- WHAT IS DIABETIC EYE DISEASE?
An eye disease that may occur as a complication of diabetes in people with diabetes. problems are called diabetic eye disease.
Problems that can be seen in diabetic eye disease:
- Diabetic retinopathy: It is the damage that develops in the blood vessels in the network layer called the retina.
- Cataract: It is the fogging of the lens of the eye and loss of transparency. Cataracts appear at an earlier age in diabetic patients.
- Glaucoma: It is an increase in intraocular pressure and as a result, it damages the optic nerve and reduces vision. A person with diabetes has twice the risk of developing glaucoma than other people.
- WHAT IS DIABETIC RETINOPATHY?
Diabetic retinopathy, nowadays It is one of the most important causes of blindness. It occurs as a result of changes in the retinal blood vessels.
The retina is the light-sensitive layer and must be healthy for visual function. Different types of damage occur in diabetic retinopathy. The structure of the blood vessels deteriorates and small bubbles form, causing bleeding and leakage of the fluid within the vessel into the surrounding tissues. In later stages, unwanted new vascular buds form on the retina and cause sudden intraocular bleeding.
In diabetic retinopathy, vision loss does not occur at first, but as the disease progresses over time, vision weakness occurs. Therefore, there is no such thing as a diabetic patient who has no complaints about his vision will not have diabetic retinopathy. Eye control is required at regular intervals. Diabetes usually affects both eyes.
- What are the stages of diabetic retinopathy?
- What are the stages of diabetic retinopathy? strong>
1- Mild non-proliferative diabetic retinopathy: In this early stage, bubbles called microaneurysms form in the retinal vessels.
2- Moderate non-proliferative diabetic retinopathy: Bubbles in the retinal vessels have increased and occlusions have occurred in the vessels.
3- Severe non-proliferative diabetic retinopathy: Vessel occlusions and bleeding have increased. , lack of oxygen in the retina is evident
4- Proliferative diabetic retinopathy: The lack of oxygen and malnutrition in the retina has increased and danger signals have been sent to the brain, causing the formation of new and unhealthy vessels in the retina. These newly formed vessels are very delicate and can cause bleeding and sudden vision loss at any time.
- How does diabetic retinopathy cause vision loss?
Diabetic retinopathy causes vision loss in two ways:
1- Fluid leaking from the weakened vessels collects in the visual center called the macula and a blister called macular edema occurs. This condition gradually reduces vision over time.
2- In advanced stages, sudden bleeding may occur from unhealthy, weak new vascular formations, leading to sudden loss of vision.
On the left is the image seen by a healthy person, and on the right is the image seen by a patient with advanced diabetic retinopathy
- Who is at risk for diabetic retinopathy?
Type 1 - What should I do to protect my vision?
If you have diabetes, at least once a year. You must have detailed retinal examination. Diabetic retinopathy is an insidious disease. A person with diabetes may develop advanced diabetic retinopathy over the years without any damage to vision. Whether or not you have vision problems, your doctor may recommend treatment for diabetic retinopathy. Early diagnosis and timely treatment can largely prevent vision loss. If diabetic retinopathy has developed, more frequent retinal examinations are required. In the presence of proliferative diabetic retinopathy, the risk of vision loss can be prevented by 95% with appropriate and timely treatment. Regulating blood sugar largely prevents or slows down the development and progression of diabetic retinopathy. Apart from this, it also prevents or slows down kidney and terminal nerve damage.
- What are the Symptoms of Diabetic Retinopathy?
Diabetic retinopathy is an insidious disease. It is a disease. In the early stages of the disease, there are no symptoms, and diabetic retinopathy is a painless disease. It is necessary not to wait for symptoms to be examined and to have a retinal examination once a year. If fluid accumulation called macular edema occurs in the visual center called the macula, blurred vision begins. If unwanted new and diseased vascularization begins in the retina in the advanced stage, these vessels may suddenly bleed and vision may suddenly be lost.
- What are the Findings of Proliferative Retinopathy in the Presence of Bleeding?
In case of sudden bleeding, floaters are often seen as the first symptom. After a while, vision may be completely blocked. If floaters are seen, it is necessary to undergo a detailed retinal examination and receive the necessary treatment without delay, otherwise the bleeding will become severe and vision may be completely blocked. Most sudden bleeding occurs in the morning while sleeping.
Sometimes, without treatment, bleeding can disappear on its own and vision can be restored. However, this is misleading and the risk of bleeding recurrence is very high. Therefore, it is necessary to consult a doctor without waiting for the bleeding to subside.
If left untreated, diabetic retinopathy results in severe vision loss. Likewise, vision gains are greater with early treatment.
- How to Detect Diabetic Retinopathy and Macular Edema?
A detailed study Retinal examination includes the following tests;
Visual acuity measurement: It measures how much vision there is from a certain distance.
Retinal examination: The pupils are enlarged by instilling various drops. A detailed retinal examination is performed using various lenses.- Eye pressure measurement.
Fluorescein angiography: During a detailed retinal examination, your doctor may recommend fluorescein angiography if deemed necessary. A dye is injected into the arm veins and retinal photographs are taken consecutively from both eyes. In this way, the vascular structure of the retina of the eye information is obtained about. Treatment is directed accordingly.
Optical coherence tomography: In recent years, a device called optical coherence tomography (OCT) has been used to detect and follow up macular edema. Without any intervention to the patient, realistic cross-sections of the macular region are obtained in a short time. Diode laser light beam is used for this. OCT gives us detailed information about macular edema.
- HOW IS DIABETIC RETINOPATHY TREATED?
Especially in the early stages, if there is no macular edema. There is no need for treatment. Blood sugar, blood pressure and cholesterol values should be kept under control only to prevent the progression of diabetic retinopathy.
If unwanted new vessels have formed in the retina (proliferative diabetic retinopathy) the entire retina (except the visual center)
/strong> laser treatment should be applied. This treatment usually takes two or three sessions. This laser treatment should be performed before bleeding into the eye begins. Laser treatment is not possible in the presence of severe bleeding.If the bleeding is very intense, surgical cleaning of the bleeding, called vitrectomy, is required. With vitrectomy, the bleeding inside the eye is completely cleared and the necessary laser treatment is applied in the same surgery.
- How is Macular Edema Treated?
Diabetic macular edema is treated with laser. Although one session is usually sufficient, in stubborn cases more than one session may be required. If there is macular edema in both eyes, one eye should be treated first, and the other eye should be treated within a few weeks.
Generally speaking, laser treatment prevents the risk of blindness due to diabetes by 90%. However, laser treatment often cannot replace vision that is already lost. That's why early diagnosis and treatment is very important.
In recent years, some new treatments other than laser have begun to be used, especially in macular edema that develops due to diabetes. These new drugs, called Anti-VEGF, provide a certain improvement in diabetic retinopathy by preventing the formation of new diseased vessels and also by preventing vascular leaks that lead to macular edema. These drugs are given by injecting them into the eye. It can be used alone or together with ASER, and it also allows a certain increase in vision compared to lasers. However, it should not be forgotten that anti-VEGF treatment is a surgical treatment and is an injection into the eye. Therefore, it inevitably brings with it some risks such as infection and retinal tear. Therefore, it is a treatment that should be applied in an operating room environment, under extremely sterile conditions, by experienced physicians who are experts on the subject. In addition, retina specialist physicians should decide in which cases it should be performed and how often it should be performed.
- What is Vitrectomy?
Inside the eye If bleeding occurs due to diabetic reetinopathy, vitrectomy surgery is performed.
Vitrectomy can be performed under local or general anesthesia. The type of anesthesia is determined by the joint decision of the patient and the physician. In vitrectomy, small holes are made in the wall of the eye and very thin instruments are inserted through these holes to clean the fluid and bleeding inside the eye, called vitreous. The cleansed fluid is replaced with a medical fluid called balanced salt solution. Laser treatment of the retina is often completed in the same surgery. Protective eye drops are applied for approximately one month after the surgery.It should not be forgotten that diabetes is a systemic disease. The health of the eye is directly proportional to blood sugar, arm blood pressure and cholesterol levels.
Diabetic retinopathy is an insidious disease. Severe damage to the retina occurs even before vision loss occurs. That's why regular check-ups, early diagnosis and correct treatment are very important.
Complete treatment of diabetic retinopathy is not possible. Certain damage it causes is permanent. The treatments applied can correct the complications caused by diabetic retinopathy in a limited way. That's why early diagnosis and treatment is very important.
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