Diabetic retinopathy: What is it, why does it occur and how is it manifested?

Diabetic retinopathy: What is it, why does it occur and how is it manifested?
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Diabetic retinopathy is a disease that affects the ability to see. It can manifest in varying degrees of visual impairment and even blindness. It is related to diabetes.

Most common symptoms

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Characteristics

Diabetic retinopathy affects the eyes and eyes. It is a disease that has genesis in diabetes.

Together, these two conditions have a negative impact on the quality of life, as diabetes itself is a multi-organ metabolic disease, and retinopathy is manifested by varying degrees of visual impairment and even blindness.

It is reported that diabetes is responsible for a large percentage of blindness in developed countries.

Of course, like diabetes itself, visual impairment significantly affects the psyche of the affected person. Especially younger students. Mostly also because it can be complicated by a painful condition that causes glaucoma.

One of the main factors that affect the overall course is the duration of diabetes, its type, and other risk factors.

Facts about diabetic retinopathy:

  • in men, it occurs before the age of 45, in women a little later
  • occurs in both types of diabetes mellitus, ie. type I. and II.
  • however, in the case of diabetes type I, it is more frequent and also more severe
  • more than 25% of those affected have severe diabetic retinopathy
  • more severe is the proliferative type of diabetic retinopathy
  • it is one of the most common causes of blindness in developed countries
  • exacerbating factors include the presence of hypertension, increased blood lipids, kidney disease, and anemia
  • when diabetes lasts more than 20 years, it damages the eyesight in 80 to 100% - type I diabetics and more than 60%-type II diabetics
  • it may have a painless and asymptomatic course
  • what makes it a harsh enemy with an advantage

Diabetes is a metabolic disease having as a weapon the elevation of blood sugar levels. This is the reality behind the gradual damage across the whole organism. The complications such as diabetic neuropathy, diabetic nephropathy, angiopathy, diabetic foot, and alike, are not unheard of among us, and that is only a part of the complication.

After years, diabetes mellitus causes irreversible changes and damage to the body.
Read more in the article:
What health complications does diabetes cause? Even neglected and untreated

It is in diabetic retinopathy that hyperglycemia is the main problem, so the increased blood sugar issue. This has a negative effect on the walls of blood vessels and over time, it damages the smallest coils in the eye, and therefore in the retina. This results in visual impairment and even blindness.

Diabetic = diabetes related.
Retino = retinal-related.
Pathia = indicates a disease, a disease state.

As already mentioned, this disease may not hurt at all and does not manifest itself in any way. Even during this asymptomatic stage, it causes microscopic damage to the tiniest vessels in the human body and also in the eye.

Subsequently, it is only when the changes are so serious that vision problems begin.

Destroyed blood vessels affect microaneurysms, fluids pass through the damaged blood vessel wall, causing swelling in the retina, with possible bleeding to the formation of new blood vessels.

According to which retinopathy in diabetes is divided into:

  1. non-proliferative retinopathy
  2. advanced non-proliferative retinopathy
  3. proliferative retinopathy
  4. diabetic maculopathy

Causes

Wondering what causes eye damage?

Yes. It's diabetes.

Fluid fluctuations are not such a problem in diabetic retinopathy, however, the high blood sugar levels is.

Read also:
Hyperglycemia: How does excessive blood sugar manifests and what is its treatment?

The cause of eye damage is destroyed capillaries, ie one of the smallest vessels in the area of the ocular background and retina.

It is based on negative changes in the blood vessels and walls, impaired blood flow, and blood supply to the retina. Reduction of flow to complete closure of vascular capillaries. Thus, it is a disorder of blood flow with the formation of swelling and bleeding into the retina and the back of the eye.

It is basically present:

  1. capillary occlusion, thus the occlusion of small vessels, which leads to non-perfusion of the sensitive area of the eye
  2. dilatation of blood vessels with fluid transfer to the environment and swelling
  3. vascular neoplasia - vascular proliferation

The table shows the division of diabetic retinopathy into species

Non-proliferative retinopathy
  • abbreviated NPDR
  • the problem is the formation of microaneurysms
  • damaged vessels affect the bulge
  • the vascular wall at this site is weakened
  • this causes focal bleeding into the retina
  • and hard exudates - the transfer of elements from the vessels to the retina and blood serum
    • storage of fat cells, the formation of yellowish deposits
  • it is often asymptomatic
  • according to the course is divided into 
    • initial
    • intermediate
    • advanced
    • very advanced
Advanced non-proliferative retinopathy
  • soft, so-called cotton-like exudates are formed
  • for minor heart attacks
  • these are caused by not bleeding due to reduced blood flow through the retina
  • or closure of small capillaries, i.e. occlusion
Proliferative retinopathy
  • abbreviated PDR
  • the most serious form
  • this form is typical of the formation of new capillaries in the area of the retina and optic nerve disc and on the iris
  • these new blood vessels are inferior and weakened
  • this process determines the presence of VEGF, a vascular endothelial growth factor produced by cells in the area of reduced oxygenation for impaired blood flow
  • blood vessels rupture
  • retinal and vitreous hemorrhage occurs (hemophthalmos)
  • this whole process results in fibrotization, scarring and bleeding with subsequent retinal detachment
  • there is worsening of vision, visual acuity, even blindness in the severe stage, and other difficulties
Diabetic maculopathy
  • abbreviated DMP
  • microangiopathy, ie damage to the smallest vessels of the retina, in the retina, when the macula is damaged, ie the area with the sharpest vision
  • formation of swelling and hard exudates
  • the decrease in visual acuity
  • the term clinically significant macular edema (KSME) is also mentioned
    • early treatment diabetic retinopathy study (ETDRS) reserves the term for the state of an acute risk of macular and central visual acuity
    • this degree of damage requires immediate laser coagulation

In addition to hyperglycemia, high blood pressure, high blood fats, anemia, and kidney disease are also involved in the damage.

Oxidative stress and retinal bleeding, formation of inferior and weakened blood vessels and fluid transfer from the blood to bleeding = irreversible damage to vision to blindness.

Risk factors include:

  • diabetes - duration of diabetes
  • insufficient or neglected treatment, decompensated diabetes mellitus
  • high blood pressure, high cholesterol, anemia
  • hematological and blood clotting disorders increased blood viscosity (density)kidney disease
  • eye surgery, such as cataracts
  • radiation
  • eye injury
  • inflammation of the eye
  • tumors
  • smoking
  • alcohol
  • hormonal contraceptives
  • pregnancy

Complications of retinopathy in brief:

  1. retinal and vitreous hemorrhage
  2. retinal detachment
  3. glaucoma and increased intraocular pressure
  4. blindness

Pregnancy and diabetic retinopathy

In this case, it is a risk period that significantly affects the progression of the disease state.

Of course, these are individual factors. There is no risk of worsening of the condition with a mild degree of the disease.

However, on the contrary, up to 50% risk of progression is in pregnant women with a slightly advanced form of diabetic retinopathy. And in severe conditions, it is more than a 50% rate of deterioration.

At the same time, however, it is stated that there may be a certain percentage of improvements after childbirth.

Therefore, an eye examination is appropriate for diabetic women before and during pregnancy. During this period, it is performed at certain intervals, during trimesters, or even every month.

There is no risk of retinopathy in gestational diabetes, ie in pregnancy diabetes.

You ask:
Is diabetic retinopathy an indication for a section, ie a cesarean section?
This decision is up to the physician to evaluate according to the condition and extent of the disease. 

Symptoms

The disease may not be proven at a mild stage at all. What is the secret weapon of diabetic retinopathy. As the difficulties begin to manifest themselves only in the stage of more advanced damage.

However, various symptoms can occur, such as:

  • impaired visual acuity, refraction
  • blurred vision
  • wavy vision, distorted image
  • deterioration of color sensitivity
  • loss of field of vision, dark and empty areas in the field of view
  • the presence of flashes - flashes of light
  • floating flakes in visual poly, flies, machules, black dots
  • the gradual painless weakening of visual acuity over weeks, years
  • up to complete loss of vision and blindness
  • eye and orbit pain

The disability usually affects both eyes.

Diagnostics

Early diagnosis is especially important in this disease. This is one of the reasons why diabetics are checked for eyesight - an eye screening test for diabetes (every two years).

The examination is performed by a specialist, ie an ophthalmologist.

It controls visual acuity, intraocular pressure, the presence of cataracts or glaucoma, so it is important a comprehensive eye examination, as well as an examination of the anterior segment of the eye, such as a slit lamp and other methods.

It is important to examine the back of the eye. It looks for signs of edema, bleeding and damage to the retina, macula, optic nerve, the presence of abnormal blood vessels, fatty deposits in the retina or fibrotic, scar tissue, and bleeding into the vitreous.

Other methods are, for example:

  • ophthalmoscopy
  • optical coherence tomography OCT
  • FFA fluorescence angiography
  • analysis of retinal vessels

As the disease can occur, regular check-ups are important for early treatment and rescue. 

Course

The disease can be without symptoms, asymptomatic, and until a relatively late stage when it is too late to save the quality of vision.

At the same time, early treatment can prevent disease progression and vision loss. Early stages and even swelling of the macula may not result in difficulty.

Macula = place of sharpest vision.

Until problems with visual acuity, blurred vision, perception of muscles and flies, blinks in front of the eyes are associated. One may perceive a distorted image or images that are not the same in both eyes. The view dropouts is associated.

During the day, the severity of the problem may vary, gradually worsen or improve.

Eye and orbit pain may be present.

Late complications are glaucoma, ie increased intraocular pressure and retinal detachment. And these help to cause a serious degree of eye damage. Severe visual impairment leads to complete blindness.

You ask:
How long can the course of the disease be? 
Weeks, months to years...

How it is treated: Diabetic retinopathy

Diabetic retinopathy: How is it treated and what medications will help?

Show more

Understanding Proliferative Diabetic Retinopathy

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Interesting resources

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  • "Diabetic retinopathy - Diagnosis and treatment". mayoclinic.org. Mayo Clinic.
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  • Li, Jeany Q.; Welchowski, Thomas; Schmid, Matthias; et al. (January 12, 2020). "Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis". European Journal of Epidemiology35 (1): 11–23. doi:10.1007/s10654-019-00560-z. PMID 31515657. S2CID 202557582 – via PubMed.
  • "Diabetic retinopathy". Diabetes.co.uk. Retrieved 25 November 2012.
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  • MacEwen C. "diabetic retinopathy". Retrieved August 2, 2011.
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  • "Nonproliferative Diabetic Retinopathy (Includes Macular Edema)". Retrieved August 17, 2013.
  • "Diabetic Retinopathy: What You Should Know" (PDF). nei.nih.gov. National Eye Institute, National Institutes of Health. June 2019. p. 3. Retrieved 19 November 2021.
  • Expert Committee on the Diagnosis Classification of Diabetes Mellitus (January 2003). "Report of the expert committee on the diagnosis and classification of diabetes mellitus". Diabetes Care26 (Suppl 1): S5–20. doi:10.2337/diacare.26.2007.S5. PMID 12502614.
  • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (July 1997). "Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus". Diabetes Care20 (7): 1183–97. doi:10.2337/diacare.20.7.1183. PMID 9203460. S2CID 219226914.
  • Williams R, Airey M, Baxter H, Forrester J, Kennedy-Martin T, Girach A (October 2004). "Epidemiology of diabetic retinopathy and macular oedema: a systematic review". Eye18 (10): 963–83. doi:10.1038/sj.eye.6701476. PMID 15232600.
  • "Facts About Diabetic Eye Disease". nei.nih.gov. National Eye Institute, National Institutes of Health.