Why does diabetes cause retinopathy?
Diabetic retinopathy is a disease of the retinal microvasculature caused by elevated blood sugar, so it can damage vision. However, the symptoms may vary depending on where the lesion occurs. If the lesion occurs in the peripheral area of the retina, the patient will not experience significant visual impairment and the lesion will often be detected during a physical examination. However, in some patients, the lesions occur in the most important areas of the retina, such as the optic nerve or macula and the posterior pole, and when the lesions occur in these three areas, the patient will experience severe vision loss. What are the symptoms?
Patients with glycosuria may experience loss of vision and distorted vision. There are also symptoms such as floaters in front of the eyes and the sensation of dark shadows rotating with the eye, which are actually vitreous floaters and may be a small amount of early fundus hemorrhage. Some people have floaters in front of their eyes first, while others have distorted vision first.
What changes occur in the retina of a person with diabetic retinopathy?
In patients with diabetic retinopathy, the fundus may show microangiomas, hemorrhages, hard exudates, cotton wool spots, and microangiopathy. As the disease worsens, patients may develop fibrous proliferation in the fundus, leading to retinal detachment. In contrast, lesions in the macular region of the retina manifest mainly as edema of the macula. Hemorrhage will occur as the neovascularization continues to develop. If the amount of hemorrhage is small it is an anterior or deep retinal hemorrhage, if the hemorrhage is severe it will be a vitreous hemorrhage, then the patient will not be able to see, not even his fingertips. As the disease progresses further, the neovascular membrane will contract and pull the retina, and the retina will detach. Usually when it progresses to the fibroplasia stage, vitrectomy is required. If the patient is still not treated at this point, further progression will result in atrophy of the eye, and the eye will slowly deflate.
Is laser treatment of the glycoplasmic reticulum reliable?
Many patients say, “Doctor, I don’t want to have laser.” Because they have heard that many patients’ vision is not as good as before after laser treatment, they are determined not to have laser treatment or surgery. It is important to emphasize here that when the glycoplasmic retina enters the pre-proliferative stage, that is, the retina already has a large area without blood perfusion, which already provides the conditions for the growth of neovascularization, and the neovascularization is about to grow out, it needs to be treated with laser immediately. In layman’s terms, the principle of laser treatment is to “spare the car and save the marshal”. The laser is applied to the non-perfused area around the retina to reduce the energy consumption, so that all the limited energy is supplied to the central part of the retina, and then the optic nerve and macular area are effectively protected. Some patients experience vision loss after the laser. Then the patient panics and wonders if the laser treatment is the cause. It is true that this is a complication of laser treatment because after laser on the periphery of the retina, the peripheral optic nerve all dies, which will cause the patient’s vision to decrease, and the contrast and sensitivity will also decrease. However, at this critical moment, it is necessary to sacrifice the peripheral vision to preserve the central vision. Because 90% of our vision comes from central vision, laser treatment is required when the lesion reaches this point. The laser is not to improve your vision, but to preserve your existing vision.
Can I have laser treatment for macular edema?
It is possible to have laser for macular edema, but it is not the same as laser for total retinal photocoagulation. The macula is the most critical part of the fundus, and a grid-like laser is used after the development of edema.
These are a few things to keep in mind when getting laser for glucose retina!
Do I need to have my blood sugar and blood pressure under control and stable before getting the laser?
This is a must. It is important to make sure that the patient’s blood sugar and blood pressure are as stable as possible before laser treatment.
Does it hurt to have laser treatment?
This is a major concern for patients. Before we give a patient a total retinal photocoagulation treatment, we use an anesthetic on the surface of the eye, which is a spot of eye drops. The laser is usually performed in an outpatient setting. After the anesthetic is administered, the treatment is not too painful for the patient, and although there is a pinch-like sensation, it is generally tolerable.
How long does laser treatment take? How many times do you usually do it?
The retina is as thin as a cicada’s wing, so the tissue structure determines that the laser cannot hit the entire lesion area at once, but must be done in stages, which is the result of very scientific and rigorous tests. If a single hit is done, the inflammatory response is often very heavy and serious complications may occur. The length of a laser treatment is related to the doctor’s proficiency.
What should patients pay attention to after laser treatment?
After laser treatment, patients should avoid strenuous exercise, violent coughing, sneezing and constipation, as well as violent head position changes, including heavy physical labor. In addition, one month after the entire course of laser treatment, it is important to come back for a review of the fundus fluoroscopy if necessary. If you find that your condition is very stable at the time of the one-month follow-up, you should have another checkup at two to three months. You should never stop checking after laser treatment. Because some patients have poor blood sugar control, high and low, it will bring conditions for the growth of new blood vessels. If these patients are not rechecked in time, the new blood vessels can easily take advantage of the situation. Therefore, after laser treatment, it is still necessary to prevent the re-emergence of neovascularization, and regular dilated eye examinations and fundus fluoroscopy must be done.
Is there any other way to treat diabetic retinopathy?
Diabetic retinopathy can also be treated with medications. Generally, patients with stage I and II disease can use drugs that improve microcirculation to improve the structure and function of the blood vessels. In addition, there are now anti neovascular drugs, which are a new treatment option. Neovascularization is a catastrophic manifestation for fundus disease. Anti-neovascular drugs can directly make the neovascularization shrink, which is a very good treatment method. When the condition reaches the final step and vitreous hemorrhage and retinal detachment occur, it is time to undergo vitrectomy.
What should I look for in the life of a person with diabetic retinopathy?
Patients with diabetic retinopathy must, first, control their blood sugar, blood pressure and blood lipids. The second is the regular review that I have repeatedly emphasized above. In addition, do not exercise strenuously, reduce eye shocks, and pay attention to rest.