Diabetic Retinopathy

What is Diabetic Retinopathy?

Diabetes is a disorder of glucose ( sugar ) metabolism owing to a deficit in insulin production or else it is an alteration in the use of insulin. Diabetic Retinopathy is a complication of diabetes and is one of the most frequent causes of blindness in our country. Estimated to be the most common cause of blindness in the working population, a person with diabetes is calculated to have 20 to 40 times more chance of becoming blind than a non diabetic person.

Why does Diabetic Retinopathy damage sight ?

In order to have good sight it is necessary for the retina to be functioning correctly. In Diabetic Retinopathy the blood vessels are lesioned owing to an increase in the amount of glucose in the blood. This in turn injures the nervous tissue, fluids leak into the extracellular space which produce an oedema and a lack of blood flow to key areas of this nervous tissue. This means that the reception and transmission of nervous stimulous will be inadequate.

Who is at risk of suffering Diabetic Retinopathy?

Everybody with diabetes, as much type 1 ( insulin dependant ) as type 2 ( not insulin dependant.) Its frequency increases with the number of years spent suffering from diabetes. After 20 years almost all type 1 patients and more than 60% of type 2 patients show signs of Diabetic Retinopathy when we explore the back of the eye.

What symptoms can a patient with Diabetic Retinopathy notice ?

You can have Diabetic Retinopthy and not notice anything at all in the initial stages of the illness. Nevertheless, as it progresses the symptoms can be the following. Blurred vision, flecks, black spots, spots flitting about, webs, and difficulty to see in low light and at night. Alteration in colour vision means that you don’t see the test strips for glucose correctly which indicates that control and treatment for diabetes is inadequate.

How can Diabetic Retinopathy be diagnosed ?

The only way to know if a person has Diabetic Retinopathy or not is by carrying out a complete ophthalmological examination. This will include a visual acuity test as sight is altered when patients are in the evolutionary stage, a microscopic examination using a slit lamp and dilation of the pupil with drops to explore the back of the eye using an ophthalmoscope. Another type of examination, depending on the case in hand , would be an angiograph which consists of injecting a colourant into a vein in the arm to see how much damage has been caused by injuries and lack of blood flow to the retina. Finally, sometimes carrying out a very sensitive OCT test may be indicated.

The degree that diabetes affects the back of the eye can be mild with the formation of a few small haemorrhage spots to serious haemorrhages flooding the the retina by oozing or by the creation of anomalous blood vessels inside the eye resulting in parcial or complete loss of sight.

How can Diabetic Retinopathy be prevented ?

All diabetics must keep strict control over their glucose levels, glycated haemoglobin , blood pressure, lipids, obesity as well as other associated cardiac vessel and kidney pathologies. Giving up smoking is also recommended as is eating the right food with regard to its glucose content and avoiding sedentary occupations.

From an ophthalmological point of view,getting periodic revisions of the back of the eye, whether you notice anything about your sight or not. This is very important because, by doing so, we can start treatment on lesions much earlier before they worsen and need more aggresive treatment.

What is the treatment?

The best treatment is prevention with strict control over glucose as well as other associated factors such as blood pressure and cholesterol levels. In cases of lesions in the retina, depending on the damage and where it is, treatment will usually begin with a photocoagulating laser attached to the slit lamp and be carried out in the consultant’s clinic.

Laser surgery means the application of a brilliant ray of light focussed through the pupil onto the damaged areas of the retina, though not onto the area known as the macula, in order to prevent greater loss of sight. This process is known as panphotocoagulation.

If the damage is more severe, other more sophisticated treatments could be necessary such as vitrectomia or the injection of specific substances , for example Anti VEGE, into the eye. These applications are carried out in the operating theatre.

Final recommendations for diabetic patients

Diabetic patients must keep a strict control over their glucose levels, and have a complete annual ocular examination with dilation of the pupil and visualisation of the back of the eye. Keep a close watch on other factors which make the development of diabetes worse by avoiding tobacco, controlling blood pressure and cholesterol levels. Be physically active, avoid sedentary habits, stick to a suitable diet, all these things will help to improve the physical and functional state of a person with diabetes. Perhaps the best recommendation for a diabetic person , in my opinion, would be that, even if loss of vision is not noticible an ophthalmological revision must be carried out annually.

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