About the effect of diabetes on the eye
He had surgery today to implant a prosthetic eye. He lost his eyesight due to diabetic retinopathy, retinal detachment, neovascular glaucoma, and recently had a corneal ulcer that almost perforated his eye, during which he was transferred to many hospitals, and still did not save his eye in the end. Although the patient’s family thanked us for trying our best to treat him, it was very heavy for us as ophthalmologists to do such a surgery. If he had come for treatment earlier and controlled his blood sugar and blood pressure, such an outcome could have been avoided. I hope that patients will have more knowledge and cooperate with their doctors to minimize the damage of diabetes. We will do our best to spread awareness about diabetic eye disease, just as we always give out Amsler forms to macular degeneration patients in our clinic to explain the prevention of macular degeneration, we also hope that diabetic patients will learn more about eye disease and maintain useful vision throughout their lives.
The following are some issues that should be noted.
1. The onset of diabetic eye disease is related to the number of years of diabetes: the longer the onset, the more severe the eye damage caused. Stable blood glucose control can slow down the onset of eye disease. Poorly controlled blood sugar can lead to earlier onset of eye disease. It is also important to control blood pressure and blood viscosity. type I diabetes has many and serious eye complications.
2. Diabetes can cause a lot of eye discomfort, not just retinopathy.
(1) Refractive changes: sometimes myopia, sometimes hyperopia.
(2) Eyelid lesions: recurrent blepharitis and blepharitis.
(3) Conjunctival disease: recurrent conjunctivitis.
(4) Keratoconus: dry eye, corneal epithelial erosion, delayed corneal wound healing, etc.
(5) Iris lesions: iritis, iris pigment loss, etc.
(6) Glaucoma: neovascular glaucoma.
(7) Cataracts: diabetic cataracts and senile cataracts in diabetic patients.
(8) Ocular muscle paralysis: can show easy fatigue after using the eyes and strabismus, diplopia.
(9) retinopathy: the most common and the most serious.
3, why do diabetics see things sometimes clear, sometimes blurred?
This is due to the lens regulation, the lens nutrition from the atrial water, when blood sugar rises, the atrial water glucose concentration increases, diffusion into the lens, lens osmotic pressure rises, the lens fibers absorb water swelling, myopia occurs, when blood sugar suddenly lowered cause the opposite osmotic pressure changes, lens water reduction, farsightedness occurs. This change in vision reminds you to pay attention to the change in blood sugar, but it is not necessary to get a lens immediately, and you should get another optometry after the blood sugar is stabilized.
4.What is diabetic retinopathy?
Diabetic retinopathy is a serious complication of diabetic eye disease that mainly affects the retina of the eye. The retina is similar to the film of a camera, which can perceive visual images. Diabetic retinopathy usually occurs after many years of diabetes. The longer you have diabetes, the greater the chance of developing diabetic retinopathy.
5. Do diabetic patients need to see an ophthalmologist even if they have no eye symptoms?
Yes, because it is very one-sided for a patient to judge whether there is a problem in the eye only based on his vision. The fundus is divided into the central area and the peripheral area, and the central area refers to the macula. If there is no bleeding or exudation in the macula, the patient may not easily notice it, but the peripheral retina may already have damage and treatment should be started.
6.How many types of diabetic retinopathy are there?
There are mainly 2 types and 6 stages. The first 3 stages can also be called non-proliferative, which are characterized by microangiomas, small pieces of hemorrhage and exudation. The latter 3 stages are called proliferative and present with fundus neovascularization, vitreous hemorrhage, fibroproliferation, and retinal detachment. Internationally, there is another stage called ETDES stage, which is more specialized, but the treatment principle is still the same.
7.What is diabetic macular degeneration?
Macula is the most sensitive part of retinal vision, which is usually used to see things, and the damage to the fundus of the eye caused by diabetes affects macula most often. Damage to macular area can be manifested as exudation, hemorrhage, macular edema, which makes you lose vision and distort your vision. It can also be assisted by drugs.
8.What is neovascularization and is it a normal blood vessel?
Neovascularization is an unhealthy blood vessel induced by retinal ischemia and hypoxia, which can grow in clusters and bleed very easily.
9.Does diabetic retinopathy always progress?
Most patients are. Stable blood glucose control and proper treatment can control the progression of the lesion and maintain useful vision throughout life.
10.How is diabetic retinopathy treated?
Blood sugar control is the key. Stage 1~2 can be treated by medication, using microcirculation improvement and hemostatic drugs, iodine preparations, stage 3~4 is mainly treated by photocoagulation, which is an effective method commonly used in the world, stage 4~6 is generally treated by surgery, and most patients can recover some of their vision after surgery.
11.What is the purpose of photocoagulation?
The purpose of photocoagulation is to prevent blindness. Studies have shown that blindness due to diabetic retinopathy can be avoided in more than 60% of eyes if treated with photocoagulation in a timely manner, especially if the blood sugar is well controlled. Photocoagulation is recommended by doctors worldwide.
12. How does photocoagulation work?
Photocoagulation reduces the risk of hemorrhage and retinal detachment by creating a concentrated light spot on the retina and reducing the substances that stimulate abnormal neovascularization. In addition, photocoagulation of the macula reduces macular edema. These are able to stop vision loss and even improve vision.
13.Does photocoagulation often improve vision?
No. The purpose of photocoagulation is to prevent blindness. The purpose of photocoagulation is to prevent blindness, and vision usually does not improve, and in most cases may decrease slightly. In addition, many patients may experience a transient blurring of vision for a few hours after photocoagulation, but then vision is restored. Occasionally, some patients with early diabetic macular degeneration may have improved vision after photocoagulation. It is important to emphasize that vision does not usually improve after photocoagulation for diabetic retinopathy. However, in the long run, because the retinopathy is controlled after photocoagulation, there is a possibility that the visual acuity will no longer decline, that is, indirectly the visual acuity is preserved.
14.How often should I have photocoagulation treatment?
It is recommended to treat a single eye at a time, alternating with a single eye whole retina photocoagulation usually takes 3~5 times to complete, 10~20 minutes each time, and then it can be reviewed periodically and still be supplemented with photocoagulation if needed. The treatment can be divided into several sessions to avoid producing too many spots in the retina at one time, too much photocoagulation can cause macular edema and temporary vision loss.
15.Is it painful during the treatment?
Usually no pain. Occasionally, there is eye pain and swelling or headache during or after treatment, which is more common in patients with repeated treatments. If needed, medication can be given to relieve the pain. In addition, the patient should be prepared psychologically before treatment and cooperate well with the doctor.
16.Can photocoagulation cure diabetic retinopathy?
No. The purpose of photocoagulation is to try to preserve the vision. The purpose of photocoagulation is to try to maintain vision and stop the deterioration of the lesion. It does this by destroying the abnormal retina and stopping the formation of new blood vessels and fluid leakage. However, the disease still progresses, abnormal neovascularization and leakage can continue, and will need to be treated again. Therefore, diabetic patients should be followed up regularly and further photocoagulation therapy is necessary.
17. Is photocoagulation always effective?
No. Photocoagulation is effective for most patients, but not all. In some cases, bleeding can continue even after photocoagulation.
18. Can laser treatment be done if an IOL is available?
Yes. In patients with a posterior chamber IOL, the pupil can be sufficiently dilated and the fundus can be treated with photocoagulation.
19.What are the applications of fundus fluorescence angiography for diabetic retinopathy?
It can analyze in detail the changes of small retinal vessels, especially it can show abnormal neovascularization with imminent hemorrhage, and it can also find atretic capillaries, which are in need of treatment. Another application is that it can show microaneurysms and leaking vessels that need to be treated, especially when they appear in the macular area and cause macular degeneration and vision loss.
20.Treatment of diabetes by ancestral medicine
The holistic view and the principle of evidence-based treatment of ancestral medicine have shown great advantages in the treatment of diabetes mellitus, which is an important treatment for regulating the general condition, controlling blood sugar and treating complications. However, once a patient has proliferative retinopathy, it is recommended that eye treatment be based on photocoagulation and surgery so as not to lose the chance of treatment.
Diabetes is a disease involving multiple systems and organs, and it is important to emphasize comprehensive treatment, pay attention to the details of life, and stay away from the risk factors of diabetes. Doctors are willing to help you control diabetic eye disease and improve the quality of life with professional knowledge and means.