If fundus disease is not controlled, beware of blindness There are many kinds of fundus diseases, and many of them have causes related to systemic diseases. With the increasing standard of living, many people suffer from diabetes, hypertension, hyperlipidemia and other diseases of affluence, which affect the human metabolism and cardiovascular function, while also causing damage to the blood vessels of the fundus, so these people are unknowingly entangled by “fundus disease”. The elderly are the main group of people with fundus disease due to their susceptibility to diabetes, hypertension, hyperlipidemia and aging of body organs. It is one of the main causes of blindness in China. Although the cause of fundus disease is complex and the development of the disease is difficult to control, as long as early diagnosis and early treatment are achieved, most patients can retain useful vision; if not treated in a timely manner, the disease will continue to develop and the retinal function will rapidly diminish, at this time, the prognosis for vision is poor, and the difficulty and cost of treatment are greatly increased, such as those who originally did not need surgery may have to operate, and those who could have operated may have lost the opportunity to operate. The time for surgery may be lost. Therefore, the biggest problem in the treatment of many fundus diseases is not a technical problem, but many patients do not know enough about fundus diseases, do not understand the danger of the disease, do not have timely medical treatment, when the development of the disease is unbearable, many are more serious, or even completely blind. In particular, the elderly are particularly prone to ignore fundus diseases, often confused by old eyes, the loss of vision, narrowing of the field of vision, mosquitoes and other phenomena mistaken for cataracts, vitreous turbidity, resulting in delayed treatment, thus losing the best time to save. Four major fundus diseases, the most common in the elderly 1, age-related macular degeneration Age-related macular degeneration often occurs in older people over 50 years old, both eyes at the same time or successive onset, and progressive damage to vision, its prevalence increases with age, is an important disease of blindness in the elderly. The cause of age-related macular degeneration is still unclear, but studies have shown that it may be related to genetics, chronic photodamage, malnutrition, poisoning, drug effects, and immune abnormalities. In addition, smokers or former smokers are much more likely to develop age-related macular degeneration than non-smokers. 2, diabetic retinopathy Diabetic retinopathy is a blinding eye disease that is difficult to reverse and is related to the course of diabetes, the longer the course of the disease, the higher the incidence of retinopathy. In the early stages of diabetes, patients not only have no obvious systemic symptoms, but also their vision is mostly unaffected. In general, eye complications begin to occur after 10 years of disease, with an incidence of about 20%, and after 2 years of disease the incidence of eye complications increases to about 50%, and after 30 years up to 90% of patients will develop eye lesions. Diabetic retinopathy, like chronic glaucoma, is painless at first, but when vision loss is detected, retinopathy is often very serious and eventually leads not only to blindness, but sometimes to severe pain due to secondary neovascular glaucoma, and even to eye removal. 3, retinal vein obstruction Retinal vein obstruction is closely related to various factors such as hypertension, atherosclerosis, hyperlipidemia, blood hyperviscosity and hemodynamics, etc. Its incidence also increases with the increasing incidence of hypertension and other cardiovascular diseases, and it is one of the most common retinal vascular diseases in the elderly, but there is still no effective treatment. The most common complication in the late stage is macular cystoid edema and neovascularization, which is the main cause of significant vision loss in patients, and some patients can go blind due to serious complications. 4. Posterior vitreous detachment Posterior vitreous detachment is an age-related degenerative change of the vitreous. Symptoms are sudden onset of floaters in front of the eyes, and floaters move with the rotation of the eye, and can be accompanied by a sense of flash in front of the eyes. The incidence of posterior vitreous detachment increases with age, and the incidence of posterior vitreous detachment in people older than 50 years old is 50% to 60%. Posterior vitreous detachment can sometimes cause retinal fissure, retinal detachment, retinal hemorrhage, vitreous hemorrhage, idiopathic macular fissure and other complications, resulting in vision loss. Therefore, once you notice a sudden floating object or flashing sensation in front of your eyes, you should be promptly examined and treated for any possible complications. The key to preventing blindness: regular eye examinations Although fundus disease has a great impact on vision, early stage fundus disease does not have obvious eye pain and redness, so patients and their families often ignore the development of the disease, especially the onset of monocular, more difficult to be detected. It is recommended that middle-aged and elderly people, especially those with systemic diseases related to fundus disease, should go to a specialized hospital regularly to check their vision and fundus even if they do not have obvious symptoms, so as to detect abnormalities at an early stage; if there are abnormal visual conditions, such as – transitory darkness, sudden dark shadows floating in front of the eyes, defects in the visual field of objects, dark areas in the center of objects, deformation of visual objects, and flashing sensation in front of the eyes, etc. For patients who have been diagnosed and are under treatment, they should be followed up regularly to understand the degree of disease development and adjust the treatment plan in time to reduce the occurrence of serious complications. A special reminder is the need for diabetic retinopathy screening. Overseas research over the past 30 years has shown that every diabetic patient has the potential to develop diabetic retinopathy, but with reasonable screening and treatment, 95% of diabetic patients can avoid serious visual impairment caused by retinopathy. At present, less than 1/3 of patients in China have eye exams within 5 years of diabetes diagnosis, and more patients are unaware of or too lazy to have regular fundus exams, which is most worrying. It is recommended that patients with diabetes, once diagnosed, receive at least one fundus exam per year. Diabetic retinopathy, age-related macular degeneration and retinal vein occlusion have in common that without early intervention, neovascularization can occur on top of the original lesion, and the leakage and bleeding of the neovascularization can lead to vision loss or degeneration. How to inhibit the growth of neovascularization and reduce exudation and bleeding has become the goal and focus of treatment. Before anti-angiogenic drugs were used in clinical treatment, there was no specific treatment for fundus neovascularization, but anti-angiogenic drugs can make neovascularization subside, reduce fluid leakage, maintain or even improve patients’ visual acuity, and are effective. However, the current clinical application of anti-angiogenic drugs has a short half-life and does not fundamentally remove the cause of neovascularization, so frequent intraocular injection therapy is required, and there is a potential risk of endophthalmitis, which is the obvious problem of anti-angiogenic drug therapy. 2.Laser treatment is a common means of treating fundus disease. For retinal fissures caused by posterior vitreous detachment, laser treatment can be used to close the retinal fissures before retinal detachment occurs, which can prevent the occurrence of retinal detachment. For diabetic retinopathy and retinal vein obstruction, if fundus angiography suggests signs of ischemia, laser treatment can control the deterioration of the disease. For age-related macular degeneration, photodynamic therapy with laser combined with photosensitizers can be used for treatment. 3.Vitreoretinal surgery With the use of vitreoretinal surgery, especially the improvement and development in recent years, the success rate of some complex fundus surgery is obviously improved, through surgery can achieve both the purpose of curing or controlling fundus disease, more importantly, some originally untreatable serious fundus disease to get the opportunity to restore light. Currently, vitreoretinal surgery is mainly used for: complex retinal detachment, severe eye trauma, diabetic retinopathy, retinal vein obstruction, etc. Because many fundus diseases are caused by various systemic diseases, if the “root” is not removed, there is a possibility of recurrence of fundus diseases at any time. Therefore, after treatment of fundus disease, regular review at the hospital is essential.