In recent years, the incidence of diabetes has gradually increased, and with it, the incidence of diabetic complications has also increased significantly. Diabetic retinopathy (DR) is a serious complication caused by diabetes and is a major cause of blindness in diabetic patients, and early intervention and treatment can greatly reduce the likelihood of severe vision loss and is critical to the prognosis. However, many patients do not seek early diagnosis due to various reasons, which eventually leads to serious complications.
I. The importance and necessity of early prevention and treatment of DR
The prevalence of DR is quite high among diabetic patients. In the literature, the prevalence of DR among diabetic patients ranges from 20.5% to 46.9%. 80% of type 1 diabetic patients with 10 years of disease develop DR; almost 100% of those with more than 15 years of disease develop DR. 15% of type 2 diabetic patients develop DR at diagnosis, and 55% of those with 10 years of disease develop DR; 70% of those with more than 15 years of disease develop DR [1]. DR occurs in patients with more than 15 years of disease [1].
The complications caused by DR, such as vitreous hemorrhage and macular edema, not only seriously affect the quality of life of patients, but also make the cost of treatment rise rapidly. Compared with diabetic patients without complications, patients with complications have 3-4 times more medical expenses, and the annual medical expenses of patients with ocular complications are 6.51 times higher than those of patients without complications.
The findings suggest that if patients with proliferative DR are promptly examined and treated, the blindness rate will be controlled from 50% to less than 5%, and effective treatment can effectively prevent severe vision loss (visual acuity <0.025) in 90% of DR patients. Therefore, the early diagnosis and treatment of DR is of great significance. However, due to the slow onset and long duration of type 2 diabetes, the effect of early DR on vision is also not obvious, so many patients already have DR when diabetes is diagnosed, and some patients even have serious complications before they come to the clinic. Therefore, the key to the prevention and treatment of DR lies in early screening and regular follow-up of diabetic patients, and early intervention and treatment.
II. Early intervention treatment
Effective intervention includes regular follow-up, laser photocoagulation and vitreoretinal surgery when necessary, in order to effectively control the disease and reduce the degree of visual impairment.
1, laser treatment: a large number of clinical trials have confirmed that retinal photocoagulation is a clear and effective method for the treatment of early DR. The results of randomized controlled clinical trials show that: laser photocoagulation for patients with mild to moderate DR combined with macular edema can reduce the risk of vision loss in 2-3 years; photocoagulation for patients with preproliferative DR combined with diabetic macular degeneration can reduce the risk of severe vision loss in 5 years; photocoagulation for patients with proliferative DR can reduce the risk of vision loss in 2-3 years. The risk of degeneration. In China, 398 patients with 776 eyes with DR underwent retinal photocoagulation and were followed up for 1 year after the surgery, and the results were: 617 eyes (79.5%) with improved visual acuity; 149 eyes (19.20%) with no change in visual acuity; and 10 eyes (0.12%) with decreased visual acuity.
The visual acuity of DR patients tended to decrease gradually with the aggravation of DR staging. Therefore, the earlier the laser intervention is performed, the more likely the patient will maintain better visual function under the premise of having indications for laser photocoagulation.
2, surgical treatment: vitreoretinal surgery is an effective way to save the vision of patients with severe DR. In advanced cases of DR, due to the occurrence of severe vitreous hemosiderosis and extensive proliferative membranes, laser treatment cannot be performed or the effect of laser photocoagulation is poor; or when significant vitreous macular traction occurs due to diffuse macular cystoid edema, vitreoretinal surgery may improve visual acuity.
Third, the reasons why patients did not undergo early treatment.
Early treatment is crucial to the prognosis of DR patients; however, many patients fail to undergo early treatment clinically, resulting in serious impairment of visual function. It was found that there are many reasons why patients did not undergo early treatment, mainly including.
① unawareness that fundus lesions can be treated with laser and fear that laser treatment will affect vision.
② Reluctance to laser and fear of laser because they can still see.
③False advertisements of drugs in the society mislead some patients about the inappropriate understanding of drug treatment for DR, which not only wastes a lot of financial resources but also delays the best time for laser treatment.
④Economic factors. From these reasons we can see that it is necessary to strengthen the popularization of scientific knowledge about diabetic retinopathy and correctly guide patients to receive laser treatment in time, which is an important measure to prevent vision loss and improve the quality of life.
IV. Prevention and treatment strategies
Large-scale screening of DM patients and diabetic high-risk groups is undoubtedly an effective method to prevent and treat DR. As the visual impairment of early DR patients is not yet obvious, they often only consult internal medicine and community doctors, who often have insufficient knowledge of DR, which leads to delayed treatment. Therefore, as ophthalmologists, we have the responsibility and obligation to educate internal medicine and community physicians and patients through all available opportunities to make them aware of the importance of early eye examinations so that the best time for treatment is not missed. For internal medicine and community physicians, when they find patients who meet the above conditions, they should refer the patients to higher level hospitals for examination if the medical institution is not available.
More importantly, the promotion of DR scientific knowledge should be widely carried out in the whole society, while refuting and stopping the propaganda of false medical advertisements. The government should also formulate specific preferential policies and strengthen social relief efforts for low-income people.
The key to early prevention and control of DR is to be patient-oriented. Doctors should establish a personal health record for each patient and provide patients with conditions for publicity, education, counseling, screening, regular lifelong checkups and follow-ups, and appropriate treatment when appropriate.
Patients with type 1 DM must have their first eye examination 5 years after diagnosis, and then follow up once a year; patients with type 2 DM should have their first eye examination when they are diagnosed, and then follow up once a year; patients with type 1 or type 2 DM should have their first eye examination before pregnancy or within 3 months of early pregnancy, and those without DR or mild or moderate non-proliferative DR should follow up once in 3 to 12 months.
V. High risk factors
The close relationship between the occurrence of DR and the duration of diabetes and the level of glycemic control has been recognized. In addition, recent studies have found that there are many risk factors for the aggravation of DR. Such as: hypertension, cardiovascular disease, hyperlipidemia, diabetic nephropathy, old age, large body mass index, alcohol consumption, etc.. Therefore, for the treatment of diabetic patients, ophthalmologists should not only discover the local condition of the eye, but also focus on systemic treatment.
VI. Outlook
We believe that with the support of governments at all levels and the joint efforts of medical workers and patients, by promoting the diabetes management model, screening, regular examination and long-term follow-up of diabetic high-risk groups and diabetic patients, and giving timely and appropriate intervention treatment, we can effectively prevent the occurrence of diabetic complications, slow down the development of retinopathy, and enable most diabetic patients to preserve useful vision.