Eye Clinic Tokyo has prepared content that will help you to understand various eye diseases.
This time, it’s about diabetic retinopathy.
■Diabetic retinopathy
【Causes・Disease】
Diabetic retinopathy is a retinal disease caused by diabetes. Hyperglycemia damages the blood vessels in the retina and is characterized by a decline in retinal function. Diabetic retinopathy is one of the three major complications of diabetes, along with diabetic nephropathy and neuropathy, and is the leading cause of blindness in adults.
When blood sugar level remains high for a long time, the small blood vessels in the retina are gradually damaged, becoming deformed or clogged. When the blood vessels become clogged, oxygen cannot reach every corner of the retina, causing an oxygen deficiency in the retina. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don’t develop properly and can leak easily. Bleeding can also cause a scab-like membrane (proliferative tissue) to grow on the retina, which can lead to retinal detachment.
【Symptoms】
Diabetic retinopathy is said to develop several years to more than 10 years after the onset of diabetes, you might not have symptoms in the early stages of diabetic retinopathy. So, it is dangerous to assume that it is okay just because you can still see things.
Diabetic retinopathy is broadly classified into three stages depending on the degree of progression.
(1) Simple diabetic retinopathy
This is early diabetic retinopathy. The first abnormalities that appear are vascular aneurysms (capillary aneurysms), which are formed when the walls of small blood vessels swell, and small hemorrhages (petechiae/ecchymoses). Proteins and fats may leak from blood vessels and form spots on the retina (hard vitiligo). These symptoms may improve if blood sugar levels are better controlled. During this period, there are almost no symptoms.
(2) pre-proliferative diabetic retinopathy
This is a more advanced condition than simple diabetic retinopathy. When small retinal blood vessels become occluded over a wide area, not enough oxygen reaches the retina, and preparations begin to be made to create new blood vessels (new blood vessels) to supply the missing oxygen. At this stage, people often notice symptoms such as blurred vision, but sometimes there are no symptoms at all. Pre-proliferative diabetic retinopathy often requires retinal laser photocoagulation.
(3) proliferative diabetic retinopathy
This is a serious stage of advanced diabetic retinopathy. New blood vessels grow toward the retina and vitreous. If the walls of the new blood vessels rupture, hemorrhage may occur into the vitreous. When bleeding occurs, you may notice a symptom called floaters, in which you see black spots or dust-like objects, and if there is a large amount of bleeding, you may notice a sudden decline in your vision. In addition, a fibrous membrane called proliferative tissue appears, which may pull on the retina and cause retinal detachment (tractional retinal detachment). Treatment at this stage often requires surgery, but even if the surgery is successful, it may not restore the vision for daily life.
【treatment】
Treatments include retinal photocoagulation (laser treatment) and vitreous surgery, depending on the progress and severity of the symptoms.
Retinal photocoagulation is performed to prevent the formation of new blood vessels or to reduce the number of new blood vessels that have already appeared.
This treatment is intended to prevent further deterioration of retinopathy, not to restore it to its original state.
The number of laser irradiations and the irradiation range vary depending on the progress of the retinopathy. Retinal photocoagulation is very effective if treated early and is an important treatment for preventing blindness.
Vitreous surgery is performed as a treatment for vitreous hemorrhage and retinal detachment caused by advanced diabetic retinopathy. This is a surgery to remove bleeding and proliferating tissue in the eye, and to restore the detached retina.
【Summary】
Diabetes management is important. It is important to properly manage blood sugar levels, blood pressure, cholesterol, etc. to prevent damage to blood vessels in the retina.
Early detection and early treatment are important to prevent the onset of the disease and prevent it from worsening. Therefore, even if people with diabetes do not have symptoms such as decreased vision, they should go to the ophthalmology regularly for fundus examinations in the stage of diagnosis of diabetes in internal clinic.