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The potential damage to the retina: Do you know the secret of how microvessels cause blindness?
Diabetic retinopathy is a medical condition in which diabetes causes damage to the retina and is one of the leading causes of blindness in developed countries. Although treatments to help people with diabetes continue to improve with the introduction of new therapies, retinopathy still affects up to 80% of people with type 1 and type 2 diabetes, especially those who have been diagnosed with diabetes for more than 20 years. Standardized treatment and regular retinal examinations can effectively reduce the incidence of new cases from progressing to more threatening retinopathy and macular degeneration by 90%. This article will explore the signs, diagnosis, classification, treatment and prevention of this condition.
Signs and symptoms
Almost all people with diabetes will develop some degree of retinal damage within a few decades, however, in the early stages, this damage is often undetectable and can only be observed through retinal examination. As the disease progresses, damage to the retina gradually becomes apparent, initially as tiny bulges in the blood vessels, called microaneurysms. Later, more severe retinal changes such as cotton-wool spots, hemorrhages, hard exudates, and other abnormalities may develop. Eventually, in severe cases, new blood vessels may develop that are prone to rupture and bleed, increasing the risk of blurred vision or complete blindness.
Approximately 50% of people with diabetic retinopathy will develop macular edema, one of the leading causes of vision loss.
Diagnosis and classification
Diabetic retinopathy is usually diagnosed by retinal examination using equipment including ocular examination and fundus photography. The American Academy of Ophthalmology divides the disease into five stages, including "no significant retinopathy," mild, moderate and severe non-proliferative diabetic retinopathy, and proliferative diabetic retinopathy. Symptoms vary from stage to stage, ranging from tiny dilated retinal arteries to more complex neovascularization.
Screening
Because diabetic retinopathy often has no obvious symptoms in its early stages, many patients do not realize they may have the disease until they are examined by an ophthalmologist. Both the American Diabetes Association and the International Council of Ophthalmology recommend that people with diabetes receive regular eye examinations. In particular, patients who are first diagnosed with type 2 diabetes should have a comprehensive eye examination at the time of diagnosis, while patients with type 1 diabetes should have the same examination within five years of onset.
Causes
The main cause of diabetic retinopathy is damage to small retinal blood vessels due to high blood sugar, which in turn triggers a variety of pathological changes. Long-term high blood sugar can lead to the death of capillary cells, increase the permeability of retinal blood vessels, ultimately affect the blood supply to the retina, and cause hypoxia, all of which can accelerate the progression of the disease.
Risk Factors
The main risk factors for diabetic retinopathy include a history of diabetes, poor blood sugar control, and hypertension. Chronic high blood sugar levels and large fluctuations in blood sugar levels increase the risk of developing disease. Other risk factors include kidney disease, high body mass index (BMI), and smoking.
Pathological mechanism
The pathological mechanism of diabetic retinopathy is mainly the damage of retinal small blood vessels and neurons. Early changes include narrowing of the retinal arteries with a concomitant reduction in blood flow, followed by dysfunction of the retinal blood-retinal barrier, which ultimately leads to leakage of outflowing blood components. As the disease progresses, hypertrophy and degeneration of neurons and glial cells will further affect the function of the retina.
Management and treatment
Currently, the treatment for diabetic retinopathy mainly includes four methods: anti-VEGF injection, steroid injection, panretinal laser photocoagulation and vitrectomy. These treatments are effective in preventing 90% of drastic vision loss, but they cannot completely cure diabetic retinopathy. Diabetic patients should also slow down the progression of the disease by controlling related data such as blood sugar, blood pressure and cholesterol.
Improving blood sugar control can also reduce the development of diabetic retinopathy.
For patients with mild to moderate nonproliferative diabetic retinopathy, the American Academy of Ophthalmology recommends more frequent eye exams to monitor disease progression. Anti-VEGF therapy works best in patients with macular edema, especially those with edema in the central part of the retina. Although treatment can improve vision, each patient's situation is different and the effectiveness of treatment will vary.
In terms of laser photocoagulation, panretinal photocoagulation can effectively reduce the risk of vision loss in patients with proliferative or severe non-proliferative diabetic retinopathy. Because this process requires creating a series of burn spots, patients may face certain visual loss or other sequelae when undergoing this type of surgery, but this is often a necessary measure to save central vision.
Advances in medical technology have provided more means for the management of diabetic retinopathy, but patients still need to remain vigilant and undergo regular check-ups in their daily lives in order to promptly detect and intervene in possible retinopathy. Do you already know how to prevent this potential retinal damage in your daily life?
