Prevention of diabetic retinopathy

Involvement of the retina of the eye in patients with diabetes mellitus (diabetic retinopathy) is the most common cause of new cases of blindness among adults 20 to 75 years of age. For the first twenty years of the disease, almost all Type 1 diabetic patients and more than 60% of patients with type 2 diabetes develop this serious complication. In the diabetic group in which the disease appears earlier ( type 1 ), 85% of cases of blindness has been attributed to diabetic retinopathy. In diabetes type 2 (in which diabetes appears later, after 40 years), one third of cases of legal blindness (even with some level of vision, someone unable to work) has been attributed to diabetic retinopathy.



The type II dibéticos should see an ophthalmologist immediately
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What is diabetic retinopathy?

Diabetic retinopathy is a serious complication of diabetes mellitus, characterized by the appearance of small dilations in the tiny microscopic blood vessels that supply the retina or innermost membrane of the eye, hemorrhages, exudates, abnormal veins and growth of new blood vessels in the membrane and the posterior surface of the vitreous that fills the eye.

Vision loss that occurs in this complication is the result of several mechanisms of action.

Risk Factors

The main risk factors include age, duration of diabetes mellitus and degree of control, high blood pressure and excess cholesterol in the blood.

The duration of diabetes is probably the most powerful predictor for the development and progression of retinopathy. The degree of control of blood sugar has been implicated in numerous scientific studies as one of the main factors, some studies that used an intensive treatment of diabetes with insulin showed a significant reduction in the risk of retinopathy.

The protective effect of good blood sugar control has also been confirmed in patients with type 2 diabetes. A major study conducted in the UK 6 years ago showed that improved blood sugar control reduced the risk of developing retinopathy and nephropathy (kidney involvement), and possibly neuropathy (nerve involvement) . The overall complication rate of small blood vessels was reduced 25% in patients receiving intensive treatment versus those who received conventional treatment.

This important study also showed that tight control of blood pressure in these patients reduced progression of diabetic retinopathy and the risk of deterioration of visual acuity and reduce deaths related to diabetes and stroke.

Measures to prevent diabetic retinopathy

Interventions that have shown benefit in preventing diabetic retinopathy are:

Good control of diabetes

comprehensive control of hypertension

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laser photocoagulation in patients with early-stage lesions.

Laser photocoagulation has proved effective to significantly reduce severe vision loss and slow the progression of retinopathy. It is a technique that involves the destruction of new blood vessels formed in the retina or vitreous hemorrhage by administration of multiple shots of a laser beam. Unfortunately, despite its effectiveness, this technique does not return the hearing loss.

It is very important to consider that diabetic retinopathy occurs with little or no visual or ophthalmic symptoms until vision loss occurs. Since this treatment is to prevent such loss and retinopathy may be asymptomatic, it is essential to identify and treat these patients early, early in the disease. To achieve this goal, diabetic patients should be routinely evaluated to detect the disease at a stage that can be treated.

In this connection it is interesting to follow these recommendations:

Patients with type 1 diabetes should be examined by an ophthalmologist between 3 and 5 years after being diagnosed with the disease.

Patients with type 2 diabetes should be evaluated by an ophthalmologist as soon as possible after diagnosis.

All diabetic patients should be examined annually by an ophthalmologist with expertise in the diagnosis of diabetic retinopathy. If cases of progressive retinopathy, checks should be made more frequently.

Because pregnancy is a factor that may accelerate the progression of diabetic retinopathy, diabetic women who become pregnant should be examined by an ophthalmologist in the first trimester of pregnancy and periodically during treatment.

It should begin treatment with laser photocoagulation in diabetic patients type 2 diabetic retinopathy lesions in early stages to prevent the progression of complications and blindness.