- WHAT IS DIABETIC EYE DISEASE?
Eye problems that may occur as a complication of diabetes in people with are called diabetic eye disease.
Problems that can be seen in diabetic eye disease:
– Diabetic retinopathy: It is the damage that develops in the blood vessels in the network layer called retina.
– Cataract: It is the fogging of the lens of the eye and loss of transparency. Cataracts occur at an earlier age in diabetic patients.
– Glaucoma: It is an increase in intraocular pressure and as a result, it reduces vision by damaging the optic nerve. A person with diabetes has twice the risk of developing glaucoma than other people.
- WHAT IS DIABETIC RETINOPATHY?
Diabetic retinopathy is one of the most important causes of blindness today. It occurs as a result of changes in retinal blood vessels.
Retina (net layer) is a photosensitive layer and must be healthy for visual function. Different types of damage occur in diabetic retinopathy. The structure of the blood vessels deteriorates and small bubbles occur, causing bleeding and leakage of the fluid into the surrounding tissues. In the later stages, unwanted new vessel buds form on the retina and cause sudden intraocular bleeding.
In diabetic retinopathy, vision loss does not develop at first, but as the disease progresses, vision weakness occurs. Therefore, there is no such thing as a diabetic retinopathy who does not have any visual complaints, and eye control is required at regular intervals. 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 form in the retinal vessels.
2- Moderate non-proliferative diabetic retinopathy: Bubbles increased in retinal vessels and occlusions appeared in the vessels.
3- Severe non-proliferative diabetic retinopathy: Vascular occlusions and hemorrhages have increased, and oxygen deficiency has become evident in the retina.
4- Proliferative diabetic retinopathy: Oxygen deficiency and malnutrition in the retina have increased and new and unhealthy vessel formation has started in the retina by sending danger signals to the brain. These newly formed vessels are very delicate and can cause bleeding and sudden vision loss at any time.
- How does diabetic retinopathy cause vision loss?
Diabetic retinopathy causes vision loss in two ways:
1- The fluid leaking from the weakened veins is collected in the visual center called the macula and water collection called macular edema occurs. This condition gradually reduces vision over time.
2- In the advanced stage, sudden bleeding may occur from unhealthy, weak new vessel formations and cause sudden vision loss.
On the left is the image seen by a healthy person, on the right is the image seen by a patient with advanced diabetic retinopathy.
- Who is at risk for diabetic retinopathy?
Type 1 and Type 2 All people with diabetes are at risk of diabetic retinopathy. Every diabetic patient should undergo a detailed retinal scan with pupil dilation at least once a year. The longer the diabetic has been in error, the greater 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 sight?
If you have diabetes, you should have a detailed retinal examination at least once a year. Diabetic retinopathy is an insidious disease. A person with diabetes may develop advanced diabetic retinopathy over years without any damage to vision. Whether you have vision problems 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 at more frequent intervals. In the presence of advanced (proliferative) diabetic retinopathy, the risk of vision loss can be prevented by 95% with appropriate and timely treatment.
Regulating blood sugar greatly prevents or slows down the development and progression of diabetic retinopathy. Apart from this, it also prevents or slows down kidney and end 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, and diabetic retinopathy is a painless disease. It is necessary not to wait for symptoms for examination and to have a retinal examination once a year.
If fluid accumulation called macular edema occurs in the visual center called macula, blurring of vision begins. If unwanted new and diseased vascularization begins in the retina in the advanced stage, these vessels may bleed suddenly and vision may be lost suddenly.
- What are the Findings of Proliferative Retinopathy in the Presence of Bleeding?
In case of sudden bleeding, floating bodies are often seen as the first symptom. After a while, the vision may be completely closed. If floating objects are seen, it is necessary to undergo a detailed retinal examination and receive the necessary treatment without delay, otherwise the bleeding will become severe and the vision may be completely closed. Most of the sudden bleeding occurs during sleep in the morning.
Sometimes, even without treatment, the bleeding may go away on its own and vision may reopen. However, this is a misleading situation and the possibility 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, with early treatment, vision gain is greater.
- How to Detect Diabetic Retinopathy and Macular Edema?
A detailed retinal examination includes the following tests;
Visual acuity measurement: How much sight is seen from a certain distance is measured.
Retinal examination: The pupils of the eyes are enlarged by dripping various drops. Detailed retinal examination is performed using various lenses.
- Eye pressure measurement.
Fluorescein angiography: In a detailed retinal examination, your doctor may recommend fluorescein angiography if deemed necessary. A dye is injected into the arm veins and retinal photographs are taken from both eyes, one after the other. In this way, information about the vascular structure of the retina of the eye is obtained. Treatment is directed accordingly.
Optical coherence tomography: Optical coherence tomography has been used in the detection and follow-up of macular edema in recent years. (OCT)
A device called is also used. Real-like cross-sections of the macular region are obtained in a short time without any intervention to the patient. Diode laser light beam is used for this. OCT gives us detailed information about macular edema.
- HOW IS DIABETIC RETINOPATHY TREATED?
If there is no macular edema, there is no need for treatment, especially in the early stages. Blood sugar, 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)to the entire retina (outside visual center) laser treatment should be applied. This treatment usually takes two or three sessions. This laser treatment should be done before bleeding into the eye starts. In the presence of severe bleeding, laser treatment is not possible.
If the bleeding is very heavy, surgical removal of the bleeding, called vitrectomy, is necessary. With vitrectomy, the bleeding inside the eye is completely cleared and the necessary laser treatment is applied in the same surgery.
- How is Macular Edema Treated?
Diabetic macular edema is treated with laser. Generally, a single session is sufficient, but more than one session may be required in stubborn cases. If both eyes have macular edema, one eye should be treated first, and the other eye should be treated within a few weeks.
In general, laser treatment prevents the risk of blindness due to diabetes by 90%. However, laser treatment often fails to restore already lost vision. Therefore, early diagnosis and treatment is very important.
In recent years, some new treatments other than laser have started to be used, especially in macular edema due to diabetes. Anti-VEGF
These new drugs called provide a certain improvement in diabetic retinopathy by preventing the formation of diseased new vessels and also by preventing vascular leakage that causes macular edema. These drugs, which are given by injecting into the eye, can be used together with the laser or alone, 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 is an injection into the eye. Therefore, it inevitably brings some risks such as infection, retinal tear. Therefore, it is a treatment that should be applied by experienced physicians who are experts in the field, in an operating room environment, under extremely sterile conditions. In addition, retinal specialist physicians should decide in which situations it should be done and how often it should be applied.
- What is vitrectomy?
If bleeding due to diabetic retinopathy develops inside the eye, vitrectomy surgery is performed.
Vitrectomy can be performed under local or general anesthesia. The type of anesthesia is determined by the joint decision of the patient and the physician. In vitrectomy, small holes are made in the wall of the eye and the fluid called vitreous and bleeding inside the eye are cleaned by entering through these holes with very thin instruments. The cleared liquid is replaced with a medicinal 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 of one month after the surgery.
It should not be forgotten that diabetes is a systemic disease. The health of the eye is directly proportional to blood sugar, arm pressure and cholesterol ratios.
Diabetic retinopathy is an insidious disease. Even without vision loss, severe damage occurs to the retina. Therefore, regular control, early diagnosis and correct treatment are very important.
Complete treatment of diabetic retinopathy is not possible. Certain damages are permanent. The treatments applied can improve the complications caused by diabetic retinopathy in a limited way. Therefore, early diagnosis and treatment is very important.