DIABETIC RETINOPATHY

Diabetic retinopathy (DR) is a complication of diabetes mellitus, which leads to irreversible damage to the vessels of the retina (which plays a major role in ensuring vision).

DR can be asymptomatic for a long time, until significant damage to the retina appears. The first symptoms may appear in one eye or in both eyes at once.

Pay particular attention to:

• The appearance of double objects
• Blurry outlines of objects
• Difficulty reading any text
• The appearance of shadows around objects
• The appearance of a dark spot in the field of view
• Impaired colour perception

normal vision                                                                visit a doctor immediately

Risk factors

In terms of importance, from most important to least significant:

• Duration of diabetes mellitus:
  • up to 5 years — the frequency of occurrence is 9-17%
  • from 5 to 10 years — 44-80%
  • from 15 years — 87-99%.
• Inadequate glycemic control
• Uncompensated arterial hypertension
• High cholesterol
• Pregnancy
• Smoking
• Obesity, hyperlipidemia

Anyone with diabetes is a potential diabetic retinopathy patient. For self-control, perform the Amsler test regularly.

Stages of diabetic retinopathy

There are three stages, depending on the degree of retinal damage:

• Stage I — Non-proliferative
• Stage II — Pre-proliferative
• Stage III — Proliferative

1. Non-proliferative diabetic retinopathy

It is asymptomatic. When examining the fundus, one can see:

• Angiopathy — a change in the caliber of blood vessels, expansion and tortuosity of veins
• Single solid exudates
• Microaneurysms
• Microbleeds

Treatment methods

• Regular examination by an ophthalmologist — once or twice a year. Despite the fact that there is no reduction in vision, examination significantly reduces the development of complications such as macular edema, vitreous hemorrhage, retinal hemorrhage.
• Adequate blood glucose control (!)
• Compensation for associated risk factors for progression: arterial hypertension, cholesterol levels.

2. Preproliferative diabetic retinopathy

It may be asymptomatic. There is a deterioration in the quality of vision: blurred contours, double vision, the appearance of a spot in the field of vision, shadow around objects, difficulty in reading, impaired colour perception.

Diagnosis reveals:

• Soft and hard exudates
• Intraretinal microvascular anomalies (IRMA)
• Severe angiopathy — looping of venules, changes in the caliber of blood vessels
• Multiple hemorrhages

3. Proliferative diabetic retinopathy

Most severe form. It manifests itself in the form of:

a) Neovascularization — newly formed vessels of the retina, optic nerve disc.

Fundus photo of a patient with proliferative diabetic retinopathy

b) Macrobleeds (preretinal, subretinal, subhyaloid, hemophthalmos) — there is a sharp decrease in vision, loss of the visual field, a dark spot in front of the eye.

Fundus photo of a patient with subhyaloid hemorrhage

c) Gliosis

d) Traction retinal detachment

Diabetic macular edema

It can develop in all conditions. It is accompanied by a sharp decrease in vision, “curvature” of straight lines and distortion of objects. Revealed by optical coherence tomography.

Optical coherence tomography of the retina of a patient with diabetic macular edema

Diabetic retinopathy treatment

Treatment depends on the stage.

1. Prevention

The “gold standard” is panretinal laser coagulation of the retina. It is carried out for uncomplicated retinopathy in the preproliferative stage. Significantly reduces the risk of complications and permanent vision loss.

2. Treatment of diabetic macular edema

The patient is given intravitreal injections of anti-VEGF drugs and / or corticosteroids:

• Eylea
• Lucentis

3. Surgical treatment

In complicated forms of proliferative retinopathy (neovascularization, hemophthalmia, retinal hemorrhages, traction retinal detachment), surgical treatment is performed — subtotal vitrectomy, removal of proliferative tissue, endolaser coagulation.

Remember: the development and outcome of the disease depends on the stage. Since DR has no obvious symptoms and appears only after irreversible changes in the fundus, it is necessary to undergo routine examinations by an ophthalmologist.

And patients with diabetes should have them at least once a year!