The World He alth Organization is sounding the alarm. The fact is that every day the number of people with diabetes is becoming more and more. The International Diabetes Association estimates that by 2030 one in nine people on the planet will have diabetes. Diabetes itself is not as dangerous as the complications it causes. It turns out that a person with this disease can quickly lose precious sight. There is a statistic that states that "sugar drinkers" are 25 times more likely to lose their sight than people without this disease. And it's all about diabetic eye retinopathy.
Disease definition
Before you begin to study the issue of diagnosis in detail, you should find out the meaning of the medical term. Leading ophthalmologists of our state believe that diabetic retinopathy refers to specific diseases of the retina. It develops in 98% of diabetic patients. This disease is taking its tollbeginning with changes in the retinal vessels, in the future it progresses and affects new vessels. The main pathological processes are occlusion and edema of the vessels of the organs of vision. This means that diabetic retinopathy leads to reduced visual acuity in people with diabetes.
Prevalence
In the state of Wisconsin (USA), epidemiological studies of this disease were carried out. Ophthalmologists have come to the conclusion that in developed countries, the able-bodied part of the population suffers from retinopathy. It is she who is the main cause of loss of vision in people. A group of diabetics with a disease experience of 15 years had a pathology of the organs of vision in 98% of cases. If the patient has a high blood sugar level for a long period, this soon leads to vascular changes and even complications from the organs of vision.
How is this happening?
Further in our article you will learn about diabetic retinopathy, symptoms, treatment. An excess of glucose in the blood leads to the fact that macro- and microvessels become thinner, become fragile and brittle. When they burst, new capillaries are formed in the same place, which are inferior in quality to the previous ones. After all these processes, the retina, which allowed a person to see the world around him, functions much worse. Patients tend to ignore the first alarm signals. Day after day, year after year, diabetic retinopathy progresses. After a certain amount of time, a person completely loses his sight. How to avoid completeblindness, you will learn in our article.
Clinical picture of the disease
Before talking about treatment, you need to pay attention to the symptoms of diabetic retinopathy. The earliest clinical manifestations are hemorrhages (hemorrhages) and microaneurysms (bulging of vessel walls under blood pressure). Further, in the later and severe stages, anomalies and neoplasms of vessels form on the optic nerve head. It was said above that retinal edema appears. It is he who causes a deterioration in visual acuity in the first stage. Then there is a hemorrhage in the body of the eye. In the final stage, the surface of the retina curves and flakes off. It is worth noting: the larger the area of the edema, the worse the prognosis for the visual functions of the eye will be.
So, when contacting an ophthalmologist, diabetics complain of deterioration or even loss of vision. This suggests that it is impossible for patients to independently determine the presence of retinopathy, therefore, it is necessary to undergo a complete examination by an ophthalmologist at least once a year.
Classification of diabetic retinopathy
In the XXI century, there are several classifications of this disease. Each of them has its own advantages, and each of them determines the clinical picture of the disease and treatment strategies to the greatest extent. For example, the American Diabetes Association in 2000 classified retinopathy into 5 stages. Domestic ophthalmologists adhere to the classification introduced by the World He alth Organization. Thus, in Russia, doctors distinguish threestage of the disease. Let's take a closer look at each of them.
First stage
Very often, during a routine examination of a patient with elevated glucose levels, ophthalmologists diagnose non-proliferative diabetic retinopathy. This is the earliest and most favorable stage for the treatment of pathology. During this period, when examining the fundus, doctors find retinal hemorrhages and microaneurysms. They also fix vascular anomalies.
In addition, already at the first stage there is exudate - this is a liquid in the tissues of the eye. In other words, capillaries are damaged - small vessels that supply the retina with food. The permeability of capillaries increases markedly, so hemorrhages occur. Then the first retinal edema develops.
Second stage
Or medically, preproliferative diabetic retinopathy, not the worst stage in the development of the disease. At this stage, ophthalmologists see areas that experience a decrease in blood supply. The changes in the retina are getting bigger, a lot of hemorrhages appear, as well as even more fluid accumulation. At this stage, the optometrist understands that the eye is experiencing a violation of the blood supply and the vessels begin to "starve". The center of the retina of the eye, or, in scientific terms, the macula, is already subject to pathological changes.
Third stage
Things are much worse for a patient if the ophthalmologist diagnoses proliferative diabetic retinopathy. At this stage, the vessels begin to grow and penetrate into the cornea. Exactly thisleads to retinal detachment - the patient becomes almost blind. Despite the fact that new vessels are formed, hemorrhages become more and more, as new capillaries are thinner and more prone to injury. The pinnacle of retinopathy is the terminal stage, when the macula no longer holds light rays, which means that the patient is completely blind.
So, we have studied the three stages of diabetic retinopathy, which were introduced into modern medicine by the World He alth Organization.
Ophthalmic examination
It is worth recalling that the main symptom of retinopathy is the deterioration of visual acuity or its 100% loss. Unfortunately, these symptoms appear in the later stages, when the course of the disease is running. Therefore, it is impossible to postpone treatment, because the patient has every chance to maintain good vision. Diabetic patients should visit the ophthalmologist regularly - twice a year will be sufficient. It is best to make an appointment with an ophthalmologist who is experienced in treating retinopathy.
Diagnosis of diabetic retinopathy can also take place outside the hospital. You can find a doctor in modern diabetes centers or clinics that specialize in the treatment of the organs of vision. Today, doctors use a very wide range of the latest techniques. Mandatory procedures are: tonometry (measurement of eye pressure), ophthalmoscopy (examination of the fundus with a dilated pupil), determination of visual acuity. Additional techniques include perimetry, gonioscopy, ultrasound,photoregistration of the fundus, as well as biomicroscopy with various contact lenses.
The main technique that provides objective data on the state of the vessels of the retina, today is optical tomography, as well as angiography of the fundus.
For patients with type 1 or type 2 diabetes, diagnosis at an early stage of the disease gives a chance to stop pathological processes. It is worth noting that even at the last stage the disease can be asymptomatic! Patients sometimes do not even realize that irreversible pathological processes in the organs of vision have begun. Remember that early diagnosis of this insidious disease is extremely important, because in the modern arsenal of ophthalmologists there is an effective treatment method called retinal laser photocoagulation.
Principles for monitoring diabetics with an ophthalmic profile
Diabetics must be under the systematic supervision of an ophthalmologist or ophthalmologist. Patients are managed according to certain principles:
- the first appointment with an ophthalmologist should be carried out immediately after the diagnosis of "diabetes mellitus";
- if pathological changes in the eye are not detected, the next examination should be carried out no later than 12 months;
- patients with elevated levels of glycated hemoglobin (> 8%) and hypertension should undergo an ophthalmological examination every six months, even if no pathology is detected;
- every diabetic should be examined by an ophthalmologist when they are transferred to insulin therapy;
- if you suddenlyIf you notice a decrease in visual acuity or you have any other eye complaints, then an examination by an ophthalmologist should be carried out immediately, regardless of the last time you were examined by a doctor;
- Such examinations should be carried out by women of childbearing age who have diabetes! This is important because diabetic retinopathy in a pregnant woman can cause heart disease in the unborn baby.
How to keep your eyes he althy
Now let's talk about how to stop diabetic retinopathy. Treatment of this disease occurs in a complex of measures.
- Firstly, diabetics need to compensate for their underlying disease.
- Secondly, ophthalmologists prescribe laser coagulation of the vessels of the retina of the organs of vision.
In other cases, they use intravitreal administration of corticosteroid drugs, as well as inhibitors. In severe cases, vitrectomy is used. Recent studies have shown that vitamin therapy, the intake of antioxidants and other enzymes do not have a therapeutic effect in the treatment of retinopathy. And this means that drugs such as Kaviton and Dicinon are not prescribed to preserve the visual function of the eye. If the eyes are not treated in time, then this ailment will cause other concomitant diseases. A diabetic patient with retinopathy often presents with glaucoma, retinal detachment, cataracts, and vision loss.
To maintain the remaining he alth, it is necessary to do away with bad habits. Smokingand alcohol in diabetes is the last thing. A passive lifestyle contributes to an increase in blood glucose levels. Try to drink more pure water, only it removes excess sugar from the body. Timely and systematic cleaning of blood vessels with antioxidants helps maintain the he alth of micro- and macro-vessels!
Injections for vision
An effective method is the introduction of modern drugs into the eye cavity with an injection. The procedure is done on the operating table. First, the ophthalmologist, using an instrument, determines the place for the injection into the eye. The patient does not feel pain, the injection is given under local anesthesia. The substance introduced into the eyeball causes the newly formed vessels to regress, that is, to curl up. In the first six months, injections are given once every thirty days. The doctor then performs angiography on the patient and decides how often and how many more injections should be given.
Laser coagulation
This method was developed back in the seventies of the XX century. It is considered the gold standard in the treatment of fundus pathology of diabetic origin. Laser surgery is considered the most effective treatment for edema and proliferative diabetic retinopathy. During this procedure, the fundus vessels are cauterized with a laser beam, after which the vessels stop pathological growth. But this method has a significant drawback - damage to a large part of the surface of the retina.
Conclusions
Treatment for diabetic retinopathy is possible! The patient should not expect deterioration in qualityvision or other complaints. A diabetic is obliged to visit an ophthalmologist at least once a year without fail. This specialist should not only check visual acuity, but also drip drops that dilate the pupil, and then examine the retina in detail.
Doctors say that early detection of retinopathy and its timely treatment, dispensary observation allow patients to maintain visual function for many decades. But it should be understood that all this requires knowledge and skills not only from endocrinologists and ophthalmologists, but the most active participation of a diabetic patient in the process of his treatment and rehabilitation! Subject to the above factors, diabetes will not be a punishment, but a way of life.
If it was not possible to save vision, then it is necessary to collect documents for medical examination in order to determine the disability group and receive a pension in the future. Be attentive not only to your he alth, but also to the well-being of relatives and friends.
