In developed countries, the greatest decrease in vision is due to diabetic retinopathy. Among patients aged 25 to 74 years, diabetic retinopathy is the leading cause of vision loss worldwide.
How Does Diabetic Retinopathy Develop?
Diabetic retinopathy occurs as a result of damage to capillaries as a result of diabetes. Due to blockage and impaired circulation in the retinal vessels, the retina cannot receive adequate blood supply. Some substances secreted from retinal areas with nutritional problems cause new blood vessel formation and leakage in existing capillaries. The leak causes the retina to thicken. The thickened and swollen retina cannot perform its normal function, resulting in a decrease in visual acuity.
As the disease progresses, the structure of the newly formed vessels is not as strong as normal capillaries, and they are prone to bleeding as a result of sudden increases in both blood pressure and sugar. Sometimes vision can be seriously reduced as a result of sudden bleeding from these vessels.
What are the Risk Factors?
Although not every diabetic patient develops retinopathy, there are some risk factors. These are briefly
- Duration of diabetes
- Uncontrolled glucose or blood pressure levels,
- Hypertension
- High cholesterol levels
- Ethnicity
- Pregnancy
- To smoke
Are There Clinically Different Types of Diabetic Retinopathy?
It is generally divided into three periods:
Essentially, the stage of the disease is determined depending on the three factors listed below.
1- Capillary leak (Diabetic macular edema)
Edema occurs as a result of capillary leaks in the visual center
2- Capillary occlusion
During this period, no new vessel development is observed and damage to normal retinal vessels is detected. During this period, bleeding, vascular disorders and extravascular cholesterol leaks occur.
3- Sequelae of retinal ischemia and new vascular development
During this period, new vessels that are dangerous and bleed easily form in the eye. Sometimes, after this and repeated bleeding, serious problems such as intraocular bleeding, retinal tears and shrinkage, and eye pressure may occur.
What are the Symptoms of Diabetic Retinopathy?
While no symptoms are detected in the early stages of the disease, sudden vision loss may occur in the later stages. At the beginning of the disease, vision is very good. It is necessary to detect and treat the disease in this period. As the disease progresses, they may be seen decreased vision, distorted vision, dark gray areas in the field of vision, objects swarming within the eye, or even sudden vision loss. Even if most patients caught in the advanced stages are treated, vision may remain low.
Is Sugar Control Important?
It can be said with certainty that diabetic retinopathy occurs later in patients with good sugar control and the rate of disease progression slows down. However, in some patients, even if their blood sugar is regular, the disease in the eye may progress due to genetic factors.
What is Done in the Treatment of Diabetic Retinopathy?
Treatment is given according to the severity and stage of the disease. Rapid advances have been made in treatment in recent years. In the disease, keeping blood sugar at normal levels is a priority. Follow-up is done in the early period. Until recent years, the main treatment was laser, but in recent years it has been used less frequently. Nowadays, intraocular drug injections are mostly applied. In the majority of patients, these treatments stop the progression of the disease. However, the disease progresses despite laser and intraocular needle treatment and intraocular bleeding may occur. If the intraocular bleeding is small, some of it will heal after a while without surgery. However, Pars Plana Vitrectomy surgery is performed on patients who do not improve visual acuity or have other problems.