Diabetic retinopathy is one of the most serious complications in the diabetic eye and is the leading cause of adult blindness in developed countries. It is preventable, controllable and poorly treatable. Diabetes prevalence in China: >9%. Diabetic blindness: 4%, mainly caused by proliferative diabetic retinopathy. Fang Zhou, Ophthalmology Department, Qilu Hospital, Shandong University
Symptoms of diabetic retinopathy.
In the early and middle stages, patients may have no conscious symptoms at all. Symptoms such as “flying mosquitoes”, flashes of light in front of the eyes, reduced visual acuity, reduced visual field and refractive changes may occur. In the late stage, sudden loss of vision, visual distortion, and even blindness. Mild to moderate damage: macular edema (60-70%) macular ischemia, hemorrhage and exudation. Severe damage: vitreous hemorrhage (80%)
Tractional retinal detachment, pre-macular fibrous gliosis, secondary glaucoma.
Prognosis.
If left uncontrolled, approximately 15% of mildly affected eyes progress to the severe stage within 5 years. In severe eyes, more than 50% of the eyes become blind within 5 years. Relationship between the duration of diabetes and the appearance of fundoplication: within 5 years of diabetes history – 40% to 50%, 5 to 10 years – 50% to 50.6%, more than 10 years – 69% to 92%. If left untreated – eventual blindness due to fundus hemorrhage, retinal detachment.
Risk factors:
Blood glucose Good long-term control of blood glucose reduces the likelihood of diabetic retinopathy (DR) by 32% to 8%, and the likelihood of DR progression by 44% to 19%.
Hypertension Hyperlipidemia Pregnancy Diabetic nephropathy Proteinuria Heredity HLA-DR4+DR3 Smoking Obesity Alcohol consumption.
Ocular local factors: glaucoma, high intraocular pressure, myopia, metabolic decline, cataract surgery, macular edema.