Treatment of diabetic retinopathy

What is diabetic retinopathy?

Diabetic retinopathy represents the complication of diabetes on the eye. It can occur in all persons with diabetes depending on the duration of the illness and blood sugar level regulation. Persons who have had diabetes for over 20 years and almost all persons who have been diagnosed with diabetes before the age of 30 are affected by some stage of retinopathy. If diabetes occurs after the age of 30, the risk of retinopathy is smaller, but in this group, retinopathy can be one of the first signs of diabetes. In the early stages, there are no subjective problems or disorders, and if the condition remains undiagnosed it leads to the gradual decrease of visual acuity. The cause of the loss of sight is the occurence of swelling or edema in the macula (yellow spot). As the illness progresses, new blood vessels appear in places of the eye where there should normally be none. These new blood vessels can easily bleed and can cause sudden or total loss of sight. In such situations the eye fills with blood (hemophtalmus), while visual acuity is reduced only to the sensing of light. In the following stages of the illness, new blood vessels occur in the anterior segment of the eye, the intraocular pressure rises and so-called neovascular glaucoma occurs.

Signs and symptoms

It is very difficult to subjectively detect changes caused by diabetic retinopathy in its early stages. The changes can only be detected by an ophthalmologist during routine examinations. At first, there is minor hemorrhaging on the periphery of the fundus, which later develops into the accumulation of lipid deposits, swelling of the macula and forming of new blood vessels. The patient notices changes in the form of blurred vision only when changes due to diabetes have already reached the macula. Unfortunately, this stage is already advanced, therefore prior visual acuity can only be partially and very rarely fully regained. In some cases the appearance of newly-formed blood vessels occurs slightly before the changes in visual acuity and this state represents the most serious and most dangerous form of diabetic retinopathy. The patient does not detect any changes, while new blood vessels a being formed and can cause sudden loss of vision. In such case, the only solution is extremely complex surgery treatment in which visual acuity is returned to an adequate level for the surgeon, but not the patient.

Treatment

Prevention represents the most important method in the treatment and avoiding of complications of diabetes on the eye. It is extremely important to maintain the blood sugar level within the normal range of 3,3mmol/l-5,5mmol/l, level of glycated Hb (HbA1c), the level of blood pressure and lipids (fats) in the blood. These are all factors that contribute to the ocurrence and severity of the course of the illness. Timely and appropriate ophthalmic ckeckups, at least once annually or more frequently if necessary, are of extreme significance. The aim of these checkups is to detect changes in the early stages and apply laser therapy on time, while there is still no loss of vision. Once decrease of visual acuity occurs, laser therapy is used not to regain sight, but to prevent its further loss. Laser therapy does not return vision to the level before the changes, but it is used in an effort to protect existing visual acuity.