One of the most important complications of diabetes occurs in the eyes and can seriously affect the vision of the diabetic. “According to research, one in ten people on our planet suffers from diabetes. One in 4 patients with type 2 diabetes will develop eye damage due to the high concentration of sugar in the body. Of these, 50% are not aware of their problem, as they do not undergo a regular ophthalmological examination. points out Mr. Pantelis Papadopoulos Coordinator Director Ophthalmologist Surgeon 1st Ophthalmology Clinic Metropolitan Hospital.

Diabetic retinopathy?

“Diabetic retinopathy”, he continues, “is one of the most serious manifestations that appear in the eyes due to diabetes mellitus and is divided into two types:

• Non-productive retinopathy: This form can occur in a mild, moderate or severe degree. In this type, the small vessels of the retina are affected first. As the disease progresses, the capillaries become blocked, causing ischemia, while the larger vessels acquire damage to their walls, causing microbleeds, microaneurysms and exudates, which can lead to a decrease in vision due to fluid accumulation in the macular area. In this case we have diabetic macular edema.
• Productive retinopathy: In this type, due to extensive ischemia, pathological vessels, also known as neovessels, appear. If not treated early, these neovessels can cause a sharp decrease in vision due to hemorrhages, tractional retinal detachment, or even increased intraocular pressure (neovascular glaucoma).”

What factors are associated with the onset of diabetic retinopathy?

The development of diabetic retinopathy is associated with the following factors:

• Duration of diabetes mellitus
• Inadequate regulation of hyperglycemia (HbA1c > 6.5%)
• Hypertension
• Smoking
• Hypercholesterolemia
• Hyperlipidemia
• Proteinuria
• Pregnancy/pregnancy

What are the symptoms of diabetic retinopathy?

“In the early stages of the disease, there are no visual symptoms. Even when there are serious changes in the retina, due to non-productive retinopathy, the patient may not perceive any symptoms that will lead him to the doctor, because he does not feel any pain or his vision is not affected, says Mr. Papadopoulos and adds:

“The first symptoms of vision loss will appear when the macula, the central area of ​​the retina, where the most important photoreceptors are located, is affected. Diabetic macular edema is due to accumulation of fluid from the leaking vessels. In this case, vision loss occurs progressively and over a long period of time. But if some intrabulbar bleeding occurs due to neovascularization, then the decline in vision will be steep. In the case of neovascular glaucoma, the decrease in vision may also be accompanied by pain.

“Nevertheless”, it is worth noting that “even in advanced cases, the disease can develop for a considerable period of time without symptoms, underscoring the need for regular ophthalmological monitoring for people with diabetes. Patients with diabetes mellitus should be examined once a year if they do not have signs of diabetic retinopathy. If they develop signs, then follow-up should be more frequent, depending on the severity of the retinopathy,” he adds.

How is diabetic retinopathy diagnosed?

The best protection against diabetic retinopathy is regular eye exams. According to the American Academy of Ophthalmology, the recommended control frequency for patients with diabetes mellitus is defined as follows:

• For patients with type I diabetes, every year after 5 years from diagnosis.
• For patients with type II diabetes, immediately after diagnosis and every year thereafter.
• For pregnant women with diabetes mellitus, screening is recommended during the first trimester of pregnancy.

The annual eye examination helps in the immediate diagnosis of diabetic eye disease and includes various tests, such as:

• Visual acuity check

• Slit-lamp examination: The presence of cataracts and neovascularization of the iris are checked.
• Tone measurement: Measurement of intraocular pressure for possible glaucoma.
• Bottom survey: Examination of the fundus for signs such as microaneurysms, effusions, neovessels, vitreous hemorrhage, retinal detachment, and optic nerve lesions.
• Fluoroangiography: Intravenous contrast injection test for diagnosis of retinal vessel ischemia or leakage.
• OCT (Optical Coherence Tomography) macular: Real-time 3D visualization of retinal layers.
• CT Angio (Optical Angiography) macular: Capillary and vasculature imaging with bloodless angiography, without intravenous contrast injection.
• Color bottom photos: Digital fundus camera recording for detailed analysis of retinal anatomy.
• Wide field color photos: Detailed representation of retinal anatomy.

Who is most vulnerable to developing diabetic retinopathy?

“Usually, the first signs of diabetes in the eye appear in the majority of people with insulin-dependent diabetes (type I) about 10 to 15 years after the diagnosis of the disease. In people with type 2 diabetes, which developed at an older age, they are usually detected during eye examinations. The time of appearance of diabetic lesions directly depends on the regulation of sugar. If patients control their glycated hemoglobin (HbA1c) below 6.5%, they will likely never develop diabetic retinopathy. In patients with dysregulated sugar, the first signs appear after a decade. In addition, genetic factors seem to influence the degree to which the disease affects the eye, while in children suffering from juvenile diabetes, diabetic changes usually appear during adolescence,” explains the expert.

How often should a diabetic patient have an eye exam?

“Patients suffering from diabetes mellitus should undergo annual examinations if they do not show signs of diabetic retinopathy. If they are dealing with diabetic retinopathy or starting insulin therapy, the tests should be performed every 4-6 months, or more often, according to the ophthalmologist’s instructions.

Every diabetic patient should initially have a complete ophthalmological examination, including fundusoscopy. In addition, performing optical coherence tomography (OCT) is essential for a detailed fundus examination, especially in individuals with initial or probable diabetic retinopathy. At the same time, the digital photography of the fundus at regular intervals helps the ophthalmologist to detect small differences in the image of the fundus.

In case there are changes that affect vision, the condition of the fundus vessels should also be examined using fluorescein angiography. This test is performed after an intravenous injection of dye and visualizes the pathological signs in the vessels and the swelling caused by them. In many cases, this is necessary for laser treatment”, he notes.

How is diabetic retinopathy treated?

“The best approach to treating the disease is to control the diabetes,” he emphasizes. “The treatment approach varies according to the type and severity of diabetic retinopathy, with the ophthalmologist choosing the appropriate approach for each patient,” he continues, listing the treatment methods:

• Argon Laser Photocoagulation: This is focal photocoagulation that uses a laser to cauterize bleeding retinal vessels, with the aim of stabilizing vision and reducing exudates.
• Intravitreal injections of anti-VEGF agents: Anti-angiogenic drugs are used to combat pathological neovascularization and retinal edema.
• Vitrectomy or vitrectomy: It is a microsurgery that involves the removal of the vitreous body, mainly in cases of bleeding or retinal detachment.
• Valve insertion in case of neovascular glaucoma: It is an anti-glaucoma procedure to reduce intraocular pressure.

“These treatments are applied according to the stage of the disease and can stabilize or even improve the vision of patients suffering from diabetic retinopathy, macular edema and other related conditions,” concludes Mr. Papadopoulos.

*The Metropolitan Hospital has a fully equipped Ophthalmology Clinic, designed according to the high standards of international level ophthalmological centers. The clinic has experienced and specialized surgeons, while the staff is always willing to provide all necessary medical services. In addition, psychological support is provided, offering comprehensive care for patients, representing Metropolitan Hospital’s commitment to provide consistently and consistently high-level eye care, based on modern practices and technology.