WHAT IS DIABETIC EYE DISEASE?
Eye problems that can occur as a complication of diabetes in people. This is called “diabetic eye diseases”
Problems that can be seen in diabetic eye disease are as follows:
- Diabetic retinopathy: It is the damage to the blood vessels in the web layer called retina.
- Cataract: It is the lens of the eye that becomes misted and loses its transparency. Cataracts occur earlier in diabetes patients.
- Glaucoma: It is the increase in intraocular pressure and consequently, decreasing vision by damaging the visual nerve. A diabetic person is at twice the risk of developing glaucoma than others.
WHAT IS DIABETIC RETINOPATHY?
Diabetic retinopathy is one of the most important causes of blindness today. Occurs as a result of changes in retinal blood vessels.
The retina (mesh layer) is the photosensitive layer and must be healthy for vision function. Different types of damage occur in diabetic retinopathy. The structure of the blood vessels deteriorates, causing small bubbles and bleeding and leakage of fluid inside the vein into the surrounding tissues. In the following stages, new unwanted vascular buds form on the retina and cause sudden intraocular bleeding.
In diabetic retinopathy, vision loss does not develop at first, and as the disease progresses, vision weakness occurs. Therefore, there is no such thing that a diabetic patient who has no complaints in seeing will not have diabetic retinopathy, regular eye control is required. Diabetes usually affects both eyes.
What are the stages of diabetic retinopathy?
1- Mild non-proliferative diabetic retinopathy: In this early stage, bubbles called microaneurysms are formed in the retinal vessels.
2- Moderate non-proliferative diabetic retinopathy: The bubbles in the retinal vessels increased and blockages in the vessels appeared.
3- Severe non-proliferative diabetic retinopathy: Vascular occlusion and hemorrhages have increased, oxygen deficiency has become evident in the retina.
4- Proliferative diabetic retinopathy: Oxygen deficiency in the retina and lack of nutrition have increased and new and unhealthy vascular formation has started in the retina by sending danger signals to the brain. These new vessels are very delicate, can cause bleeding and sudden vision loss at any time.
How does diabetic retinopathy cause vision loss?
Diabetic retinopathy makes vision loss in two ways:
1- Fluid leaking from the weakened vessels collects in the visual center called macula, and water accumulation called macular edema occurs. This gradually reduces vision over time.
2- In the advanced stage, sudden bleeding may occur due to weak new vascular formations and cause sudden vision loss.
On the left, the image seen by a healthy person, on the right, the image seen by a patient with advanced diabetic retinopathy is observed.
Who is at risk for diabetic retinopathy?
All people with Type 1 and Type 2 diabetes are at risk of diabetic retinopathy. Each diabetic patient should undergo detailed retinal screening, at least once a year, with an enlarged pupil. The longer the diabetes error, the higher the risk of developing diabetic retinopathy.
Pregnancy is another risk for women with diabetes. The frequency of detailed retinal examination should be increased during pregnancy.
What should I do to protect my eyesight?
If you have diabetes, you should have detailed retinal mines at least once a year. Diabetic retinopathy is an insidious disease. In a diabetic person, advanced diabetic retinopathy may develop over the years without any damage to vision. Whether you suffer from vision or not, your doctor may recommend treatment for diabetic retinopathy. Early diagnosis and timely treatment can greatly prevent vision loss
If diabetic retinopathy has developed, retinal examination is required more frequently. In the presence of proliferative diabetic retinopathy, the risk of vision loss can be prevented by 95% with appropriate and timely treatment.
Regulating blood sugar greatly hinders or slows down the development and progression of diabetic retinopathy. In addition, it prevents or slows down kidney and nerve damage.
What are the symptoms of diabetic retinopathy?
Diabetic retinopathy is an insidious disease. In the early stages of the disease, there are no symptoms, as well as diabetic retinopathy is a painless disease. It is not necessary to wait for symptoms for examination and to have a retinal examination annually.
If the accumulation of fluid called macular edema occurs in the vision center called macula, the vision begins to blur. In the advanced stage, if unwanted new and diseased vascularization begins in the retina, these vessels may bleed suddenly and vision may suddenly be lost.
What are the findings of proliferative retinopathy in the presence of bleeding?
In the event of sudden bleeding, flying objects frequently appear as the first symptom. After a while, the vision may close completely. If flying objects are seen, it is necessary to undergo a detailed retinal examination and the necessary treatment as soon as possible, otherwise the bleeding will be aggravated and vision may be completely closed. Most of the sudden bleeding occurs during sleep in the morning.
Sometimes, without treatment, bleeding may go away on its own and vision may reopen. However, this is a misleading situation and the probability of recurrence of bleeding is very high. Therefore, it is necessary to consult a doctor without waiting for the bleeding to pass.
If left untreated, diabetic retinopathy results in severe vision loss. Likewise, vision gain is higher with early treatment.
How is Diabetic Retinopathy and Macular Edema Detected?
A detailed retinal examination includes the following tests;
1. Visual acuity measurement: How much vision is measured from a certain distance.
2. Retinal examination: The eyeballs are enlarged by dropping various drops. Detailed retinal examination is performed using various lenses.
3. Eye pressure measurement.
4. Fluorescein angiography: In the detailed retinal examination, your doctor may recommend performing fluorescein angiography if necessary. A dye is injected through the arm vessels and retinal photographs are taken from both eyes in succession. In this way, information about the vascular structure of the retina of the eye is obtained. Treatment is directed accordingly.
5. Optical coherence tomography: In recent years, a device called optical coherence tomography (OCT) has been used in the detection and monitoring of macular edema. Unlike any attempt to the patient, realistic sections of the macula region are obtained within a short time. For this, diode laser light beam is used. OCT gives us detailed information about macular edema.
HOW IS DIABETIC RETINOPATHY TREATED?
There is no need for treatment, especially in the early stages, if there is no macular edema. blood glucose, blood pressure and cholesterol values should be kept under control only to prevent the progression of diabetic retinopathy.
If unwanted new vessels have formed in the retina (proliferative diabetic retinopathy), laser treatment should be applied to the entire retina (outside the visual center). This treatment usually takes two or three sessions. This laser treatment should be done before bleeding into the eye. Laser treatment is not possible in the presence of severe bleeding.
If the bleeding is very intense, the surgical removal of the bleeding, called vitrectomy, is required. With vitrectomy, bleeding in the eye is completely removed and necessary laser treatment is applied in the same surgery.
How Is Macular Edema Treated?
Diabetic macular edema is treated with laser. Generally, one session is sufficient, but more than one session may be required in stubborn situations. If both eyes have macular edema, one eye must be treated first, and the other eye within a few weeks.
Generally, laser treatment prevents 90% risk of blindness due to diabetes. However, laser therapy often cannot perform vision that is already missing. That is why early diagnosis and treatment is so important.
In recent years, some new treatments have been used in addition to laser, especially in macular edema due to diabetes. These new drugs, called anti-VEGF, provide a certain improvement in diabetic retinopathy by preventing the formation of diseased new vessels, as well as preventing vascular leaks that cause macular edema. These drugs, which are given by injecting into the eye, can be used alone or together with the laser, and allow a certain increase in vision compared to lasers. However, it should not be forgotten that anti-VEGF treatment is a surgical treatment and a needle on the eye. Therefore, the infection necessarily brings some risks such as a rupture in the retina. Therefore, it is a treatment that should be applied by experienced physicians who are experts in the subject, in highly sterile conditions in the operating room. In addition, it should be decided by retinal specialist physicians in which cases it should be done and how often it should be applied.
What is Vitrectomy?
If bleeding due to diabetic retinopathy has developed in the eye, vitrectomy surgery is performed.
Vitrectomy can be performed under local or general anesthesia. The form of anesthesia is determined by the joint decision of the patient and physician. In vitrectomy, small holes are drilled into the wall of the eye, and very thin tools are entered through these holes to remove fluid and bleeding called vitreous inside the eye. The cleaned liquid is replaced with a medical liquid called balanced salt solution. Laser treatment of the retina is often completed in the same surgery. Protective eye drops are instilled for an average month after surgery.
It should not be forgotten that diabetes is a systemic disease. The health of the eye is directly proportional to the blood pressure, arm blood pressure and cholesterol rates.
Diabetic retinopathy is an insidious disease. Severe damage to the retina occurs without visual loss. That is why regular control, early detection, correct treatment is so important.
Complete treatment of diabetic retinopathy is not possible. Certain damage caused is permanent. The therapies applied can improve the complications caused by diabetic retinopathy to a limited extent. That is why early diagnosis and treatment is so important