WHAT IS DIABETIC RETINOPATHY?
Diabetic Retinopathy Definition: The diabetic retinopathy is a complication of diabetes mellitus. It is a microangiopathy of the blood vessels of the retina.
- Non-proliferative Diabetic Retinopathy: Constantly elevated blood glucose levels lead to pathological changes among the thinnest blood vessels (capillaries). The first signs are bulges of the vessel wall, which can be visualized by the eye specialist by means of special examinations (eg fluorescence angiography). As a result, small bleeding, fluid deposits (diabetic macular oedema), deposition of fats and reduced blood flow in the nerve fibre layer may occur.
Macular oedema causes vision impairment but can remain unintended for a long time. Regular inspection of the retina by the eye specialist is particularly important for diagnosis and early therapy. There are three Stages of non-proliferative retinopathy, that is, Mild, moderate and heavy (higher grade ischemia of the retina, immediate precursor of proliferation)
- Proliferative form Diabetic Retinopathy: In this form of retinal disease, there is a new formation of diseased vascular neoplasms which grow into the vitreous body. Because these vessels are more brittle than normal vessels, there is a risk of a vitreous haemorrhage associated with sudden vision impairment or loss of vision. Therapy of choice is a laser treatment.
WHAT CAUSES DIABETIC RETINOPATHY?
Diabetic Retinopathy Causes: is the collective term for changes in the eye background caused by the blood glucose (diabetes). The World Health Organization ( WHO) assumes that about 5 million people worldwide are blinded in 2002 due to diabetic retinal changes.
WHAT ARE THE SYMPTOMS OF DIABETIC RETINOPATHY?
Diabetic Retinopathy Symptoms: Swelling of the retina (macula) or diseased vascular neoplasms and resulting visual impairment. Since symptoms only occur in advanced stages, a regular examination of the fundus by an eye specialist is particularly important. Diabetic retinopathy is divided into a non-proliferative and a proliferative form.
WHAT ARE THE RISK FACTORS OF DIABETIC RETINOPATHY?
Diabetic Retinopathy Risk factors: Numerous pathogenetic factors of diabetic retinopathy influence development and risk of progression. Secured risk factors for diabetic retinopathy are:
- Chronic hyperglycemia: Intensified blood glucose control (reduction of HbA1c from 7.9% to 7.1%) leads to a significant reduction in the need for laser coagulation. To prevent the progression of diabetic retinopathy, a reduction of HbA1c below 7% is recommended.
- Arterial hypertension: Intensified blood pressure adjustment (reduction of blood pressure from 154/87 to 144/82 mmHg) leads to a 35% reduction in the need for laser coagulation due to diabetic retinopathy. To prevent the progression of diabetic retinopathy, a lowering of the blood pressure below 140/80 mmHg is recommended.
- Hyperlipidemia: Patients with type 2 diabetes mellitus and dyslipidemia have an increased risk of developing hard exudates, diabetic maculopathy, and visual loss. In addition, the risk of proliferative diabetic retinopathy is increased.
WHAT TREATS DIABETIC RETINOPATHY?
Diabetic Retinopathy Treatment: In this form of the retinal disease, there is a new formation of diseased vascular neoplasms which grow into the vitreous body. Because these vessels are more brittle than normal vessels, there is a risk of a vitreous haemorrhage associated with sudden vision impairment or loss of vision. Therapy of choice is a laser treatment.
In principle, the best possible set of the blood glucose is extremely important. In case of regular examination of the eye background by the eye doctor, changes can be recognized in time. Diabetics should, therefore, visit the ophthalmologist every year for screening. Starting stages of a diabetic retinopathy can be recognized and treated in time. In the case of advanced eye damage, therapies with special metabolism-inhibiting drugs (see also New therapy for moist AMD ) or laser treatments can protect against complications in the eye.
In addition to controls, the best possible set of the metabolism is important, so that diabetic retinopathy does not occur at all.
Multifactorial therapy approaches (lifestyle change with more movement, weight reduction or normalization, smoking cessation, blood glucose improvement, blood pressure improvement, lowering or normalization of elevated blood lipid values and an introduction of platelet aggregation inhibition) can reduce the risk of retinopathy in high-risk patients by up to 50%.
In macular oedema ( oedema in the area of the optic nerve disc ), the laser is treated with a laser treatment of the affected area. In the case of large-area retinopathy (proliferative or difficultly non-proliferative), the laser treatment must be extended to the whole retina and distributed over several sessions.