Diabetic Retinopathy: causes and prevention

Diabetic retinopathy is a very common but serious eye related complication. Though it can effect any diabetic patient easily, but  almost all person with type 1 diabetes show some symptoms of diabetic retinopathy usually after about 20 years of living with diabetes.

As there is no clear early symptoms of the disease, doctors often feel reluctant to treat the disease. But if diabetes is not treated in time, can damage eyes permanently.

Diabetic retinopathy (damage to the retina) caused by complications of diabetes mellitus, can eventually lead to blindness. It is an ocular manifestation of systemic disease which affects up to 80% of all patients who have had diabetes for 10 years or more. Despite these alarming statistics, research indicates that at least 90% of new cases could be reduced by proper and vigilant treatment along with regular monitoring of the eyes.

The disease has no early warning signs, and that is the worse part to be deal with. Even macular edema, which may cause vision loss more rapidly, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day.

As new blood vessels form at the back of the eye as a part of proliferative diabetic retinopathy (PDR), they can bleed (hemorrhage) and blur vision.

In the preliminary stage it may not be very severe. In most cases, it will leave just a few specks of blood, or spots, floating in a person’s visual field, though the spots often go away after a few hours.These spots are often followed within a few days or weeks by a much greater leakage of blood, which blurs vision. In extreme cases, a person will only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from the inside of the eye, and in some cases the blood will not clear. These types of large hemorrhages tend to happen more than once, often during sleep.On fundoscopic exam, a doctor will see cotton-wool spots, flame hemorrhages, and dot-blot hemorrhages.

All people with diabetes mellitus are at risk – those with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset). The longer a person has diabetes, the higher the risk of developing some ocular problem. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. After 20 years of diabetes, nearly all patients with type 1 diabetes and >60% of patients with type 2 diabetes have some degree of retinopathy.

Prior studies had also assumed a clear glycemic threshold between people at high and low risk of diabetic retinopathy. However, it has been shown that the widely accepted WHO and American Diabetes Association diagnostic cutoff for diabetes of a fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl) does not accurately identify diabetic retinopathy among patients.

The cohort study included a multi-ethnic, cross-sectional adult population sample in the US, as well as two cross-sectional adult populations in Australia. For the US-based component of the study, the sensitivity was 34.7% and specificity was 86.6%. For patients at similar risk to those in this study (15.8% had diabetic retinopathy), this leads to a positive predictive value of 32.7% and negative predictive value of 87.6%.

There are three major treatments for diabetic retinopathy, which are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of keeping their vision when they get treatment before the retina is severely damaged. These three treatments are :

  • laser surgery,
  • injection of triamcinolone into the eye(intraocular injections),
  • and vitrectomy (Vitero-retinal surgery).

It is important to note that although these treatments are very successful, they do not cure diabetic retinopathy. Caution should be exercised in treatment with laser surgery since it causes a loss of retinal tissue. It is often more prudent to inject triamcinolone. In some patients it results in a marked increase of vision, especially if there is an edema of the macula.

Hopefully, people worldwide are more aware of the disease and its dangers. For example in the recent time, Dr. Stephen Akafo, through his lecturer at the Ophthalmologic Unit of the University of Ghana Medical School (UGMS) called for the creation of awareness on the effects of diabetes on eyesight among primary diabetic patients in Ghana. He also said that, many physicians fail to conduct screening tests for Diabetic Retinopathy, which is caused by the leakage of materials such as water and proteins from the blood vessels into the retina.

He said risk factors that affect the retina include duration of one’s Diabetic status, level of control of the disease, hypertension, kidney disease and age. He said,

“Diabetic Retinopathy remains the major sight threatening eye disease in the working age population in the developed world. By the year 2030, 851,000 people face the risk of contracting diabetes and 140,415 for diabetic retinopathy.”

Source: Joyonline

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One Response to “Diabetic Retinopathy: causes and prevention”

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