What are the symptoms of early retinal vascular changes?
Patients who have been chronically diabetic for 10-15 years should be worried about blurred vision that is difficult to explain. Especially if he is aware that he has not always properly controlled the level of glucose in the blood. This may be due to the penetration of glucose into the eye lens. It changes its shape, it blurs the sharpness of sight. This disorder disappears slowly, after optimal treatment implementation.
Glucose levelin blood
is now recognized
the most common glucometer.Glucose levels are too high (hyperglycemia!)
and denotes diabetes when:
♦ in double fasting, it exceeds 126 mg / dl (7.0 mmol / l)
♦ in random measurement it is greater (or equal to) 200 mg / 100 ml (11.1 mmol / l) and there are typical symptoms of diabetes.
Glucose levels are too low and mean dangerous hypoglycaemia when:
♦ the blood sugar level will drop below 2.8 mmoles / l (50 ml / dl) - this means severe hypoglycaemia.
Warning!
However, you must know that the symptoms of retinopathy, such as blurred vision, are not good indicators of early diagnosis of diabetes. These types of symptoms of changes in the retina are rarely seen before the age of 15 diabetes.
How to recognize the early phase of macular edema, ie maculopathy?
The swelling of the yellow macula is diagnosed based on an accurate fundus examination. An examination using the so-called stereoscopic biomicroscopy, a method based on the use of a set of lenses giving a three-dimensional image of the eye. Such an image allows to detect and determine the severity of retinal edema. If clinical signs of edema are found, fluorescein angiography is indicated, which is the basic examination allowing accurate identification of vascular leakage sites causing edema.
Diagnostics of retinopathy
The diagnosis of retinopathy is based more and more on laser eye scanning (imaging). It involves penetrating the fundus with a beam of infrared radiation, as a result of which colorful retina sections are obtained, in which the colors correspond to the optical properties of individual structures. This allows very accurate assessment of macular edema. It is a non-invasive examination, which allows its frequent performance.
What does modern medicine offer to treat retinopathy?
The principle is a comprehensive treatment in which pharmacotherapy, retina laser therapy and surgical treatment complement each other. It should be emphasized that rigorous glycemic control is a necessary condition for the effectiveness of this treatment - ie constant maintenance of optimal blood sugar values.
Some patients complain that they can see worse with the optimal leveling of diabetes than before?
Indeed, after the implementation of optimal glycemic control, visual deterioration is observed. However, this is a transient symptom, and the disease is progressing more slowly than with decompensated diabetes. Tight glycemic control reduces the risk of developing retinopathy by 60%. TREATMENT OF RETINOPATHY
Medications and retinopathy
These are drugs: 1 / antiaggregation (reduce blood clotting, e.g. acetylsalicylic acid); 2 / fibrinolytic, increasing the flow through the vessels; 3 / sealing vessels necessary for haemorrhagic changes, e.g. Calcium Dobesilate, Rutinoscorbin; 4 / about anti-haemorrhagic activity. 5 / It is also recommended to use antioxidants - vitamins (A, E and C) and minerals (zinc, manganese, selenium). The condition for the effectiveness of treatment is regularity and long-term administration of drugs.
How effective is retina laser therapy?
Laser therapy is the most effective treatment for retinopathy. It consists of m.in.on the operative closure of leaky blood vessels, which prevents the formation of new pathological vessels prone to rupture and giving outjections to the retina and vitreous. Used in a timely manner, it improves vision in nearly every second patient. It also inhibits the progress of retinopathy and saves the sight of many patients. However, the chance to improve vision exists until the patient has a sense of light.
Does treatment of comorbidities with diabetes prevent loss of sight?
Excess lipids, cholesterol, obesity, hypertension, atherosclerosis, blood coagulation disorders accelerate the damage of the macula. It is therefore necessary to lower the LDL and triglyceride levels, e.g. with a diet. It also helps to increase physical activity. However, if the natural methods are ineffective, pharmacological treatment is necessary: fibrates, statins, etc. Treatment prevents the development of pathological changes in the retina (maculopathy), and thus the edema of the macula and impaired vision.
When the patient is at risk of blindness?
The risk of blindness appears in the advanced stage of the disease (proliferative). At this stage, abnormal blood vessels in the retina appear. They are very delicate and easily burst, which causes bleeding into the vitreous body of the eye. This body, which is a transparent, jelly-like substance under the influence of bleeding, stops transmitting light into the retina. There may then be a worsening of vision or total blindness. Another risk is the formation of scars that can "pull" the retina and cause it to detach. This type of retinopathy can be treated with a laser. If there is a hemorrhage and loss of vision - then an operation called vitrectomy is used. It removes blood from the eye. This treatment allows you to regain your eyes often.
What should the patients with diabetes remember?
Once a year, it is necessary to check the eye of the ophthalmologist. He watches the eye, using special optical devices, examines intraocular pressure. If there are changes in the bottom of the eye - visits to the ophthalmologist should be more frequent. Early diagnosis of changes enables effective treatment. Systematic eye tests, early treatment, with close glycemic control, best protect the eyes from retinapathy.
Ed. Edward Ozga Michalski, MA
Consultation by prof. dr hab. med. Andrzej Danysz
