Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it does produce. Insulin is a hormone that controls blood glucose levels. A common consequence of uncontrolled diabetes is hyperglycemia, or high blood glucose (sugar), which over time can cause severe damage to many body systems, especially the nerves and blood vessels.
In 2014, the incidence of diabetes among adults aged 18 years and older was 8.5%. Diabetes was the direct cause of 1.5 million deaths in 2019, and 48 percent of all diabetes-related deaths occurred before age 70. Another 460,000 deaths were due to diabetes-related kidney disease. In addition, elevated blood glucose is responsible for approximately 20% of cardiovascular deaths.
Type 2 diabetes
Type 2 diabetes (formerly non-insulin-dependent diabetes, adult-onset diabetes) is caused by the body’s inability to use insulin effectively. More than 95% of diabetics suffer from type 2 diabetes. This type of diabetes is mainly caused by excess weight and lack of physical activity.
Type 1 diabetes
In type 1 diabetes (first insulin-dependent, juvenile, or childhood), which is characterized by insufficient insulin production, the patient needs daily insulin injections. In 2017, there were 9 million people with type 1 diabetes worldwide, most of them in high-income countries. Currently, the cause of this type of diabetes is unknown, and preventive measures have not been developed.
Eye damage in diabetes
Diabetes mellitus is a common disease that causes serious public health problems worldwide. The number of diabetic patients is increasing every year and currently,y there are at least 200 million people Diabetes is particularly dangerous due to the presence of chronic complications. The retina of the eye is affected first in diabetes, ie. Its inner shell consists of visual cells – consisting of rods and cones. These eye complications of diabetes are called diabetic retinopathy and always lead to significant vision loss and in some cases total blindness. Why do these disorders arise? Violation of the metabolic process causes pathological changes in the vessels of the eye, through the wall of which the liquid part of the blood begins to penetrate easily, which leads to swelling of the visual cells. As the disease progresses, retinal capillaries may become obstructed, leading to rapid retinal oxygen starvation and irreversible vision loss. Oxygen starvation of the retina leads to the formation of pathological, newly formed vessels, which sprout, and contribute to the development of internal bleeding in the eye – hemophthalmia. Their growth causes the growth of connective tissue, which in turn can cause retinal detachment. All this visualization cann lead to a rapid decline in function. The prevalence of diabetic retinopathy is directly related to the duration of diabetes. Therefore, if during the first 5 years after the onset of the disease, eye damage occurs in only a few patients, with more than 20 years of experience with diabetes mellitus, retinopathy is recorded in 80-100% of cases. Currently, the most common methods of assessing the condition of the organs of vision in diabetic patients are a visual acuity test and fundus examination using a special ophthalmic device – an eyepiece. However, with early changes in the retina, these diagnostic methods do not always allow a complete assessment of the nature and severity of eye changes in diabetic patients. In recent years, a fundamentally new tool for the early diagnosis of diabetic eye damage has emerged – optical coherence tomography. tomograph . The introduction of this method has revolutionized the diagnosis and treatment of diabetic retinopathy. This study is a completely harmless non-contact method that uses light waves to obtain an image of the eye’s membranes. With the highest resolution, the tomograph allows you to quantitatively measure the thickness of the retina and identify the smallest physical changes in the layer of visual cells. In addition, an important advantage of the device is the automatic storage of all received images in the computer memory, which allows objective dynamic monitoring during the disease.
What are the types of hereditary disorders in diabetic retinopathy?
Depending on the changes detected, they can be divided into five categories: non-proliferative, premature, proliferative stages, acute diabetic eye disease, and macular edema. As you can see, this division by severity is based on the presence or absence of a proliferative component (meaning either the presence of newly formed vessels or the growth of connective tissue in the eye). As well as reflecting the most functionally important area of the fundus, which is responsible for high visual acuity – the macula. Also, diabetics can develop clouding of the lens – cataracts. Opacity in the lens is characteristic of snowflakes. Laser photocoagulation of the retina is the primary treatment for diabetic retinopathy worldwide. A laser beam is a light beam characterized by high intensity and a narrow beam. The goal of this treatment is to freeze the pathological areas of the retina -So that no toxins are produced for the retina and the disease does not progress.
This type of treatment is a less painful way to affect the retina. The operation is performed on an outpatient basis, in one or more sess, ions and is quite safe. It should be understood that this treatment only prevents visual impairment, and does not restore good vision. It is also very important to understand tt that good compensation for diabetes is a condition for a stable positive effect of laser coagulation, other, wise retinopathy will continue to develop.
There is now indisputable evidence of the benefits of intensive care for diabetes in achieving normal levels of glucose and blood pressure in preventing the development of vascular complications. In this regard, self-monitoring of blood sugar levels and normalization of blood pressure is the most important thing to maintain vision in diabetic patients. So it was found that a glycemia level not exceeding 6.5 mmol/liter reduces the risk of retinal edema by 26%. At the same time, blood sugar levels above 7 mmol/L on an empty stomach and 9 mmol/L after a meal are already a high risk for developing eye complications. In addition, most researchers associate the development of diabetic retinopathy with cholesterol and blood lipid levels.
Depending on the stage of the diabetic lesion, different methods of laser coagulation of the retina are used depending on the volume and area of effect. Therefore, extensive panretinal coagulation of the retina is usually used to eliminate newly formed vessels and eliminate proliferative retinopathy. This operation allows you to concentrate the blood flow in the central parts of the fundus and reduce the stimulating effect of the ischemic process on the formation of defective vessels.
For the treatment of macular edema, a small amount of – focal laser coagulation is used, which allows the sealing of the vessels of the central area of the fundus, reducing the swelling and accumulation of liquid and solid exudates in the retina. causes to happen. This operation reduces the risk of severe visual impairment due to maculopathy by more than 50%. Due to the almost asymptomatic development of retinopathy in the early stages of the disease, diabetic patients need to have a regular evaluation of the condition of the organ of vision to detect eye complications early. Every patient should visit an ophthalmologist regularly even in the absence of visual complaints. It is very important to get regular check-ups soon after diagnosis, as retinopathy develops gradually and does not cause vision loss in the early stages. When the vision is so reduced that the patient begins to notice it, then the advanced stages of retinopathy develop, and effective treatment is no longer possible.
In the absence of retinopathy, it is recommended to be examined by an ophthalmologist once a year with early signs of background retinopathy – at least once every 6 months, and if non-proliferative and proliferative stages, Bleeding into the eye cavity and loss of vision. If detected, an urgent examination by a specialized ophthalmologist is necessary. Regular eye follow-ups of diabetic patients, continuous monitoring of blood sugar and blood pressure, and timely laser treatment will help preserve vision and prevent disability and blindness.
