Diabetic retinopathy is an extremely serious pathological condition that can lead to a significant impairment of visual function. The essence of this disease lies in the fact that with long-term diabetes mellitus, the vessels supplying the retina of the eyeball are affected, leading to a gradual decrease in vision. This pathology has a slowly progressive course and, in severe cases, can cause secondary glaucoma, cataracts, hemophthalmia and even complete blindness. However, if you notice an emerging disorder in time and optimize glycemic control, diabetic retinopathy has a favorable prognosis. In this regard, it is important to seek medical help on time.
It is interesting that leading to the development of such a pathological process diabetes both the first and second type. Among patients suffering from elevated glucose, diabetic retinopathy in about eighty percent of cases causes visual impairment. According to statistics, among people with glycemia, blindness occurs twenty-five times more often than among other population groups. At the same time, men and women are equally prone to the occurrence of this disease.
As we have said, diabetic retinopathy is characterized by damage to the blood vessels supplying the retina of the eyeball. More specifically, with this disease, the vessels become more permeable, the lumen of the capillaries narrows, and newly formed vessels appear. Ultimately, this pathological process leads to proliferative changes.
The main condition for the onset of diabetic retinopathy is long-lasting diabetes. In the event that its duration is less than two years, approximately fifteen percent of people identify these or other changes in the vessels. If a person suffers from hyperglycemia for five years, the likelihood of developing diabetic retinopathy is already twenty-eight percent. With experience from ten to fifteen years, this figure rises to approximately forty-five percent.
In addition to duration, many other related factors play an important role in the formation of diabetic retinopathy. They not only increase the risk of such a disease, but also accelerate its progression. First of all, here we can say about the high level of glucose, long-term intractable hyperglycemia, existing problems with lipid metabolism and arterial hypertension. Predisposing factors also include overweight, chronic renal failure, nicotine addiction, hormonal disorders, and much more.
Classification and symptoms of diabetic retinopathy
There are three main options for retinopathy, developing on the background of sugar diabetes. These include nonproliferative, preproliferative and proliferative variants. In essence, they are stages of the same pathological process.
The first option, or non-proliferative, is accompanied by an increase in the permeability of the vascular wall. In this case, the vessels become much more brittle. As a result of the changes taking place in the region of the eyeball, point hemorrhages appear, and microaneurysms are formed. Due to the infiltration of intravascular fluid, swelling in the area of the retina is increasing. Often, at this stage, no symptoms are detected. In the event that edema has spread to the central zone of the retina, a sick person may indicate blurred vision, some difficulty in reading at close range.
The second option is preproliferative. Diabetes mellitus leads to the fact that ischemic changes are increasing in the retina. Immediately, ischemia itself is caused by narrowing of the arterioles, impaired movement of the blood through the veins and the appearance of larger hemorrhages. At the same time, concomitant symptoms indicating problems with visual function become more pronounced.
The most recent and unfavorable option is proliferative. It is detected in about ten percent of sick people. The likelihood of its occurrence is significantly higher if a person suffers from myopia, has atrophic changes in the optic nerve area, or has experienced detachment of the vitreous body.From a morphological point of view, this option is characterized by even more progressive ischemia, against the background of which new vessels are formed, aimed at restoring the normal level of tissue nutrition. Neovascularization in turn causes recurring hemorrhages. Massive hemorrhages often lead to irreversible fibrous proliferation in the vitreous region.
Due to hemorrhages, the clinical picture is complemented by such symptoms as the appearance of dark spots and veils, which often disappear on their own after a while. In the case of massive hemorrhage, there is a sharp and pronounced decrease in visual function, up to its complete loss.
Diagnosis and treatment of the disease
It is possible to suspect this disease on the basis of a long-existing hyperglycemia. Of the additional methods, ophthalmoscopy, visometry, biomicroscopy, ultrasound of the eyeball, electrophysiological tests, gonioscopy, fluorescence angiography and much more are used.
In case of retinopathy caused by diabetes mellitus, it is first necessary to adjust the level of glucose. To do this, you should choose the right regimen of insulin or glucose-lowering drugs. Also appointed angioprotectors, antihypertensive drugs, antiplatelet agents and much more. If necessary, glucocorticosteroids are administered into the vitreous. Good effect is observed with laser coagulation of the retina.
Prevention of the development of retinopathy in diabetes mellitus
Main methods prophylaxis are strict adherence to all the recommendations of the doctor regarding lifestyle and selected therapy, as well as the systematic passage of routine examinations by an ophthalmologist with existing hyperglycemia.