Diabetic retinopathy - symptoms, treatment, diagnosis

In this article we will tell you:

Symptoms of diabetic retinopathy
What causes diabetic retinopathy?
Diabetic retinopathy is divided into three types
Prevention of diabetic retinopathy
How is diabetic retinopathy treated?
Basic correction methods

Diabetic retinopathy is not an independent disease, but a complication of diabetes that affects the retina of the eye and can lead to blindness if left untreated. It develops due to damage to the blood vessels of the light-sensitive tissue in the retina.

Diabetes is a chronic disease in which the pancreas does not produce enough insulin or the body cannot process it. Insulin is a hormone that regulates blood sugar levels. A common consequence of advanced diabetes, hyperglycemia, or elevated blood sugar levels, leads to serious damage to many body systems over time, especially nerves and blood vessels.

The influence of ocular manifestations of diabetes mellitus on human vision.

Diabetic retinopathy is damage to the retina that occurs with diabetes.
A high level of long-term glycemia changes the structure of the wall of the retinal blood vessels, making them more permeable, allowing fluid to penetrate into the intraretinal space. The development of diabetic retinopathy most often occurs in people 5-10 years after the onset of diabetes. Diabetic retinopathy occurs differently depending on the type of diabetes. In type I (insulin-dependent), it is rapid - in this case, proliferative diabetic retinopathy (an advanced stage of the disease) occurs quite quickly. In type II diabetes mellitus (non-insulin-dependent), changes arise and develop in the central zone of the retina. Diabetic retinopathy is a disease that mainly causes blindness in people whose ages range from 20 to 65 years. Diabetes mellitus, high blood pressure, excess weight, high cholesterol levels are all factors that increase the risk of complications significantly.

Classification

According to the clinical picture, diabetic retinopathy is divided into three main forms: background nonproliferative, preproliferative and proliferative. As can be seen from the terms, the distinguishing criterion in this classification is proliferation (“growth”). In this case, we mean the tendency to form and branch a network of new blood vessels (this phenomenon is more accurately called neovascularization), which is observed in the later stages of retinopathy, when the own vessels are no longer able to provide blood supply to the retina.

In addition, diabetic maculopathy, or diabetic macular edema (predominantly affecting the central photosensitive macular zone of the retina) is considered as a relatively independent form.

Background (non-proliferative) retinopathy is the initial stage of diabetic retinopathy. Subjectively, it may not be felt, visual functions are not significantly affected, or the symptoms are “flickering” (impairments appear and then disappear again for a while). Clinically it is characterized mainly by angiopathic (vascular) focal changes: the formation of lipid plaques, thickening of the basement membrane, increased permeability of the walls. Microaneurysms (protrusions) and microhemorrhages are possible - minor hemorrhages and bruises under the vessels.

Preproliferative retinopathy is a natural development of the initial phase. At the second stage, retinal ischemia acquires a distinct character, multiple pathological foci are formed, hemorrhages become more frequent and intensified, the structure and appearance of the veins change.

Finally, proliferative retinopathy is characterized by active neovascularization, proliferation of fibrous tissue, gross organic changes in the tissue of the vascular walls and functional degradation of blood vessels; hemorrhages become massive and reach the level of general hemophthalmos (intraocular hemorrhage). The ingrowth of newly formed vessels leads to various kinds of mechanical anomalies - traction (stretching), compression, compression, etc., which can lead to catastrophic consequences for the eye: for example, the diagnosis of “tractional retinal detachment” literally means forceful separation of the retina by ingrown into the vitreous and mechanically stressed ties.

Diabetic macular edema , i.e. edema of the central zone of the retina (macula, macula) is divided according to the degree of prevalence into focal (local) and diffuse, covering the entire area of the macula. It can lead to loss of central vision, since the photosensitive macula, or macula, is responsible for this visual field, which is the sharpest and clearest. Swelling develops as a result of abundant effusion from blood vessels, liquid and solid exudative foci are formed.

Causes

Long-term hyperglycemia (increased blood sugar) is the main and most significant cause of the development of diabetic retinopathy. This disease is diagnosed in approximately half of people who have diabetes mellitus for approximately 10-15 years.

Factors in the development of pathology include:

Long-term smoking;
Overweight;
Genetic predisposition;
Chronic renal failure;
History of frequent episodes of hypoglycemia.

Prevention

It is almost impossible to prevent diabetic retinopathy in patients with diabetes mellitus, accompanied by a constant increase in glucose concentration. In order to slow down pathological changes and avoid blindness, it is necessary to lead a healthy lifestyle, maintain blood glucose levels, and take medications prescribed by a doctor. Prevention consists of timely diagnosis and identification of signs of complications.

Diabetes mellitus negatively affects the state of the visual system, causing disturbances in its functions, and in severe cases, complete blindness. At a certain point, changes occurring in the ocular structures become irreversible, so people with such pathology need diagnosis and prevention of complications.

During your appointment, your doctor will answer all your questions and tell you how to treat diabetic retinopathy specifically in your case.

Symptoms of diabetic retinopathy

Symptoms of the disease appear in the later stages of development, usually when the process becomes irreversible. Most often, the disease is asymptomatic, but patients may complain of a blurry image of objects. For many people, symptoms may not appear until the disease progresses to more severe stages, at which point it can lead to vision loss and blindness. For this reason, all patients diagnosed with diabetes should undergo an ophthalmological examination every six months.

The main symptoms of diabetic retinopathy:

Decreased vision (more often this symptom indicates severe stages of retinopathy);
Twinkling “stars” in the eyes;
Discomfort and pain in the eyes;
Decreased visual acuity and the presence of a “veil” before the eyes;
It is possible to develop complete blindness.

If you experience similar symptoms of the development of this disease, we advise you to make an appointment with an ophthalmologist at the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency. Timely diagnosis will prevent possible negative consequences for your health!

Lifestyle (recommendations)

Diabetes mellitus significantly affects the quality of life, requiring the patient to take a responsible attitude to medical prescriptions, recommendations and warnings. Quite strict restrictions in diet and lifestyle are inevitable. On the other hand, observing these same restrictions would not hurt many healthy people, since proper nutrition, quitting smoking and alcohol, optimal exercise and rest, self-control and self-diagnosis skills are, in fact, the basis of active longevity. As for the visual system, any modern person constantly faces loads and overloads that are unnatural for it and do not exist in nature. Periodic, at least once a year, preventive visits to an ophthalmologist should become a habit. If there is such a formidable and serious disease as diabetes mellitus, with the accompanying high statistical risk of retinopathy, regular ophthalmological examinations are necessary and mandatory.

Diagnostics

To determine the disease, it is first necessary to consult an ophthalmologist. To diagnose your vision, your doctor will conduct some tests:

Perimetry (ophthalmological examination in which the field of vision is determined);
Biomicroscopy (detailed study of the structures of the visual organs using a slit lamp);
Ophthalmoscopy (a method of examining the fundus of the eye using a special optical device);
Fundus photography (a diagnostic study during which photographs of the fundus structures are taken using a special camera);
Optical coherence tomography of the retina (examination of tissue with a laser device).

The results of the listed diagnostic studies will give the doctor a complete picture of the patient’s vision condition. Treatment will be prescribed based on information about the stage of development of the pathological process in the eyes. At the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, you can undergo all the specified diagnostic tests and receive a consultation with a treatment regimen during one visit to our center.

How the disease develops

Diabetes is accompanied by changes in the structure of the endothelium (inner lining) of the blood vessels that supply the retina, as well as metabolic disorders. The permeability of the retinal vessels is impaired, because of this various undesirable substances begin to penetrate into the retina, while the supply of oxygen to the eye tissues deteriorates. Against the background of the changes occurring, the formation of microaneurysms, the growth of pathological vessels, and pinpoint hemorrhages are noted. Gradually, the described disorders progress, leading to severe visual impairment and blindness.

Treatment of diabetic retinopathy

The level of glucose and glycated hemoglobin in the blood is one of the most important indicators in treatment. The therapy is based on strict regular monitoring of these indicators. It is necessary to carefully organize the treatment of the patient’s underlying disease – diabetes.

During the treatment of diabetic retinopathy, a multidisciplinary approach is required; not only ophthalmologists, but also endocrinologists should be involved in treatment. The choice of treatment method largely depends on the current stage of the disease.

The following methods of treating diabetic retinopathy are used at the Federal Scientific and Clinical Center of FMBA:

Drug therapy. Angioprotective drugs, steroidal and non-steroidal anti-inflammatory drugs, anticoagulants, and drugs to improve microcirculation are used (according to indications).
Laser treatment. At this point in time, the most effective and reliable method of preventing the development of diabetic retinopathy is laser coagulation of the retina (RLC). LCS is an outpatient procedure. It is absolutely painless for patients; local anesthesia is used during the procedure, which eliminates pain. The purpose of LCS is coagulation (“cauterization”) of ischemic areas of the retina, as well as the most incompetent “leaking” retinal vessels and, possibly, the creation of temporary pathways for the outflow of accumulated intraretinal fluid.
Endovitreal administration of neoangiogenesis inhibitors (Lucentis or Eylea) as well as the drug Ozurdex. This type of treatment is used for the development of macular edema. These drugs are injected into the vitreous body in an operating room under local drip anesthesia. After administering the drug, the patient goes home 1-2 hours later with the necessary recommendations. The therapeutic effect of the implant lasts from 30 to 90 days from the date of insertion.
Microinvasive vitrectomy. Removal of the vitreous humor (the transparent gel that fills the eye cavity) - in the presence of hemorrhages in the vitreal cavity.
Surgical treatment of tractional retinal detachments occurring in proliferative diabetic retinopathy. Modern methods of vitreoretinal surgery are used with the introduction of special substances into the eye cavity - silicone oil or gas-air mixtures.

Treatment prices

The cost of treatment depends on the severity of diabetic retinopathy and other factors. Based on this, a treatment regimen is selected, which can also be carried out with laser exposure (the price of sectoral retinal coagulation is 9,000 rubles per eye), parabulbar and intravenous injections, etc.

The Moscow Eye Clinic has developed a comprehensive treatment program for patients with diabetic retinopathy, which allows them to maintain and improve visual function in this eye disease.

You can find out the price of the procedure by calling 8 (800) 777-38-81 and 8 (499) 322-36-36 or online, using the appropriate form on the website.

Go to the “Prices” section>>>

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Risk factors for significant vision loss

Diabetic cataract. True diabetic cataracts occur more often in children and young people than in the elderly, more often in women than in men, and are usually bilateral. Unlike age-related, diabetic cataracts progress very quickly and can develop within 2-3 months, several days and even hours (during a diabetic crisis). In the diagnosis of diabetic cataracts, biomicroscopy is of great importance, allowing to identify flaky whitish opacities in the most superficial subepithelial layers of the lens, opacities under the posterior capsule, subcapsular vacuoles in the form of dark, optically empty, round or oval zones. However, unlike blindness due to retinopathy, blindness due to diabetic cataracts can be treated surgically.

Neovascular glaucoma is a secondary glaucoma caused by the proliferation of newly formed vessels and fibrous tissue in the anterior chamber angle and on the iris. During its development, this fibrovascular membrane contracts, which leads to the formation of large goniosynechiae and an intractable increase in intraocular pressure. Secondary glaucoma is relatively common; when severe, it is difficult to treat and leads to irreversible blindness.