Diabetic retinopathy is a change in the retina that occurs over the years in diabetics. The vessels of the retina calcify, new vessels can form, which grow into structures of the eye and thus severely endanger vision. Bleeding also occurs in diabetic retinopathy.
Depending on the stage of the disease, deposits, new vessels or even retinal detachment and hemorrhages occur. Diabetes is seen as the cause. This disease is often responsible for blindness.
How common is diabetic retinopathy?
Diabetic retinopathy is often responsible for blindness. In fact, it is the most common cause in people between 20 and 65 years of age. The trend is that diabetic retinopathy is becoming more common. This is simply due to the fact that the underlying disease diabetes is also becoming more common.
- Optic nerve (nervus opticus)
- Cornea
- Lens
- Anterior eye chamber
- Ciliary muscle
- Glass body
- Retina (retina)
What forms of diabetic retinopathy are there?
Forms of diabetic retinopathy:
- Non-Proliferative Retinopathy (Proliferation: proliferation/new formation, Retina: retina) Non-proliferative retinopathy is characterized by the fact that it is predominantly confined to the retina. It is there that the smallest aneurysms, cotton wool foci, bleeding and retinal edema occur within the retina, which can usually be detected by the doctor in a slit-lamp examination. In the non-proliferative form, a further distinction can be made between a mild, a moderate and a severe stage.
The classification depends on the occurrence of different symptoms and lesions. The stage can be defined using the so-called “4-2-1” rule.
The “4-2-1” rule plays an important role in determining the stage of non-proliferative retinopathy. This form of retinopathy is divided into a mild, a moderate and a severe form.
The severe form is defined by the occurrence of at least one of the following three lesions: 1. at least 20 microaneurysms per quadrant in all 4 quadrants. 2. pearl-like veins in at least 2 quadrants. 3. intraretinal microvascular anomalies (IRMA) in at least 1 quadrant.
Thus, the “4-2-1” rule describes the number of quadrants that must be affected by the lesion for non-proliferative retinopathy to be classified as severe. The more diabetic retinopathy is advanced, the more vision deteriorates. Vision also depends on the type of disease (proliverative/non-proleiferative).
If there is an accumulation of fluid in the macula (macular edema), vision is impaired. Important for the vision are anyway almost exclusively processes that take place in the macula (yellow spot). Also lipid deposits (fat deposits) disturb the vision.
The patients notice blurred or distorted vision or blind spots. The ophthalmologist recognizes the changes in the retina by means of the reflection of the fundus of the eye. To get a better view of the eye, drops are administered to dilate the pupil.
This allows a good view into the eye. Another method of diagnosis is the so-called FAG (fluorescence angiography). The patient is injected via the vein with a dye (not a contrast medium), which is quickly distributed in the body’s vessels, including the eye.
Photos of the vessels are taken at different stages so that it is possible to see whether a vessel is dilated or even leaking and dye is leaking. The pupil must be dilated for this examination as well. The basis of the therapy is the successful treatment of the basic disease diabetes mellitus.
The blood pressure must also be well adjusted. There is no drug treatment for diabetic retinopathy. However, there are medications available that stop the growth of the blood vessels.
Vessels can be closed by laser to prevent excessive growth. This treatment can be applied to a large area of the retina. Vision is usually not affected too much, as sufficient areas remain intact.
As side effects, however, visual field restrictions may occur. Color vision and adaptation to darkness are also affected. A further therapy is the removal of the vitreous body.
It is mainly used for retinal detachments. The vessels that have grown into the vitreous draw connective tissue and thus create a pull on the retina. It can come to detachment.To reattach the retina, not only the vitreous body has to be removed, but also a gas or oil has to be filled into the eye instead.
Only such a filling guarantees that the retina is pressed on and can grow together again. Laser treatment is particularly suitable for proliferative and severe forms of non-proliferative retinopathy. The laser application destroys undersupplied areas of the retina by means of coagulation, and also reduces the growth stimulus for the formation of new vessels.
In the case of large lesions on the entire retina, the treatment is carried out in several sessions. Risks of laser treatment are limitations of night vision and visual field reduction. In order to detect diabetic retinopathy at an early stage, regular check-ups by the ophthalmologist should be a priority in cases of known diabetes.
As a patient, go to your ophthalmologist quickly if changes or vision problems occur. In most cases, the changes in the retina are already advanced by then. Diabetes patients (diabetes mellitus) should therefore see their doctor even before the visual problems occur.
Simply make a commitment to one visit to the ophthalmologist per year and, if possible, do not miss any. The prophylaxis depends on the type of diabetes. Type 1 diabetics must be checked annually from 5 years after the onset of their disease and quarterly after 10 years of diabetes.
Type 2 diabetics (mostly elderly people) must also be examined regularly, but at shorter intervals. The injection of antibodies against growth factors is a kind of prophylaxis. These are intended to stop the growth of blood vessels and are administered directly into the eye.
- The risk of retinopathy can already be significantly reduced by an optimal adjustment of blood sugar and blood pressure. A permanent reduction of HbA1c below 7% and of blood pressure to 140/80mmHg is recommended.
- In addition, obesity, increased blood lipid levels and smoking should be reduced.
The cause of diabetic retinopathy lies, as the name suggests, in the presence of the underlying disease diabetes. This damages the already small vessels in the eye.
This leads to premature sclerosis (a type of calcification) of the vessels, which can lead to vascular occlusion. If a vessel is blocked, the retina can no longer be supplied with blood and thus cannot be nourished. The eye tries to compensate for this fact by stimulating increased vascular growth.
People with diabetic retinopathy have blurred and blurred vision. Depending on which areas of the retina are affected, the severity of the symptoms varies. If the macula (yellow spot = the area of sharpest vision) is affected, blindness is imminent.
The diagnosis is made by the ophthalmologist using non-invasive ocular fundus mirroring. In order to be able to say more precisely about the stage of the disease, a retinal dye examination is usually necessary. The therapy is difficult.
Newly grown vessels can be obliterated by laser, but only if they are not located in the macula (yellow spot). If the retina is detached, it must be reattached by surgery (the laser is of no use here!!!). There is no drug therapy for diabetic retinopathy.
