3,000 people lose their eyesight (visual impairment) every year due to diabetes
Eye diseases caused by diabetes, especially diabetic retinopathy, have a scary feature that the disease progresses without any symptoms, such as pain, itching, or blurred eyes. Moreover, one day one will go to the ophthalmology department immediately because the eyes feel the accumulation of soot, or feel the red curtains become blurred, at which point the disease has progressed to the point of no return and one has to face the reality of blindness.
Because having diabetic retinopathy, even if it does not reach the level of blindness, creates an obstacle to adapting to society as a whole. People who are recognized as visually impaired become social welfare care recipients. The number of people with this condition is about 1 in 5 of those with visual impairment, and can reach 3,000 a year.
These people suddenly lose their sight in their young adulthood and are unable to receive social care, and the psychological guidance for social reintegration does not take place as desired, which increases the burden on their families.
Diabetic retinal patients with diabetes, if they do not take care of their blood glucose control, will not understand the complications of diabetes until 7 or 8 to 10 years later.
Of the 2,300 people (type 2 diabetes) in the entire hospital treatment center, about 37% had diabetic retinopathy, and about 17% of them had simple retinopathy. With proper glycemic control, it can be controlled. It is not too much to say that the remaining 20% may be at risk of losing their eyesight at any time. In addition, according to the Ministry of Health and Welfare, after 25 years from the onset of diabetes, more than 80% of patients have retinal disease as a complication. The onset of retinal disease varies from person to person. Generally speaking younger diabetic patients under 40-50 years of age develop more rapidly and require adequate attention.
Why does blindness occur
Complications of diabetes that occur with blindness and visual impairment include cataracts and vascular neovascular green cataracts, in addition to retinopathy.
1.Retinopathy
Retinopathy is the result of damage to the retina, which acts as a film for irradiating images. The retina has the ability to perceive light and color and relay its results to the brain. The retina is filled with many tiny blood vessels that are sticky, so it can clog the tiny blood vessels, which aggravates the burden on the vessel walls and triggers capillary disease, causing retinal nutrients and nutrient deficiency, which leads to retinopathy with symptoms of fundus hemorrhage and nitrosomal hemorrhage.
The development process of retinopathy is divided into three stages: simple retinopathy, preproliferative retinopathy, and proliferative retinopathy.
2.Cataract
Cataracts caused by diabetes are mainly due to the increase of sugar in the body. It is equivalent to the crystal body of a camera lens, which becomes blurred because of the accumulation of sugar. In general, most cataracts are advanced cataracts. When you have diabetes, you will get cataracts soon. The main treatment nowadays is to remove the crystalloid and install an intraocular lens made of plastic. When the condition is severe, even this kind of surgery cannot be done.
3.Vascular neovascular green cataract
When retinal disease progresses to the terminal stage, it will be complicated by vascular green cataract. The pathway of development is different from that of green cataract in the general sense. When diabetic retinopathy develops to a very serious stage, some abnormal neovascularization is produced in the part called the rainbow, which plays the role of narrowing the aperture. In order to moisten the eye, a part with water is usually formed around the rainbow, and because of the appearance of neovascularization, the outlet of water is blocked, therefore, the eye pressure increases, the optic nerve is compressed, the vision is weakened, and eventually the condition of blindness develops.
Precision fundus examination should be long-term
Diabetic retinopathy is asymptomatic in the early stages, and it is likely that abnormalities are found during physical examinations. In addition, the earlier it is detected, the higher the success rate of treatment.
It is very effective to perform a thorough fundus examination. The so-called precision fundus examination is a test in which the light is aimed at the eye so that the internal measurements of the eye can be better observed, eye medication is used to suppress the contraction of the pupil (called dilated pupil in technical terms), and a detector and fundus camera are used to examine the condition of capillary hemorrhages and breaks in the retina. This test can detect fairly small capillary hemorrhages and disruptions.
A fundus examination can be performed during a lifestyle disease consultation. In this case, instead of dilating the pupil as in a precise fundus examination, a diagnostic test is performed mainly by taking pictures of the central part of the fundus. Therefore, it may not be possible to detect the initial signs of diabetic retinopathy, such as hemorrhage and rupture.
In order to detect diabetic retinopathy as early as possible, it is necessary to have regular and precise fundus examinations by a professional ophthalmologist in addition to the general lifestyle health examination. type 2 diabetic patients may be diagnosed with diabetes without knowing when the onset of the disease begins, and the complication retinopathy has already progressed to a deep stage. Therefore, it is necessary to make a habit of starting regular diagnostic and sophisticated examinations with an ophthalmologist at the same time as the diagnosis of diabetes.
The progression of diabetic retinopathy
Diabetic retinopathy is divided into three stages: simple retinopathy, preproliferative retinopathy, and proliferative retinopathy.
They can be clearly distinguished by looking at the fundus of the eye.
The 3 stages of diabetic retinopathy
1. Simple retinopathy
The retina is filled with capillaries everywhere. Due to high blood sugar, the blood vessels become brittle and hard, and the blood vessels become clogged, causing a state of bleeding in small spots (punctate hemorrhage). The proteins and fats in the blood begin to leak out, and the resulting hard white spots and capillaries become abscessed, forming a capillary hemangioma.
Self-perceived symptoms: Not at all
Treatment: With proper blood sugar control, it will usually disappear naturally.
2. Preproliferative retinopathy
Capillary disease caused by diabetes is progressing. Once the capillaries are blocked, the nerves in this part are in a state of anemia and soft white spots are formed. Due to the lack of oxygen, the blood vessels themselves are on the verge of necrosis everywhere. In order to replenish the necrotic blood vessels, preparations are made to create brittle capillaries that cause hemorrhage in the retina and nitrosphere. In addition, the veins swell up abnormally and the capillaries become irregular in shape.
Self-perceived symptoms: Almost none.
Treatment: To get the true picture, sometimes a fluoroscopic fundus examination is performed. In this condition, performing laser coagulation surgery is the most effective treatment.
3. Proliferative retinopathy
New blood vessels continue to the nitrophthalmos. As the blood pressure of the new blood vessel rises, it produces a ruptured nitrosomal hemorrhage. As a result of the new blood vessels, a new film, called proliferative film, is produced on the retina. This proliferative film causes peeling of the healthy film, indicating that the disease has progressed to a severe stage.
Self-perceived symptoms: Mild to high degree of vision loss, at which point blindness occurs.
Treatment: Laser coagulation surgery is sometimes performed. When the condition of nictitating body hemorrhage and retinal detachment is severe, nictitating body surgery is performed.
Surgical treatment for diabetic retinopathy
In the stage of simple retinopathy, if the blood sugar is properly controlled, the disease condition will not continue to progress, but if it does, surgical treatment surgery is necessary. In this case, laser coagulation surgery is performed in the pre-proliferative retinopathy stage, and nitrosome surgery is required in the proliferative retinopathy stage.
1.Laser coagulation surgery
In the proliferative retinopathy stage, due to hyperglycemia and lack of oxygen, in order to replenish the necrotic retina, neovascularization is formed, which previously did not exist in the healthy eye. The neovascularization is very brittle and gives a bad effect on the retina and nitidarium. The so-called laser coagulation procedure is a treatment that uses a laser to prevent such blood vessels before they form or, for those that have already been created, to burn them up.
It is possible to treat it in a general outpatient clinic. It takes about 15 minutes to apply anesthesia to the eye, and although you may feel shaking eyes, there is no special pain, and it can be performed safely. If the retinopathy deepens, it can be performed in 3-4 sessions, with a dozen to several hundred coagulations each time.
Laser treatment, in its early stages, is 80% effective. In severe cases, the effectiveness rate decreases to 50-60%. This treatment does not restore vision, but it is a very effective treatment from the point of view of preventing the development of retinopathy.
2.Nitreous body surgery
Laser coagulation is an operation performed on retinas that cannot be controlled. Either the blood leaking from the new blood vessels is sucked out, the location of the nictitating body that is the cause of the bleeding is electrically coagulated, or the detached retina is returned to its original position. At the same time, a laser is aimed at the site that became the cause of the detachment to prevent rebleeding and recurrence of retinal detachment.
This surgery is difficult, and even if it is successful, it is almost impossible to restore the vision to its original position. As a result of the surgery, corrected vision is restored to 0.5 or more in about 25% of cases, and most of them have vision of 0.1 or less and stay at the level of being able to do their own things with good difficulty.
Key points of retinal disease control
Nowadays, treatments for diabetic retinopathy like laser coagulation have been greatly improved. But in any case, the key to preventing blindness is self-control of blood sugar. We know that people who aim for good glycemic control and tenaciously adhere to food and exercise regimens will have a hard time developing diabetic retinopathy, and even if they do develop it, it will be difficult to progress further.
In order to avoid diabetic retinopathy, it is important to pay adequate attention to it in general. Even if you are unfortunate enough to have retinopathy, you must pay attention to the following matters.
1. Sudden blood sugar control
In type 2 diabetes, if blood sugar levels remain high and are left unchecked, retinopathy may develop. Because the discovery of retinopathy, the sudden start of strict control of blood glucose can sometimes aggravate the retinopathy instead. It is necessary to treat the disease in a medical way and also to conduct a precise examination of the eye.
2. Restricted exercise therapy
Exercise therapy is very important to maintain good blood sugar control habits. When the disease progresses to the stage of pre-proliferative retinopathy, ball games, jogging, and swimming are possible; when the disease progresses to the stage of proliferative retinopathy, because intense exercise may cause neovascular hemorrhage, this stage is limited to light exercise such as walking.
3. About childbirth
There is a risk of blindness due to further deterioration of retinopathy as a result of childbirth. Beforehand, you should undergo a precise fundus examination, and depending on your condition, retinal disease should be treated with laser coagulation methods. If the blood sugar is well controlled, pregnancy and delivery are not relevant.
Prevention and early detection can prevent blindness
Although prevention and early detection and treatment of diabetic retinopathy are possible because of proper blood sugar control and regular sophisticated fundus examinations, it is eventually known to the world as the first cause of blindness.
This is the result of not having regular eye examinations.
The percentage of patients who had developed proliferative retinopathy at the first visit to the ophthalmology department of the Tokyo Women’s Medical University Diabetes Center was 10% (survey conducted between January 1998 and December 94). Of these, 33.6% were company employees and civil servants, 28.1% were self-employed, and 36.8% were unemployed, including housewives. From the results of this survey, we can see that among those who directly develop proliferative retinal disease, there are many corporate employees, self-employed people, and housewives who are compelled to undergo lifestyle disease health care.
It is important for diabetic patients to be aware of the risk of losing their eyesight in their life course, and to actively undergo lifestyle disease diagnosis and regular precision eye examinations.