It is estimated that the number of people suffering from SD will reach 629 million in 2045.
“We can liken the eye to the camera. The cornea and the lens of the eye correspond to the lens of the camera while the retina corresponds to the film where the images are recorded.
The retina contains all the nerve cells and embryologically, it is an extension of the brain. It is sensitive to anatomical and biochemical disorders and has no special regenerative abilities. The retinal nerve cells are concentrated and through the optic nerve and the optic pathway end up in the occipital lobe of the brain.
In the occipital lobe, the high process of image recognition takes place “.
Diabetic retinopathy is the most common complication of small vessel diabetes. It is the main cause of reduced vision in the productive age. And the more common the diabetic retinopathy, the older the age and duration of the condition or the less well-controlled the diabetes is.
Glycosylated hemoglobin is an important indicator of their blood sugar control and the patient should make sure that it is checked regularly by his treating physician. 80% of patients with diabetes for more than 10 years develop lesions of diabetic retinopathy.
Diabetic retinopathy has several stages. In the early stages, diabetic retinopathy does not need treatment. However, when the ophthalmologist detects the initial lesions of diabetes in the retina, the next step is to optimize glucose regulation, hypertension and hyperlipidemia. The aim is, by controlling all the parameters that create similar damage to the vessels, to reduce the rate of development of the lesions.
As the lesions progress, swelling may occur in the macula, which is the area of ​​the retina responsible for acute vision, that is, reading and seeing details and colors. Swelling, ie the presence of fluid between the cells, leads to visual disturbance with reduced sharpness, blurring and distortion of the image. In this case, it may be necessary to start treatment with injections into the bulb, which by affecting the biochemistry of the disease lead to the absorption of fluid.
At a more advanced stage, the retina may show ischemia, ie reduced oxygen supply in some areas due to vascular lesions.
In the stage of pre-productive, as it is called, retinopathy, deep hemorrhages appear and new pathological vessels that, however, do not have the ability to cause bleeding. In the next stage of productive retinopathy, however, abnormal blood vessels are produced, which are very fragile and can cause bleeding inside the bulb and even retinal detachment as the changes worsen.
Vision is reduced quite dramatically depending on the severity of the bleeding while it is treated with an extended laser in the retina which aims to reduce the abnormal blood vessels and stop the recurrent bleeding. The bleeding is usually absorbed within a month, as long as it is relatively mild. If the laser is not done in time, it can recur. Surgery can be done if the bleeding is not absorbed or in cases where the lesions have led to retinal detachment.
Most of the difficult cases of diabetic retinopathy would have been predicted if a systematic eye examination had been performed. It is important to understand that the lesions that occur in the eyes are similar to those that occur in organs that cannot be directly examined, such as the heart, kidneys and brain.
Therefore, the image of the eyes guides the treating physicians in the regulation and treatment of diabetes as a whole.
According to the guidelines of the American Ophthalmological Society and most European protocols, patients with diabetes should have a complete eye examination at diagnosis and then every year in the absence of retinopathy or in very mild diabetic retinopathy. The intervals thicken as the disease progresses, with screening every 3-4 months for patients with pre-productive retinopathy. In patients who have been treated for the productive form, the ophthalmological examination should be done even monthly in some cases.
Repeat that the ophthalmological examination can help in prevention by informing the patient and the treating physician about the general course of the disease.
The ophthalmological examinations that must be done are taking the visual acuity, measuring the intraocular pressure and dredging. It is extremely important to take color bottom photos that will be used comparatively per test. Optical Coherence Tomography (OCT) shows even non-clinical swelling in the macula and guides us in its progression. In some cases, fluoroangiography is needed, a special examination with a shadow that shows all areas of retinal ischemia, possible macular ischemia and any abnormal neo-vessels.
All the above examinations help in the accurate diagnosis and in the creation of a plan for the treatment of the diabetic lesions of the eyes.
In cases where the ophthalmologist needs to intervene therapeutically, he can literally prevent a serious and irreversible loss of vision. Today, we have intravitreal injections in our therapeutic quiver which can improve vision and anatomically stabilize the area. They are supported by a large volume of research work and are widely used worldwide.
Regular eye examinations with additional examinations as well as timely treatment can improve diabetic lesions and enable diabetic patients for an excellent quality of vision and therefore, life.
Writes:
Mr. Mania Niskopoulou PhD, Ophthalmic Surgeon at Metropolitan General,
Specialist in Macular-Retinal Diseases, Specialization at Moorfields Eye Hospital, London, UK, President of the Hellenic Society of Vitreous-Retina
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