What is it?
Diabeticretinopathy
It is an ocular and vascular complication of diabetes mellitus that originates when the vessels that irrigate the retina deteriorate. It can affect any patient with type 1 and type 2 diabetes. Insufficient control of this disease by the patient and high blood glucose levels cause microcirculatory alterations that can affect the retina in different ways, resulting in two types of diabetic retinopathy.
In any of these cases, progressive damage to fundamental ocular structures as a result of diabetes can lead to severe vision loss and even blindness if not properly treated.
Diabetic retinopathy is the most common retinal disease and the main cause of blindness in the western world. Two of the main risk factors that can condition the early onset of this pathology and aggravate its development are diabetes, when it is suffered for a prolonged period of time with metabolic decompensations, or arterial hypertension.
TYPES OF DIABETIC RETINOPATHY
- Non-proliferative diabetic retinopathy (NPDR)
This is the earliest stage of diabetic retinopathy. It occurs when the altered vessels dilate and become more permeable, leaking fluids into the vitreous space (plasma, lipids and/or blood) that begin to swell the retina(macular edema).
- Proliferative diabetic retinopathy (PDR)
Occurs when there are obstruction phenomena(macular ischemia) in the blood vessels with lack of irrigation in the retina. In an attempt to supply blood to the affected areas, the retina responds by forming new blood vessels (neovascularization). However, these vessels covering its surface are abnormal, as they do not provide adequate blood flow and are accompanied by scar tissue. This situation can lead to important complications for vision. The most common are vitreous hemorrhage or hemovitreous hemorrhage, retinal detachment and glaucoma.
SYMPTOMS
In the early stages of the disease, people with diabetic retinopathy do not perceive any visual alteration. However, as the disease progresses, it causes a loss of vision that, in very advanced cases, is not recoverable.
When the vision of a person with diabetes is slowly and progressively affected, it usually indicates the formation of macular edema, which is the presence of fluid accumulated in the central area of the retina. The blood vessels begin to fail and it is then that the patient notices a decrease in their visual capacity and can also see deformed objects(metamorphopsia). Macular edema is the main cause of vision loss in diabetics.
Other times, diabetic retinopathy results in macularischemia caused by the narrowing or occlusion of small blood vessels in the retinal area, which stops functioning properly because it does not receive enough blood flow. When this occurs, the patient’ s vision becomes blurred.
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In the most severe cases, when a vitreous hemorrhage situation occurs, the main symptom is the sudden appearance of spots that partially or totally obscure vision.
Proliferative diabetic retinopathy (PDR) can cause more severe vision loss than non-proliferative diabetic retinopathy (PNR), as both central and peripheral vision are affected.
Treatment
The risk of suffering ocular complications in a diabetic patient is high. Therefore, it is essential to undergo regular ophthalmological check-ups (fundus examination), bearing in mind that diabetic retinopathy is asymptomatic at first, and to adopt responsible behavior to keep it under strict control and thus prevent it from progressing.
Some of the recommendations for the treatment of this disease are the monitoring of blood glucose levels, cholesterol and arterialhypertension, weight control according to the endocrinologist ‘s guidelines, regular exercise and not smoking.
When diabetic retinopathy is in more advanced stages, it is no longer sufficient to carry out controls; other treatment options such as laser photocoagulation (in combination or not with intravitreal injections with antiangiogenic agents) must be used. This treatment is applied selectively on abnormal retinal vessels to reduce edema or on areas that have been deprived of blood supply to prevent the disease from worsening.
The use of ocular drugs may also be indicated. In severe cases such as vitreous hemorrhage and/or retinal detachment, surgery (vitrectomy) is necessary.
In many cases, it is possible to restore vision to blind patients, even if not completely. However, there are fewer and fewer cases in which intervention is necessary, thanks to greater awareness of this disease and its consequences for visual health.
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