Recently, I saw several diabetic patients one after another, all because they did not know that diabetes can affect the eyes, or they usually do not pay attention to blood sugar control without symptoms, resulting in serious vision loss, and when they came to see the doctor, diabetic retinopathy was already in the advanced stage. So although it’s a cliché, I think it’s important to tell you more about the dangers of diabetes to the eyes.
Diabetes affects all parts of the eye, for example, diabetic patients are prone to wheals, conjunctivitis, keratitis, dacryocystitis, cataracts, corneal epithelial detachment, and may also develop diabetic optic neuropathy and diabetic ocular muscle paralysis.
The risk of complications such as poor wound healing, excessive bleeding, corneal edema, corneal epithelial damage, and endophthalmitis in diabetic patients after ophthalmic surgery increases accordingly. Diabetic retinopathy (hereafter referred to as glycoplasty) is the most serious complication of diabetic eye disease and one of the major causes of blindness. It accounts for about 8% of all blindness-causing eye diseases. China is a major diabetic country, with the second highest incidence of diabetes in the world in 2003, and there are about 10 million diabetic patients with complications of glucose retina. Among diabetic patients older than 40 years old, about 40% suffer from glycoplegia.
Figure 1 Fundus manifestation of diabetic retinopathy
Who is at risk for diabetic retinopathy?
Two of the most important risk factors for developing glucose retinopathy are the duration of diabetes and glycemic control. More than 70% of patients with disease duration greater than 10 years will have varying degrees of glucose retinopathy, and more than 90% of patients with disease duration greater than 20 years will have glucose retinopathy. For every 1% reduction in glycosylated hemoglobin HbA1C, the risk of DR will be reduced by 21% and the risk of progression will be reduced by 43%, so the most important thing for diabetic patients is to control their blood sugar well, prevent blood sugar fluctuations, and prevent the occurrence of glycemic reticulum is much more important than treating it after it appears. There are also a number of risk factors that can increase the chance of developing the retina, such as high blood pressure, high blood cholesterol, anemia, renal insufficiency, pregnancy, and poor lifestyle habits.
How can I determine if I have diabetic retinopathy?
The majority of diabetic patients are elderly and when they have some slight changes in their eyes, they often mistake it for a normal decline or cataract. In addition, diabetic retinopathy usually starts in the mid-periphery of the retina and has no obvious effect on vision in the early stage, so there can be no symptoms. Clinically, many diabetic patients have never undergone eye examinations because they have no symptoms, and when they come back for examination after vision loss, they have already entered the advanced stage, which is difficult and ineffective to treat. There are also many patients who go to check their blood sugar only because they have eye problems and the ophthalmologist suspects that they are caused by diabetes, but it turns out that they already have very serious complications. Therefore, we recommend that diabetic patients do not go to the ophthalmologist based on whether they can see well or not.
Experts recommend that diabetic patients should go to the ophthalmology department for a dilated fundus examination immediately from the time of diagnosis, and at least every 3 months if they are found to have glycogen reticulum, and once a year for those who do not have glycogen reticulum for the time being, and once every 1-3 months for diabetic patients during pregnancy, regardless of whether they have glycogen reticulum. If you already have symptoms such as decreased vision, flashing sensation in front of your eyes, floating objects in front of your eyes, distorted, smaller or obscured vision, eye redness, eye pain, etc., then you may have diabetic eye disease and should go to an ophthalmologist for a detailed examination as soon as possible.
Visual acuity, intraocular pressure, slit lamp examination and fundus examination after dilated pupil are the most basic examinations that should be performed for diabetic patients. Because lesions in the sugar retina often appear in the peripheral part of the retina and are difficult to detect without dilating the pupil, a dilated pupil examination is essential. Usually the doctor will use a fast-dilating medication that will make your eyes feel blurry and shaky, but it only lasts for five to eight hours and will not affect your vision at all.
Ophthalmology OCT is a non-invasive eye exam that is very helpful in the early detection of macular edema caused by diabetes and is often more accurate than the doctor’s naked eye judgment. For patients with vision loss or visual distortion, OCT is a must if macular edema is suspected.
Another commonly used invasive test is fundus fluorescence angiography, which is based on imaging the blood vessels in the fundus to detect lesions that are difficult to see with the naked eye, such as vascular leakage, neovascularization and areas of retinal ischemia. If your fundus lesions have reached a certain level of severity, your doctor will often recommend a fluorescent fundus angiogram to determine if you need laser treatment.
In short, people with diabetes should have regular eye exams to prevent problems before they occur and to protect their vision.
Figure 2 Fundus fluoroscopic angiography in a patient with diabetic retinopathy showing vascular leakage, neovascularization and areas of retinal ischemia
How is diabetic retinopathy treated?
Treatment of diabetic retinopathy depends on the severity of the lesion. Before the development of neovascularization in the retina, it is usually called background or non-proliferative diabetic retinopathy, and after the development of neovascularization in the retina, it is usually called proliferative diabetic retinopathy.
Mild to moderate non-proliferative retinopathy can be treated conservatively with oral medications to improve microcirculation and neuroprotection. Severe nonproliferative and proliferative retinopathy requires total retinal photocoagulation. The purpose of total retinal photocoagulation is to control the progression of diabetic retinopathy. However, short-term transient vision loss may occur after total retinal photocoagulation, which may also cause some damage to the visual field, but in the long run, it is beneficial for disease control and vision maintenance. Therefore, the timing of laser treatment is very important for the patient’s prognosis.
Vitrectomy is required for those with large hemorrhages or those who have caused retinal detachment to help patients restore and maintain their vision.
Surgical treatment is also required for complications such as cataract and glaucoma.
Figure 3 Fundus of the eye after total retinal photocoagulation
Macular edema caused by diabetes is also a major cause of vision loss. In the past, the only treatment for macular edema was laser in the macula, but even then about 1/3 of patients would still experience vision loss within 2 years. In recent years, emerging anti-VEGF drugs have achieved good results in the treatment of diabetic macular edema, effectively improving the patient’s vision and stopping vision loss, and this approach has now increasingly replaced the traditional laser treatment as the preferred treatment option for macular edema. However, the shortcoming of this treatment is that it usually requires several repeated injections to achieve the best results.
Macular edema caused by diabetes
Complete resolution of macular edema after treatment with anti-VEGF drugs
In conclusion, the best treatment option for diabetic retinopathy should be chosen only after a thorough evaluation by your doctor.
Finally, a few suggestions for diabetic patients.
1. Adjust your mindset. There is no cure for diabetes, so you must face reality, adapt to a life with diabetes, defy it strategically, pay attention to it in life, adjust your habits, have regular regular comprehensive checkups, and get your blood sugar, blood pressure, and blood lipids under control!
2.Confidence. Correct and timely intervention can make more than 90% of diabetic patients avoid blindness, and new treatment methods have emerged in recent years, as long as actively cooperate with the treatment, should have confidence to be able to protect their eyesight.
3, perseverance. The treatment of diabetes is a long-term process, you can not expect to see the doctor a few times to get well, you need to persistently cooperate with the doctor’s examination and treatment for a long time, do not avoid the disease, miss the good opportunity to treat.