More than 40% of patients with diabetes belong to the age group 40-59 years, ie they belong to the active working population.
About one in three diabetics will develop diabetic retinopathy.
“The patient with diabetes should be aware that deregulated sugar can cause a number of serious complications that can jeopardize vital functions such as vision or even life itself.
“Regulated sugar in combination with good levels of lipids and blood pressure contributes significantly to the prevention of the above ocular complications, as well as all the complications of diabetes”, says Mr. Konstantinos G. Fotis, MD, MSc, FEBO, Director of the Department Hemiperium, Ophthalmologist Surgeon of the 2nd Ophthalmology Clinic of the Metropolitan Hospital, who explains to us the severity of the damage that diabetes can cause to the patient’s vision.
How does diabetes affect the eye?
Elevated blood sugar levels result in its accumulation in the walls of blood vessels, causing narrowing and blockage of blood vessels. Small vessels such as those of the retina as well as the vessels that feed the nerves, precisely because of their small diameter are particularly affected by this accumulation of sugar.
THE diabetic retinopathy is a form of microvascular disease that causes changes in the blood vessels of the retina.
In the early stages, or in the stage of non-productive diabetic retinopathy, microangiopathy is limited to the retina.
The progression of the disease to its productive form occurs because microvascular lesions limit the supply of oxygen to the retina. In the body’s effort to make up for the lack of oxygen, new abnormal vessels (new vessels) develop from the retina to the inside of the vitreous cavity. This development can lead to dramatic loss of vision due to bleeding in the vitreous, attractive retinal detachment and neovascular glaucoma.
At any stage of retinopathy, diabetic pallor can occur, ie the central area of ​​the retina, the macula, which is responsible for our central vision, can be affected. The lesion can be caused either by disturbance of blood circulation and subsequent ischemia and atrophy, or by leakage of fluid and subsequent macular edema (focal or diffuse).
Sometimes diabetes can cause swelling of the optic nerve, a condition called diabetic optic neuropathy. This is not related to the severity of the retina. It generally does not significantly affect vision, but is an indicator of poor diabetes control.
There are also eye diseases, which are not due to diabetes, but are more common and, in some cases, progress faster in diabetics. Those that should also be checked are:
The diplopia. Diabetes is the leading cause of neurological damage that affects the mobility of the eyes.
The waterfall. Type 1 diabetes can cause a type of cataract, and age-related cataracts tend to occur earlier in diabetic patients.
Glaucoma. In diabetics, any type of glaucoma occurs (chronic open-angle glaucoma, closed-angle glaucoma, neovascular glaucoma).
The obstruction of the central vein of the retina or its branch.
Ischemic optic neuropathy, which is due to vascular damage and differs from the aforementioned diabetic optic neuropathy.
What are the symptoms of diabetic retinopathy and pallor?
The appearance of symptoms depends on the type and degree of lesions. Many times patients remain asymptomatic even in relatively advanced stages of the disease, which underscores the need for periodic eye examinations.
Fluctuations in blood glucose levels can lead to corresponding fluctuations in the quality of vision, but these are usually transient.
Diabetic pallor and macular edema cause blurred vision.
Productive diabetic retinopathy can cause small bleeds inside the vitreous, which are perceived as dark spots (flies). “Greater bleeding, however, can lead to loss of part of the visual field (” killings “) to complete loss of vision,” said Mr. Fotis.
In even more advanced cases of productive disease, attractive retinal detachment can be observed, which, if it affects central vision and is not treated in time, can lead to permanent vision loss.
Finally, in rare cases of advanced productive disease, neovascular glaucoma can be induced, where a sharp increase in intraocular pressure causes severe pain, nausea, photophobia, and decreased vision.
Proposed program of initial ophthalmological examination and continuous monitoring
Type 1 diabetes: First examination within 5 years from the diagnosis. If the history is unclear as to the diagnosis, then it is considered that 5 years have passed. In children, the first check-up is done at the age of 5 from the diagnosis or in adolescence, whichever is earlier.
Then annual monitoring. The frequency of screenings may increase if diabetic retinopathy is diagnosed, depending on the severity of the findings.
Type 2 diabetes: First examination immediately after diagnosis of the disease. Then annual monitoring. The frequency of screenings may increase if diabetic retinopathy is diagnosed, depending on the severity of the findings.
Gestational diabetes mellitus: First examination immediately after diagnosis and regularly (every 3 months) during pregnancy. If diabetes does not persist after childbirth, no further monitoring is required.
What does the ophthalmological examination include during the periodic examination of the patient?
Every patient diagnosed with diabetes has a complete ophthalmological examination, which includes measurement of visual acuity, examination of the anterior half of the eye in the slit lamp and measurement of intraocular pressure. Then, and after the administration of drops for dilation of the pupil (mydriasis), follows the endoscopy for the detailed control of the retina and the optic nerve.
An imaging test is also performed, which includes retinal and macular imaging with a bottom photograph, optical coherence tomography (OCT) and OCT angiography.
Depending on the case and clinical and imaging findings, retinal autofluorescence examination, digital fluoroangiography with intravenous dye injection and ultrasound (B-scan) may be performed.
What is the treatment for diabetic retinopathy and pallor?
“Today, we have several treatment options for treating diabetic retinopathy, pallor and macular edema.
“These include the intravitreal injection of anti-angiogenic agents (Anti-VEGF) or corticosteroids, which is done by injecting the drug inside the eye,” the doctor points out.
THE laser φωτοπηξία of macular degeneration also reduces swelling and can be done with a conventional laser (focal or “network trial”), as well as with micropulse lasers that can be combined with intravitreal injections.
The treatment of productive diabetic retinopathy includes laser retinal photocoagulation, in which the laser covers the peripheral retina and not the macula, aiming at the retraction of the new blood vessels and the preservation of existing vision by avoiding vision.
When complications of productive diabetic retinopathy occur, such as significant bleeding and / or retinal detachment, then the treatment is surgery: it is an operation called pars plana vitrectomy.
The operation removes the vitreous and bleeding, and seeks to remove the neovascular membranes to prevent traction of retinal detachment. “In case of presence and detachment, then surgical treatment is sought to maintain vision,” concludes Mr. Fotis.
Writes:
Mr. Konstantinos G. Fotis, MD, MSc, FEBO, Director of the Posterior Department,
Ophthalmic Surgeon of the 2nd Ophthalmology Clinic of the Metropolitan Hospital
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