The World Health Organization is sounding the alarm. The fact is that every day the number of people with diabetes is becoming more and more. The International Diabetes Association estimates that by 2030, one in nine people on the planet will be a diabetic. Diabetes itself is not so dangerous, unlike the complications that it causes. It turns out that a person with this disease can quickly lose precious vision. There is a statistic that says that sugar consumers are 25 times more likely to lose their eyesight than people without this disease. And all the blame for diabetic eye retinopathy.
Disease definition
Before you begin to study the question of diagnosis in detail, you should find out the meaning of the medical term. Leading ophthalmologists of our state believe that diabetic retinopathy refers to specific diseases of the retina. It develops in 98% of diabetic patients. This disease originates from changes in retinal vessels, in the future it progresses and affects new vessels. The main pathological processes are occlusion and edema of the vessels of the organs of vision. This means that diabetic retinopathy leads to a decrease in visual acuity in people with diabetes.
Prevalence
In Wisconsin (USA), epidemiological studies of this disease were conducted. Ophthalmologists have come to the conclusion that in developed countries the able-bodied part of the population suffers from retinopathy. It is she who is the main cause of vision loss in people. A group of diabetics with an experience of 15 years had a pathology of the organs of vision in 98% of cases. If the patient has high blood sugar for an extended period, this soon leads to vascular changes and even complications from the organs of vision.
How does this happen?
Further in our article you will learn about diabetic retinopathy, symptoms, treatment. Excess glucose in the blood leads to the fact that macro- and microvessels become thinner, become brittle and brittle. When they burst, new capillaries are formed in the same place, which in quality are much inferior to the previous ones. After all these processes, the retina, which allowed a person to see the world around him, is already functioning much worse. Patients, as a rule, ignore the first alarm signals. Day after day, year after year, diabetic retinopathy is progressing. After a certain amount of time, a person completely loses sight. You will learn how to avoid total blindness in our article.
The clinical picture of the disease
Before talking about treatment, you need to pay attention to the symptoms of diabetic retinopathy. The earliest clinical manifestations are hemorrhages (hemorrhages) and microaneurysms (protrusion of the walls of blood vessels under blood pressure). Further, in later and severe stages, anomalies and neoplasms of the vessels on the optic nerve disc are formed. It was said above that there is retinal edema. It is he who causes the deterioration of visual acuity in the first stage. Then there is a hemorrhage in the body of the eye. At the final stage, the surface of the retina is bent and peeled off. It should be noted: the larger the area of the edema, the worse the prognosis for the visual functions of the eye.
So, when contacting an ophthalmologist, diabetics complain of worsening or even loss of vision. This suggests that it is impossible for patients to independently determine the presence of retinopathy, therefore it is necessary to undergo a full examination at the ophthalmologist at least once a year.
Classification of Diabetic Retinopathy
In the 21st century, there are several classifications of this disease. Each of them has its own advantages, and also each of them most determines the clinical picture of the disease and treatment strategies. For example, the American Diabetes Association in 2000 classified retinopathy into 5 stages. Domestic ophthalmologists adhere to the classification introduced by the World Health Organization. Thus, in Russia, doctors distinguish three stages of the disease. Next, we consider each of them in detail.
First stage
Very often, during a routine examination of a patient with high glucose levels, ophthalmologists diagnose non-proliferative diabetic retinopathy. This is the earliest and most favorable stage for the treatment of pathology. It is during this period that when examining the fundus, doctors find retinal hemorrhages and microaneurysms. They also fix vascular abnormalities.
In addition, already at the first stage there is exudate - this is a liquid in the tissues of the eye. In other words, capillaries are damaged - small vessels that supply the retina with food. The permeability of capillaries increases markedly, therefore hemorrhages occur. Then the first retinal edema is formed.
Second stage
Or, in medical terms, preproliferative diabetic retinopathy is not the worst stage in the development of a disease. At this stage, ophthalmologists see areas that experience a decrease in blood supply. Changes in the retina are becoming larger, there are many hemorrhages, as well as even more fluid accumulation. At this stage, the optometrist understands that the eye is experiencing a violation of blood supply and the vessels begin to "starve." The center of the retina, or, in scientific terms, the macula, is already susceptible to pathological changes.
Third stage
The patient’s situation is much worse if the ophthalmologist diagnoses proliferative diabetic retinopathy. At this stage, the vessels begin to grow and penetrate the cornea. This is what leads to retinal detachment - the patient becomes almost blind. Despite the fact that new vessels form, hemorrhages become more and more, as new capillaries are thinner and more prone to injuries. The peak of retinopathy is the terminal stage, when the macula no longer holds the rays of light, which means that the patient is completely blind.
So, we have studied the three stages of diabetic retinopathy, which were introduced into modern medicine by the World Health Organization.
Ophthalmologic examination
It is worth recalling that the main symptom of retinopathy is a deterioration in visual acuity or its 100% loss. Unfortunately, these symptoms appear in the later stages when the course of the disease is started. Therefore, it is impossible to postpone treatment, because the patient has every chance to maintain good vision. Diabetic patients should visit an optometrist regularly - twice a year will be enough. It is best to make an appointment with an ophthalmologist who has experience in the treatment of retinopathy.
Diagnosis of diabetic retinopathy can take place outside the hospital. You can find a doctor in modern diabetes centers or clinics that specialize in the treatment of organs of vision. Today, doctors use a very wide range of the latest techniques. Mandatory procedures are: tonometry (measurement of eye pressure), ophthalmoscopy (examination of the fundus with an enlarged pupil), determination of visual acuity. Additional methods include perimetry, gonioscopy, ultrasound, fundus photorecording, as well as biomicroscopy with various contact lenses.
The main technique, which presents objective data on the state of the vessels of the retina of the eye, today is optical tomography, as well as fundus angiography.
For patients with type 1 or type 2 diabetes, diagnosis in the early stages of the disease gives a chance to stop the pathological processes. It is worth noting that even at the last stage, the disease can be asymptomatic! Patients sometimes do not even realize that irreversible pathological processes in the organs of vision have begun. Remember that early diagnosis of this insidious disease is extremely important, because in the modern arsenal ophthalmologists have an effective treatment method called laser retinal coagulation.
Ophthalmic Diabetic Observation Principles
Diabetics must be systematically monitored by an ophthalmologist or ophthalmologist. Management of patients occurs according to certain principles:
- the first appointment with the ophthalmologist should be carried out immediately after the diagnosis of diabetes mellitus has been identified;
- if pathological changes in the eye are not detected, the next examination should be carried out no later than 12 months later;
- patients with elevated levels of glycated hemoglobin (> 8%) and hypertension should undergo an ophthalmic examination once every six months, even if pathologies are not detected;
- every diabetic should be examined by an ophthalmologist when he is transferred to insulin therapy;
- if you suddenly found a decrease in visual acuity or if you have any other complaints about the eyes, then an ophthalmologist should be examined immediately, regardless of when the doctor last examined you;
- Such examinations should be carried out by women of childbearing age who have diabetes! This is important because diabetic retinopathy in a pregnant woman can cause heart disease in an unborn baby.
How to maintain eye health
Now let's talk about how to stop diabetic retinopathy. The treatment of this disease occurs in a complex of measures.
- First, diabetics need to compensate for their underlying illness.
- Secondly, ophthalmologists prescribe laser coagulation of the vessels of the retina of the organs of vision.
In other cases, they use intravitreal administration of corticosteroid drugs, as well as inhibitors. In severe cases, vitrectomy is used. Recent studies have shown that vitamin therapy, antioxidants and other enzymes do not have a therapeutic effect in the treatment of retinopathy. This means that drugs such as Caviton and Dicinon are not prescribed to preserve the visual function of the eye. If you do not do eye treatment on time, then this ailment will also cause other concomitant diseases. In a diabetic patient with retinopathy, glaucoma, retinal detachment, cataracts and loss of vision are often detected.
To maintain your remaining health, you need to end bad habits. Smoking and drinking alcohol for diabetes is the last thing to do. Passive lifestyles increase blood glucose levels. Try to drink more pure water, only it removes excess sugar from the body. Timely and systematic cleaning of blood vessels with antioxidants allows you to maintain the health of micro and macro vessels!
Injections for vision
An effective method is the introduction of modern drugs into the cavity of the eye with an injection. The procedure is done on the operating table. First, the ophthalmologist with a tool determines the place for an injection inside the eye. The patient is not hurt, an injection is placed under local anesthesia. The substance introduced into the eyeball causes the newly formed vessels to regress, that is, to coagulate. In the first six months, injections are given once every thirty days. Then the doctor does the patient an angiography and decides how often and how many more injections are needed.
Laser coagulation
This method was developed back in the seventies of the XX century. It is considered the gold standard in curing fundus pathology of diabetic origin. Laser surgery is considered the most effective procedure for treating edema and proliferative diabetic retinopathy. During this procedure, the vessels of the fundus are cauterized by a laser beam, after which the vessels stop the pathological proliferation. But this method has a significant drawback - damage to a considerable part of the surface of the retina.
conclusions
Treatment for diabetic retinopathy is possible! The patient should not expect deterioration in the quality of vision or the appearance of other complaints. A diabetic must at least once a year go to an appointment with an ophthalmologist. This specialist should not only check visual acuity, but also drip drops that dilate the pupil, and then examine the retina in detail.
Doctors say that the early detection of retinopathy and its timely treatment, clinical follow-up allow patients to maintain visual function for many decades. But it should be understood that all this requires knowledge and skills not only from endocrinologists and ophthalmologists, but also the most active participation of the diabetic patient in the process of treatment and rehabilitation! Subject to the above factors, diabetes will not be a punishment, but a way of life.
If it was not possible to maintain vision, then it is necessary to collect documents for medical examination in order to determine the disability group and in the future receive a pension. Be attentive not only to your health, but also to the well-being of relatives and friends.