Description
Early diagnosis of diabetic retinopathy is crucial in preventing vision loss and managing the disease effectively. Regular eye screenings help detect retinal damage at an initial stage before symptoms appear. Timely intervention through lifestyle modifications, blood sugar control, and medical treatments can slow disease progression. Advanced imaging techniques like optical coherence tomography (OCT) and fluorescein angiography aid in accurate and early detection. Raising awareness about routine eye check-ups among diabetic patients is key to reducing blindness caused by this condition.
Summary Listen
- Diabetic retinopathy, a major ocular complication, affects a significant portion of diabetic individuals, with type 1 diabetes patients facing a higher risk (around 40%) compared to type 2 (around 20%). This condition is a leading cause of legal blindness in individuals aged 20-65, and approximately half of all diabetics will eventually develop retinopathy, often accompanied by diabetic macular edema, a primary driver of vision loss.
- Several factors increase the likelihood of developing diabetic retinopathy, including the duration of diabetes, poor blood sugar control, pregnancy, hypertension, and kidney damage (nephropathy). While the duration of diabetes is unavoidable, poor blood sugar control stands out as a modifiable risk factor that patients can actively address through dietary adjustments and lifestyle changes.
- Beyond the retina, diabetes can impact other parts of the eye. Common complications include retinopathy (retina), iridopathy (iris), and unstable refraction. Less frequent issues encompass oculomotor nerve palsy, styes, decreased corneal sensitivity, cataracts, and neovascular glaucoma. Rare complications involve papillopathy, pupillary light-near dissociation, Wallenberg syndrome, and rhino-orbital mucormycosis (black fungus).
- The pathogenesis of diabetic retinopathy is rooted in microangiopathy, affecting small blood vessels. High blood sugar directly damages retinal cells, and elevated levels of VEGF (vascular endothelial growth factor) play a critical role. Retinopathy is classified into non-proliferative (NPDR) and proliferative (PDR) forms. NPDR is further categorized as very mild, mild, moderate, severe, and very severe. PDR includes mild to moderate, high-risk, and advanced stages.
- Background diabetic retinopathy is characterized by microaneurysms (localized bulging of capillary walls), retinal hemorrhages, macular edema (fluid accumulation in the macula), and hard exudates (lipid and cholesterol deposits). Microaneurysms can lead to plasma leakage into the retina due to the breakdown of the blood-retina barrier.
- Pre-proliferative diabetic retinopathy signifies an intermediate stage between background and proliferative retinopathy. Hallmarks of this stage include cotton wool spots (nerve fiber layer debris), intraretinal microvascular abnormalities (IRMA), venous and arterial changes, and dark blot hemorrhages, indicating retinal ischemia.
- Proliferative diabetic retinopathy involves the growth of new, abnormal blood vessels on the inner surface of the retina. This occurs when at least 25% of the retina becomes non-perfused. These new vessels are often found at the posterior pole and optic disc. In advanced stages, neovascularization can also affect the iris, leading to neovascular glaucoma.
- Management of diabetic retinopathy starts with patient education, emphasizing the importance of systemic control, particularly glycemic control. For non-proliferative retinopathy, regular follow-up is crucial, with the frequency depending on the severity of the condition. For patients with clinically significant macular edema (CSME), anti-VEGF injections are indicated. In sphere and very sphere NPDR, close monitoring (every 3 months) is essential due to the high risk of progression to PDR.
- Panretinal photocoagulation (PRP) is a treatment option for high-risk PDR, though it may not always improve vision and can potentially worsen diabetic macular edema. The PRP procedure involves creating thousands of laser spots across the retina. Potential complications of PRP include transient vision blurring, headaches, and, in the long term, vision field loss and night vision loss.
- Anti-VEGF injections are crucial in managing diabetic macular edema. Furthermore, both dexamethasone and fluocinolone acetonide are steroid implants to address fluid issues that can damage the retina. In advanced diabetic eye disease, vitrectomy may be necessary to remove blood and alleviate traction on the retina. Optimizing glycemic control, blood pressure, and lipid profile are essential for reducing the risk and slowing the progression of diabetic retinopathy.
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