Assoc. Prof. from Medicana Samsun Hospital, Department of Ophthalmology. Dr. Emrah Kan said, ''Diabetic retinopathy is the most common eye disease due to diabetes and is an important cause of blindness in adults.
Assoc. Prof. from the Department of Ophthalmology at Medicana Samsun Hospital. Dr. Emrah Kan gave information about the effect of diabetes on the eye:
It occurs with the deterioration of the vascular structure in the retinal layer, and as a result, abnormal new vascular formations occur in diabetic retinopathy.
Patients with diabetic retinopathy initially lose vision. Some changes may occur. With the duration of diabetes, the likelihood of developing diabetic retinopathy and serious retinal problems that may lead to vision loss increases. Diabetic retinopathy usually affects both eyes together.
How does diabetic retinopathy affect vision loss?
Blood vessels damaged as a result of diabetic retinopathy cause vision loss in two ways. It happens:
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Abnormal blood vessels that bleed easily may develop, and as a result of their bleeding into the eye, blurred vision occurs.
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Due to diabetes. The liquid part of the blood from the damaged blood vessel walls can leak into the center of the macula (macular spot), where sharp and central vision occurs. The leaking fluid causes swelling in the macula and blurred vision. This condition is called macular edema. Although the risk of macular edema increases as the disease progresses, it can occur at any stage of the disease. Approximately half of patients with proliferative diabetic retinopathy also have macular edema.
Who is at risk of diabetic retinopathy?
This risk exists for all people with both type I and type II diabetes. For this reason, it is beneficial for everyone with diabetes to have a comprehensive fundus examination using a dilated pupil at least once a year. The longer a person has had diabetes, the greater the risk of developing diabetic retinopathy. Approximately 40-45% of diabetic patients have diabetic retinopathy at any stage. is. A patient with diabetic retinopathy may be recommended treatment by her doctor to prevent the progression of the disease.
Diabetic retinopathy during pregnancy can be a problem for pregnant women with diabetes. In order to protect vision, it is beneficial for all diabetic pregnant women to have a detailed fundus examination as soon as possible. Your doctor may request some additional tests during pregnancy.
What can you do to protect your vision?
If you are a diabetic, a detailed eye examination is performed at least once a year. You should have an examination and keep the following in mind:
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Proliferative retinopathy can develop without any symptoms. At this advanced stage, the patient is at high risk for vision loss.
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Macular edema can occur at any stage of diabetic retinopathy.
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Even if the patient develops both proliferative retinopathy and macular edema together, the person's vision may be good. However, these patients are at high risk for vision loss.
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Early diagnosis and timely treatment can prevent vision loss, whether or not there is a change in your vision.
Studies conducted on patients with diabetes show that good control of blood sugar slows the emergence and progression of retinopathy. Kidney and nerve disease are also less common in diabetic patients who can keep their blood sugar as close to normal limits as possible. Good blood sugar level control will also reduce the need for laser.
Some other studies have shown that the risk of vision loss can be reduced by correcting high blood pressure and cholesterol levels. Correcting these will help protect your vision and is also important for your general health.
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Are there any symptoms (patient complaints) of diabetic retinopathy?
Usually in the early stages of the disease, the patient does not have any complaints and there is no pain. A patient with diabetes should never wait for complaints to appear. A detailed fundus examination using dilated pupils should be performed at least once a year.
Blurred vision may occur when the macula (the area of the retina where sharp central vision is provided) swells as a result of fluid leakage. This condition is called macular edema.
If abnormal new vessels form on the surface of the retina, vision loss may occur as a result of these vessels bleeding into the eye.
If bleeding occurs, what are the patient's complaints in proliferative retinopathy? Will it happen?
First of all, you will see the dots formed by the blood or the stain floating in the eye. If spots appear in your eyes, you should consult your ophthalmologist as soon as possible. You may need treatment before more serious bleeding occurs. Bleeding usually occurs during sleep and tends to occur more than once.
Sometimes, without treatment, eye spots can disappear and you can see better. However, bleeding may recur and serious visual impairment may occur. You should be examined by your ophthalmologist as soon as visual impairment occurs before bleeding increases.
How are diabetic retinopathy and macular edema detected?
Diabetic retinopathy and macular edema are detected during a comprehensive examination that includes:
Visual acuity test: The level of vision at different distances is measured.
The eye is made by dilating the pupil. examination
Eye Angiography and retinal tomography: Fundus fluorescein angiography (eye angiography) and OCT (optical coherence tomography) are examination methods used to evaluate the fundus in detail.
How is diabetic retinopathy treated?
In order to avoid the progression of diabetic retinopathy, diabetic patients' blood sugar, blood cholesterol and blood pressure levels must be kept under strict control.
Proliferative retinopathy is treated with laser.
The purpose of laser treatment is to help close abnormal blood vessels. Your doctor creates 1000-2000 laser burns away from the macula area to close the abnormal vessels in the retina of your eye. Since it is necessary to create a large number of laser burns in the treatment, the treatment is usually completed in 4 or more sessions. peripheral vision Although there may be a decrease in vision, the aim is to maintain your current vision level with laser treatment.
Laser treatment is more effective when applied before abnormal blood vessels begin to bleed. For this reason, diabetic patients should regularly undergo detailed eye fundus examination using dilated pupils. Even if bleeding begins, laser treatment may still be possible, depending on the level of bleeding.
If bleeding is severe, a surgery called vitrectomy may be required. Vitrectomy surgery cleans the blood inside the eye.
How is macular edema treated?
Macular edema is treated with laser. This method is called focal laser treatment. Your doctor places multiple small laser burns in the area that causes leakage in the retina surrounding the macula. These burns reduce the amount of fluid that accumulates in the macula by slowing leakage. Generally, the treatment is completed in a single session. Sometimes more intensive treatment may be required.
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Another method that can be applied in the treatment of macular edema in cases that do not respond to laser treatment is intravitreal (intraocular) injection.
In this treatment method, small injections are made into the eye. Special medications are injected with a needle. This application is usually performed in the operating room. The procedure takes a very short time and the patient usually feels a slight sting. The patient can go home after the procedure.
In some cases that are resistant to laser treatment and intravitreal injection treatment and in patients where the eye gel shrinks on the visual center, vitrectomy surgery can also be performed in the treatment of macular edema.
Laser treatment and regular follow-up can reduce the risk of blindness by 90%. Unfortunately, laser treatment cannot usually restore vision that has previously been lost. Therefore, the best way to prevent vision loss is to diagnose diabetic retinopathy at an early stage.
What is vitrectomy?
If there is too much bleeding inside your eye, vitrectomy surgery is performed to restore your vision. may need to be applied. If both eyes need surgery, first one eye will be operated on and a few weeks later the other eye will be operated on.
Vitrek TOMI surgery can be performed with local or general anesthesia. Your doctor creates a small incision to get inside your eye during surgery. Then, with a special tool inserted into the eye through this incision, the vitreous gel (the gel-like substance that fills the inside of the eyeball), which has become cloudy with blood, is cleaned. The vitreous gel inside the eye is replaced with a special liquid (balanced salt solution).
You can go home after the vitrectomy operation. Some patients may stay in the hospital overnight. There will be redness and tenderness in your eyes after the surgery. Your eyes may be closed for a while to protect your eyes. Some drops are used to protect from infection after surgery.
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