[Part II] How does unregulated sugar damage the eyes?

Diabetes is a chronic disease that damages the whole organism. Part I explained the eye conditions that occur as a result of diabetes: dry eye, cataracts, eye movement disorders. In this section, I will explain more about diabetic retinopathy, glaucoma and treatment in people with diabetes.

Diabetic retinopathy

Diabetic retinopathy is a vascular complication that occurs in all types of diabetes. In addition to the regulation of glycemia during the day, an important factor in the development of diabetic retinopathy is the duration of the disease and the existence of diabetic nephropathy (kidney damage). A very important recommendation for everyone who has diabetes, as well as for the medical staff who lead these patients, is that every newly diagnosed diabetic should go for an ophthalmological examination immediately. Diabetic retinopathy, in its early form, may not cause symptoms that would prompt the patient to visit an ophthalmologist. The disease may go unnoticed until extensive bleeding occurs in the eye, after which vision is sharply and significantly reduced. Early symptoms that should not be overlooked are: gray or black spots and blemishes in the field of view, distortion or blurring of the image. The ophthalmological examination includes an examination of the retina, through the dilated pupil (with previous drops), as well as a possible examination of the macula and optic nerve with OCT (optical coherence tomography) to detect the earliest changes in blood vessels, bleeding, swelling, exudates, leaks of fluid that would lead to retinal stratification. Early diagnosis provides the opportunity for timely treatment involving laser photocoagulation and intravitreal drug administration. The goal is to prevent the growth of new blood vessels (neovascularization), which are accompanied by the growth of fibrous tissue and change the normal function of the retina faster and more aggressively. With the intravitreal application of anti-VEGF therapy, diabetic retinopathy is for the first time seen as a reversible condition rather than permanent retinal damage.

Glaucoma

Glaucoma in patients with diabetes occurs in an advanced stage of proliferative diabetic retinopathy, when blood vessels grow and through the front of the eye (variegated), close the corner of the eye as a dense network through which it is difficult for ocular water to flow. Unfortunately, this type of glaucoma is called neovascular, it is difficult to regulate with drug therapy, it is very painful and in the past, it was often a reason to remove the eye. With the advent of anti-VEGF therapy, the prognosis in these patients is significantly better.

Treatment

Drug treatment of retinal diseases has advanced significantly in recent years. A number of scientific studies have sought to find less invasive and longer-lasting treatment. Every day new substances are discovered that influence the development of diabetic retinopathy and attempts are made to block them, so that diabetic retinopathy would not develop or be cured. The next level of treatment for diabetic retinopathy is surgical treatment. Unfortunately, in Macedonia a huge number of patients are for surgical treatment, i.e. the disease is very advanced at the moment it is detected. Thus, the prognosis for visual quality is significantly worse than if detected early. Surgical treatment, however, allows mechanical cleansing of the blood from the inside of the eye, fibrous proliferations, excess accumulated substances that promote the growth of new blood vessels, which intravitreal drugs do not have the capacity to block. Vitrectomy is a microsurgical method, where the surgeon and his experience and knowledge are one of the most important factors for a successful surgery. Recommendation to all who have diabetes and those who have some contact and influence on patients with diabetes: the eye is a window into the condition of the kidneys and brain. A look at the retina gives an idea of ​​how much damage diabetes has done to the body. Annual eye examinations are more than mandatory for people with diabetes.