More about diabetes treatment for dr. Mirjana Sazdovska

• How does diabetes affect vision?

Diabetes is a chronic disease in which there is a metabolic disorder, not only of sugars but also of fats and proteins. It is the leading cause of blindness and reduced visual function of the working age population in the world. High blood sugar damages large and small blood vessels. That is why the most affected organs are the eyes. The course of the disease in these patients depends primarily on good blood sugar regulation and the duration of the disease. If good glycemic control is maintained, eye changes may be delayed. Patients with diabetes often complain of constant tearing and itching of the eyes. Blurring of the lens (cataract) is much more common in them. The most important and certainly the most serious change of the eyes is the so-called diabetic retinopathy.

• What is diabetic retinopathy?

Diabetic retinopathy is damage to the inner lining of the eye (retina) that leads to vision loss and if not treated in time, leads to blindness. It is a serious condition of the eye that should be constantly monitored, and timely intervened. The disease is characterized by fasting retinal bleeding and microaneurysms, the presence of fatty deposits, microinfarctions, clogged retinal capillaries, the presence of focal or diffuse swelling, and the appearance of new blood vessels.

A disturbing circumstance in these patients is the presence of high blood pressure and smoking. All these changes that occur in the eye are asymptomatic, so the patient does not feel any symptoms, and the disease progresses. That is why it is important for every newly discovered patient, in addition to other examinations, to have an ocular examination. We, in our hospital, insist on such an examination.

• What are the most common symptoms?

When symptoms appear, the condition is already in a more advanced stage. Patients often complain of blurred vision, the appearance of distorted images of objects, the appearance of flies in the visual field, or a sudden loss of vision. In case of any of these symptoms, it is important for patients to contact an ophthalmologist immediately. An examination of the fundus of the eye, always on an enlarged pupil, is mandatory with additional examinations, such as OCT and ultrasound, which are necessary to assess further treatment. Based on the obtained findings, application of anti-WEGF, laser photocoagulation or emergency surgery, vitrectomy is recommended.

• Why is it important to find out early?

Early and timely detection of this disease is crucial for maintaining visual acuity. Often, when all possible therapeutic treatments and party interventions are undertaken, the visual function is very poor and the patients are disappointed. Depending on the stage of the disease, intravitreal injections, laser photocoagulation, or both are recommended. According to world recommendations, anti-WEGF is applied first, and then, if necessary, laser photocoagulation is performed.

In cases when there is bleeding in the vitreous, surgery is recommended – vitrectomy. An ultrasound is done beforehand to determine if, in addition to bleeding, there is retinal detachment, which is an immediate indication for surgery.

• How is its development prevented?

To avoid these severe complications of diabetes, every person with diabetes must have regular eye examinations at least once a year, and if necessary more often, it depends on the stage of the disease. The examination must consist of dilation of the pupils and insight into the background of the eye with a magnifying glass or prism, and not just a vision check because the changes may have already occurred although no vision impairment is observed.