Diabetic retinopathy - a disease of the eye caused by long-lasting diabetes, initially threatening to lose visual acuity and later a complete loss of vision. The direct cause of eye pathology is high blood glucose (hyperglycemia!) That damages the retinal blood vessels. This threat applies to almost every diabetic.
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.
Diabetic retinopathy (pre-proliferative)
Visible lesions of the small retinal vessels and the discharge of blood from the capillaries of the gallbladder around the yellow spot of the eye - indicative of the onset of diabetic maculopathy.
Who and why is it threatened by deterioration of visual acuity?
The most endangered with diabetic retinopathy are people with long-term diabetes. This applies to both patients with type I diabetes (requiring insulin injections) and type II (not requiring insulin injections.) World statistics indicate that after 10-15 years of disease duration - in 50% of patients, there are signs of retinopathy, and after 20 -25 years, up to 75-90% of patients! The second risk factor is the advanced age of the patient.In this context, we can speak of a paradox, because the advances in the treatment of diabetes resulting in a prolonged life of people with diabetes cause that the effects of retinopathy come first in statistics on the causes of irreversible blindness.
Thanks to what we can see?
To see an object - the light reflected from it must pass through the pupil, the lens of the eye, the vitreous body and focus on the retina of the eye. The retina of the eye receives the light stimulus and processes it into a nerve signal - conscious in the brain as a picture of the object. Particularly important for visual acuity is a cluster of retinal cells about 1.5 mm in diameter highly sensitive to light, called the macula of the eye.
How does retinopathy interfere with the vision mechanism?
Under the influence of diabetes, damage to the retina occurs. Morbid changes in the retina of the eye cause damage to the small vessels that supply blood. Bleeding from these retinal and vitreous vessels causes swelling. Swelling poses a special threat to the macula cells of the eye, which are the most important part of the retina from the point of view of visual acuity. An additional risk is disorders in the blood supply to the retina of the eye causing hypoxia and poor nutrition. It deepens and accelerates the deterioration of sight.
We detect retinopathy during ophthalmologic examinations
A thorough method to detect early diabetic complications within the retina is a thorough eye examination. The stimulus for such a study should be, for example, blurred to explain blurred vision. Among various reasons, this may also be the result of the penetration of glucose into the eye lens. It changes its shape, blurring the visual acuity. This disorder disappears slowly after the treatment is implemented.
Hidden type 2 diabetes
WHAT DAMAGE TO THE TOOLVISION?
Numerous damage - so-called diabetic microangiopathy - which consist of:
a / the expansion of venous retinal vessels,
b / damage to small vessels, weakening their walls,
c) formation of microtuberomas,
d / closing of the arteriolar light before the retinal capillaries,
e / the formation of new blood vessels,
f / blood haemorrhage due to rupture of altered capillaries.
What are the causes of the above changes in the vessels of the eye?
The main cause of vascular changes is diabetes that has not been recognized or treated for a long time.
What is the risk of no treatment and development of vascular changes for the retina of the eye?
Under the influence of the development of the disease there are circulatory disorders in the retina and its ischemia. It threatens the sight impairment and even its loss.
What are the different stages of development of retinopathy?
We distinguish two stages of diabetic retinopathy - the initial stage - called non-proliferative retinopathy, and a more severe stage - later, advanced, called proliferative retinopathy. In this second stage, the loss of vision is greater, and even total blindness can occur.
When does visual impairment occur?
A harbinger is macular edema of the yellow eye. In the early stage of the disease (non-proliferative) - high blood glucose damages the retinal blood vessels The resulting leakage from the vessels collects in the central part of the retina, i.e. in the macula causing swelling. Macular edema causes loss of visual acuity, i.e. blurred vision. This stage of the disease is reversible, as the macular edema can be treated with a laser.
Jak develop retinopathy?
The initial stage of retinopathy is called macular edema caused by the vascular changes mentioned above: weakening of small retinal vessels, increased permeability, development of microvessels, closing of the arteriolar light. Vascular lesions - referred to as maculopathy - trigger a blockage of blood circulation in the retina and ocular macular edema. The consequence of edema is impairment of visual acuity. This is the most common cause of decreased visual acuity signaled by diabetic patients, especially type II. Swelling of this type with impaired visual acuity is found in about 10% of all diabetic patients, and among people with long-term illnesses (over 20 years), the percentage increases up to 30%!
Ed. Edward Ozga Michalski, MA
Consultation by prof. dr hab. med. Andrzej Danysz
