Dr Aidin Rawshani

Retinopathy and eye diseases: diabetes and visual impairment

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Retinopathy and visual impairment in diabetes

Our eyes are actually part of the brain. It can be said that the eye and optic nerve (photo below) are an advanced part of the brain. The eye is struck by light from the environment and when light reaches the retina of the eye, light is converted into electrical signals sent (via the optic nerve) to the brain. In the brain, the signals are interpreted and this gives us our vision. Here below is a schematic picture of the eye. People with diabetes can over the years develop retinopathy, which means disease of the retina. Retinopathy can lead to visual impairment and blindness. To reduce the risk of retinopathy, good blood sugar control is crucial. Retinopathy can affect both people with type 1 diabetes or type 2 diabetes. People with diabetes may also suffer from other eye diseases, which is also discussed here below.

This image displays the eye with vascular damages along the retina due to elevated blood sugar levels.

What is retinopathy?

Retinopathy means that the retina becomes damaged and this leads to visual impairment. The more retinopathy you have, the more pronounced the visual impairment becomes. You can go blind by retinopathy, and the fact is that blindness as a result of diabetes is the most common cause of blindness in the West.

How does retinopathy occur?

Retinopathy is a consequence of the fact that the blood vessels of the retina change and function worse. This occurs in two ways:

The blood vessels in the retina expand. The dilated blood vessels leak fluid and can even bleed. Such fluid and bleeding are very harmful to the retina.It is formed new blood vessels and eventually it becomes too many blood vessels in the retina. The new blood vessels are formed because there is oxygen starvation of the retina, which

The blood vessels leak, in addition to liquid, also egg whites (protein), which makes it possible to see small yellow spots on the retina when photographing it. The reason for getting new blood vessels is because the existing vessels do not work well, which causes new vessels to form and this is unfavorable. Overall, this leads to damage to the retina, resulting in impaired vision.

Retinal damages due to cardiovascular risk factors such as elevated blood glucose and blood pressure

How many suffer from retinopathy?

Retinopathy is unfortunately very common in diabetes and this applies to both type 1 diabetes and type 2 diabetes. Approximately 60% of all people with diabetes have changes in the retina and of these, 10 -35% suffer from visual impairment. Although the risk is high, most people with diabetes have only small concerns with their eyes. If you have problems with the eyes, there is also good treatment today.

How can I avoid or reduce the risk of retinopathy?

To reduce the risk of retinopathy, it is crucial to have good blood sugar control. We know today with great certainty that high blood sugar is by far the most important cause of retinopathy. Therefore, in order to reduce the risk of retinopathy, blood glucose control should be as good as possible.

In addition to blood sugar, blood pressure is also important. High blood pressure is also harmful to the retina and therefore one must be careful about controlling blood pressure.

The longer you have diabetes, the higher the risk of retinopathy. This is because blood vessels are burdened with high concentrations of sugar while having diabetes. The longer you have diabetes, the greater the total load on the vessels.

If to develop retinopathy, then it is possible to treat it with laser therapy. This treatment involves directing a laser beam at the vessels that are bad so that they stop growing and stop bleeding.

The figure shows an enlarged image of the retina. The large irregular red spot in the middle is a bleeding due to a rupture of a blood vessel.

The figure shows an enlarged image of the retina. The large irregular red spot in the middle is a bleeding due to a rupture of a blood vessel.

Glaucoma (glaucoma)

People with diabetes have 40% higher risk of glaucoma (glaucoma), compared to people without diabetes. The longer you have diabetes, the more common glaucoma.

Glaucoma means that the pressure inside the eye rises. The eye is filled with fluid and if too much fluid accumulates in the eye, the pressure rises. The high pressure can lead to compression of the blood vessels so that the blood flow to the retina and optic nerve becomes worse. This gradually leads to visual impairment.

Glaucoma can today be treated with medicines or surgery.

Cataract (cataract)

Cataracts is common among the elderly in the population. However, people with diabetes have a 60% higher risk of cataracts, which is the same as cataracts. People with diabetes tend to have cataracts earlier in life and the disease has a more aggressive course. Cataract means that the lens of the eye (the structure at the front) becomes cloudy and this leads to light being unable to get through the lens as usual. Cataracts can be remedied with special sunglasses. If you have a pronounced cataract, it may be necessary to remove the lens of the eye (it is possible to have a new lens transplanted).

More about retinopathy

Retinopathy means disease of the retina. However, there are different types of retinopathy, which are explained here below.

Non-proliferative retinopathy

This is the most common type of retinopathy and it means that the smallest vessels under the retina swell, as a result of which the blood flow gradually becomes worse. Non-proliferative retinopathy is graded from 1 to 3 (mild, moderate, severe). People who have non-proliferative retinopathy do not have any symptoms of this. In principle, everyone with type 1 diabetes develops non-proliferative retinopathy. Most people with type 2 diabetes also develop this.

Macular edema

What is the macula: the yellow spot?

The above picture shows a yellow spot in the retina of the eye. The yellow spot is also called macula. It is with the help of the yellow spot that we can see objects sharply (thus, it is the focus of the eye).

What is macular edema?

In retinopathy, the blood vessels of the eye function poorly, which allows them to leak fluid (from the blood) to the retina. Then the retina swells and if this affects the macula, you can no longer see sharply (vision becomes blurred).

Proliferative retinopathy

Proliferative retinopathy means that retinopathy gradually worsens and this is more serious. The blood vessels at this stage are so bad that they can be completely blocked. Then new vessels are formed in the retina and these new vessels are of inferior quality than the original vessels. They can begin to bleed and this condition is called vitreous hemorrhage.

New blood vessels can also lead to the formation of scar tissue in the retina. Scar tissue damages the retina and can also pull it to detach it from the substrate. When the retina loosens, retinal detachment occurs, which is a serious condition that needs to be treated by a doctor.

It is a proliferative retinopathy that leads to visual impairment and blindness. Fortunately, this type of retinopathy is less common.

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