All You Need to Know About Diabetic Retinopathy

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What Is It?

It is a serious complication that occurs post-diabetes. It affects the retina and during working age, it is the leading cause of low vision and blindness for people in developed countries. It is estimated that about one-third of diabetics are diagnosed with retinopathy.

How Widespread Is It?

The World Health Organization estimates that there are 422 million diabetics in the world. It particularly affects the elderly i.e. 16.5% of the people aged 65 and above.

If, Type 1 diabetes (the most severe) is diagnosed after the age of 30, the prevalence of diabetic retinopathy is 20% after 5 years of the disease, 40-50% after 10 years and over 90% after 20 years.

The International IAPB States:

Previously, the most affluent countries were particularly affected by this pathology. Today, even low and middle-income states consist 75% of individuals diagnosed with diabetes. Many of these poor countries lack proper equipment to diagnose the disease correctly, treat it and take care of the various consequences that come with this complex pathology. Currently, Southeast Asia and the Western Pacific account for more than half of adult diabetics in the world.

However, the area where the highest prevalence of diabetics is recorded, is the Eastern Mediterranean (13.7% of the adult population), while the European region as a whole stand at 7.3% (the Africa is at 7.1%).

In Diabetes Report the WHO states:

Diabetic retinopathy is a central reason of blindness and occurs as a result of long-term accumulated damage to the small blood vessels of the retina.

In 2010, diabetic retinopathy has caused 1.9% of visual impairment (moderate or severe) and 2.6% of blindness, globally. There are studies that suggest that the prevalence of any type of retinopathy in people with diabetes is 35%, while that of proliferating retinopathy (dangerous for sight) is 7%.

Can Diabetic Retinopathy Be Prevented?

Yes, retinal damage is generally preventable by controlling your diabetes level. In particular, it has been shown that careful control of blood pressure in patients with Type 2 diabetes reduces the risk of micro-vascular disease by 37%, the rate of diabetic retinopathy progression by 34% and the risk of worsening the visual acuity by 47%.

Attention must always be paid on prevention by focusing on carefully monitoring risk factors such as elevated blood glucose, arterial hypertension and dyslipidemia. Secondly, by identifying diabetic retinopathy and preparing the necessary treatments. The final focus should be on visual rehabilitation.

How Can It Be Diagnosed And Moderated?

First of all, by periodically checking the level of sugar in the blood circulation. It is necessary to undergo the required blood tests (particular checking blood glucose). Furthermore, it is essential to perform periodic checks of the fundus and, if necessary, undergo specific tests (such as Fluorangiography and OCT) to assess the possible presence of the disease and its status. The latter mostly depends, on the degree of decompensation of diabetes. What matters is not only the value of blood sugar, but also its daily variations (the difference between maximum and minimum values). A reliable test take is of glycated hemoglobin (HbA1c). This is taken with a simple blood sample and gives a measure of the blood sugar level in the recent months.

How Is The Diagnosis Made?

For the diagnosis of diabetic retinopathy, observation of the ocular fundus (direct and indirect ophthalmoscopy) is an essential factor to be looked into for a person with diabetes mellitus.

Other methods which allow studying the microcirculation and discovering the alterations of the retinal vessels include:

  • Retinography: useful when comparing the fundus conditions over time
  • Fluorangiography: the digitization of this method allows images to be processed that highlight the smallest alterations of the capillary network with great clarity and provides useful information for a possible laser treatment
  • OCT: a non-invasive retinal diagnostic test that allows the assessment of the possible presence of fluid in retinal tissues (diabetic macular edema) and its evolution over time.

What Is The Cause?

The main cause of diabetic retinopathy is the result of poorly controlled diabetes over time. This leads to the development of alterations in small blood vessels, to the point of creating real bulges (called microaneurysms) and the transudation of the liquid part of blood into the center of the retina. This can cause diabetic maculopathy (macular edema).

The accumulation of substances outside the vessels is called exudate. The disease develops slowly causing previously treatable mutilation, to become progressively irreversible. The retinal nerve tissue can be damaged and vision can be lost if not treated properly.

What Are The Symptoms?

Sometimes diabetic retinopathy leads to a gradual decrease in sight, leading up to visual impairment and blindness. In most cases, the symptoms in the initial stages of the disease aren’t very obvious. Until, it reaches the advanced stage where serious decline and sudden visual acuity can be observed.

What Treatments Can You Follow?

It is essential, to bring glycemia and glycosylated hemoglobin back to normal values. For this purpose, hypoglycemic drugs and/or specific dietary supplements, vasoprotective and anti-edemigenic remedies (against the accumulation of liquids under the retina) may be useful to diabetics. In addition to the general use of insulin, for cases of advanced diabetic retinopathy, it may be necessary to resort to photocoagulative laser ethanol therapy in order to save residual sight. If you are suffering from severe diabetic retinopathy with substantial bleeding, vitrectomy surgery(removal of vitreous humor and any membranes) may be necessary. In the presence of diabetic macular edema, intravitreal injections can also be used which inhibit the undesired proliferation of harmful retinal vessels.

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