What is diabetic retinopathy
Diabetic retinopathy, referred to as glycoretinopathy, is one of the complications of diabetes. Its prevalence is high, with a prevalence of 9.84% in the normal population in China; it is even higher in the diabetic population: 31.02% in the Anhui Province census; and 67.89% in a survey of hospitalized diabetic patients in Qinghai Province. This prevalence increases as the duration of diabetes increases, and a study in the United Kingdom showed that the incidence of diabetes in patients with only 3 years of disease was 8%, while at 5 years it was 25%, at 10 years it was 60%, and at 15 years it was 80%.
The damage to vision caused by the sugar network is extremely dangerous! This is because.
1. it has a very high incidence, with more than half of patients who have had diabetes for more than 10 years developing glycoplegia.
2. It causes irreversible damage to retinal function, and once vision is lost or degraded, it is unlikely to be treated to return to the pre-onset level of vision.
3.Both eyes develop. Therefore, patients with untimely treatment of advanced glucose retina will inevitably lose their ability to lead a normal working life due to total blindness in both eyes.
What are the diabetic retinopathies?
Diabetic retinopathy is generally divided into 2 types, one is diabetic microangiopathy, which is a gradual change in the fundus of the eye. Typically, diabetic retinopathy begins with a slight degeneration of the tiny blood vessels in the retina, and once this condition develops, it progresses to a more serious condition that threatens vision, called proliferative retinopathy.
In proliferative retinopathy, abnormal new blood vessels grow on the surface of the retina. These fragile new blood vessels are very prone to rupture and blood can flow to the middle part of the eye and obstruct vision, which is commonly referred to as vitreous hemorrhage or blood accumulation. This new blood vessel is also very prone to atrophy and the scar tissue formed by its atrophy may also form around the retina, eventually leading to retinal detachment. When we say earlier, irreversible visual impairment, we are mainly referring to the condition that goes into proliferative retinopathy.
There is another one, because the fluid in the blood will continue to leak from the retinal vessels and cause macular edema. The macula is the part of the retina that is responsible for providing sharp, clear vision when reading and driving. When this important part of the macula becomes swollen with too much fluid, vision can become so blurred that it becomes difficult to perform or lose its function. Macular edema can develop unlike microangiopathy, which only affects vision at a certain point; it can appear at any time in the course of diabetes and severely affect vision from the start.
What does a comprehensive eye examination include?
1.Visual acuity meter measurement: the easiest way to determine good or bad visual function, but good vision has the potential to conceal lesions.
2. Slit lamp microscopy: to know if there are other eye complications of diabetes such as cataracts and inflammation.
3. Direct fundoscopy: the easiest way for ophthalmologists to diagnose the sugar network, but it is not comprehensive and is best performed with dilated pupils.
4. Fundus photography: visual record of the retinal condition of the fundus, which facilitates sequential comparison during long-term visits.
5.Fundus fluorescence imaging: very sensitive to indicate retinal vascular changes and can show lesions before the doctor finds them with fundoscopy. It can also be maintained over time for easy comparison.
6.OCT: To do fine scanning of macular edema, showing the presence or absence of lesions and already the record of lesion development.
7.IOP measurement: detect early glaucoma to facilitate timely treatment.
The above examination results should be kept as files, arranged in chronological order.
What are the treatment methods for diabetic retinopathy?
In general, there are four major parts to the treatment of diabetic retinopathy.
1. Systemic disease treatment
Systemic disease treatment is the most critical part of diabetic retinopathy prevention. Early control of blood glucose, blood pressure and lipids can delay the onset and progression of diabetic retinopathy.
2.Medication
The medications for diabetic retinopathy are divided into oral medications, eye drops and intraocular injections. Oral drugs are mainly some drugs that improve microvascular circulation. Among the eye drops, there are no drugs specifically for the treatment of the disease, some of which can improve the microcirculatory function of the fundus. Intraocular injections of drugs mainly target macular edema, such as some hormones and biological agents against neovascular growth.
It should be reminded that all drugs should be given by doctors under close testing.
3.Laser treatment
It is the most effective method known to protect vision and should be performed when diabetic retinopathy occurs to a certain extent. When the disease progresses to a point where it may enter the proliferative phase, a thorough total retinal photocoagulation should be done in time to stop the progression of the disease. However, it is possible that laser treatment may, in the short term, aggravate macular edema and cause short-term vision loss.
It should be noted here that before and after laser treatment, it is better to determine the scope and extent of treatment and the effect of treatment by fundus fluorescence imaging.
4.Surgical treatment
Surgery is the only effective treatment for diabetic retinopathy after it enters the proliferative stage and there is a large amount of blood accumulation and scarring in the eye, even after it leads to retinal detachment. Vitrectomy can more completely remove the accumulated blood and scars and reset the detached retina, however, it is important to emphasize: never base your hope of vision recovery after the onset of diabetic retinopathy on surgery! Because this surgery, which is very risky and expensive, and does not help much in restoring the vision of the already diseased retina, being able to maintain the patient’s current vision is the most satisfactory result.
As a diabetic, what should I do to prevent and stop diabetic retinopathy?
Patients who have been diagnosed with diabetes for the first time, or who have not yet discovered any eye abnormalities.
1. Schedule a comprehensive eye exam for yourself once a year.
2. Create a personal eye examination file: include medical records of each fundus examination, fundus photography, OCT and fluoroscopy and other imaging materials. (Keep it personally, if the hospital you visit has such a service, establish a file at the hospital)
3. Strict control of blood sugar, blood pressure and blood lipids.
Patients found to have diabetic retinopathy, or those who have had diabetes for greater than 10 years
1. Undergo a comprehensive eye examination immediately
2. Based on the examination results, consult a doctor specializing in fundus disease to determine the treatment plan.
3. Any other diabetic eye disease, such as cataracts, should be treated early to prevent these conditions from interfering with the observation and treatment of diabetic retinopathy.
All diabetic patients should be aware of the following points.
1. The damage to vision caused by diabetic retinopathy, especially in its advanced stages, is largely irreversible. Therefore, once diagnosed with diabetic retinopathy, following the guidance of an ophthalmologist and early and reasonable treatment is the only way to protect vision;
2. Diabetic retinopathy can occur with good vision, so don’t use your senses to determine whether the disease is present and whether it has progressed;
If you feel any changes in your vision, see an ophthalmologist promptly.