Diabetic Retinopathy

Dr. Nabil Michel Macaron 
Surgery and Disease of Eyes, USJ
Specialist at Paris hospitals
Head of Service at Khoury Général Hospital Zahle 
Specialist at Eye and ear Hospital
Laser-vision Hazmieh

 

Diabetic Retinopathy (DR) is a serious complication of diabetes that results from the damage of retinal blood vessels and affects the visual prognosis. The retina is a thin layer of visual cells in the eye, that is irrigated by small blood vessels. High levels of sugar in the blood damages the capillary wall which can also lead to other complications such as retinal edema, neo-vessels, and hemorrhage; all of which affect and sometimes impair vision.

Diabetes is the first cause of acquired blindness in adults in occidental countries; and around 30% of diabetes patients have retinopathy.

There are 2 types of diabetes:

-          Type I: Usually affects youth or children and its treatment is based on insulin. In this type, Diabetic Retinopathy may being to appear 7 years or more after the date of diagnosis.

 

-          Type II: Usually affects people over the age of 50 years and its treatment is based on a healthy diet combined with oral hypoglycemic medication. Around 20% of people diagnosed with this type of diabetes develop diabetic retinopathy.

 

The main risk factors of Diabetic Retinopathy are:

-          Bad control of blood sugar (HBA1C <7%)

-          Seniority and diabetes stage

-          Hypertension

-          Hyperlipidemia

-          Impaired renal function

-          Obesity

-          Smoking

-          Alcohol

-          Physical inactivity

Diabetic Retinopathy can be silent with no obvious symptoms, though some signs of worsening vision (or a difficulty to move from darkness to light) may sometimes be noticed by patients. Thus, regular checkups (at least once a year) by an eye specialist, are necessary for early detection and diagnosis of DR.

 

DR is classified into 2 categories based on its development stage:

1.   Early stage

2.   Moderate, advanced stage: involving the formation of new abnormal vessels, which can lead to hemorrhage.

If DR advances, it can damage the center of the retina and the macula. Furthermore, if DR remains untreated, it can cause serious untreatable vision problems such as blindness due to hemorrhage, glaucoma, and retinal detachment.

Managing DR depends on the stage of the disease and consists of preventing or slowing its progress.  This is why the treatment is more efficient when it is done early in the course of the disease. Educating the patient is an essential part of DR management. It is important to raise awareness about the benefits of good blood sugar control and associated diabetes complications (hypertension, renal impairment, hyperlipidemia), which, if left uncontrolled, can contribute to speeding up the development and advancement of DR.

Monitoring DR

In the absence of DR, or in case of an early diabetes diagnosis, an annual check-up is recommended. However, in the case of more advanced RD, regular checkups every 4-6 months are required.

Treatment

Early diagnosis of DR, couple with good blood sugar control (HBA1c < 7),as well as controlled blood pressure and lipidemia, are the essential elements for the prevention and treatment of DR. Nonetheless, in case of the diagnosis of advanced Diabetic Retinopathy, three therapeutic treatments are available, which include:

1-   Argon Laser that consists of photocoagulation of the retina;

2-   Intraocular injection to reduce the edema and neovessels;

3-   Surgery to treat the complications (hemorrhage, retinal detachment).

 

DR is a major cause of vision loss, yet it is frequently under-estimated or neglected. Raising awareness about the need for yearly eye checkups and proper glycemic control in diabetic patients is of the utmost importance to prevent vision loss.

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