treatment in time, and the retinopathy develops to the proliferative stage, the vitreous hemorrhage is not absorbed for more than 1 month, or the retina has proliferative membrane with retinal detachment, which affects the central vision, surgery must be performed. The purpose of surgery is to remove the hemorrhage, peel off the proliferative membrane, reset the retina, and further enhance the laser photocoagulation treatment.
Two points must be reminded: First, it is now unanimously accepted that surgery should be done early and not delayed. It is generally accepted that if the bleeding cannot be absorbed in a month or so, surgery and laser should be performed, rather than waiting until there is a lot of neovascularization in the proliferative membrane and the retinal detachment is so large that the proliferative membrane cannot be peeled off during surgery; secondly, it is important to realize that once diabetic retinopathy reaches a lot of proliferative membrane, the efficacy of surgery is generally not satisfactory. Do not expect too much in this regard.
Therefore, once again: close review and follow-up, early treatment, including laser and surgery, must be done early! Never because diabetes is not painful, and ignore the hospital examination, ignore the blood sugar control, then regret too late, no one can help!
Nine, a few recommendations.
1, to learn to live with diabetes. There is no cure for diabetes, so we must face the reality and defy it strategically, but we must pay attention to it in life. We must regularly check in big hospitals to form a routine to control blood sugar, blood pressure and blood lipids well! Especially don’t eat and drink a lot, smoke and drink a lot.
2, firm confidence. A large number of multicenter studies have shown that: correct and timely intervention can make more than 90% of diabetic retinopathy patients avoid blindness. Here regular eye examinations are especially important, and timely laser and adequate laser are especially important!
3.The combined application of new therapeutic measures can achieve better results in the treatment of diabetic retina, such as the application of anti-angiogenic drugs.
4. Finally, once again: diabetic retinopathy can be controlled! It is especially important to control the troika of blood glucose, blood pressure and blood lipids! Timely eye examination and regular eye review are especially important! Treatment early!