With diabetic retinopathy, there is a risk of going blind. High blood sugar levels favor the onset and influence the severity of the disease.
The average time to retinopathy in type 1 diabetics is five to ten years after the onset of diabetes.
Type 2 diabetics are already at risk at the time of diagnosis, as structural damage may already be present due to years of latency.
After 20 years, the risk of diabetic retinopathy in diabetics is around 90 percent.
Overall, more than 30 percent of diabetics in Germany suffer from this secondary disease.
In its development, diabetic retinopathy is asymptomatic, so that the patient is initially unaware of the existence of the disease.
Only when the retinopathy has affected the yellow spot does a deterioration in vision become noticeable. In some cases, the deterioration in vision is also associated with a vascular hemorrhage.
Comparison of a healthy eye and an eye with diabetic retinopathy @ joshya /AdobeStock
Experts differentiate between several forms of diabetic retinopathy.
Basically, they distinguish between non-proliferative and proliferative retinopathy. The difference is that in the proliferative form, the changes are limited to the retina.
In the non-proliferative form, on the other hand, the damage to the retina progresses. The transitions are fluid and usually follow a linear pattern.
In all phases, there is usually swelling in the area of the sensory cells, the macular edema.
The non-proliferative form includes four subgroups.
In diabetic retinopathy, at least one microaneurysm occurs in the eye. Microaneurysms are small bulges in the capillaries in their damaged vessel wall. In the mild form of the disease, there is only one microaneurysm.
At this stage , there are already several microaneurysms with bleeding and fatty deposits in the vessels. In addition, there are already isolated nerve fiber infarctions.
In addition to the changes in the retina already mentioned, a change in the vascular structure can be seen here. It takes on a beaded appearance. There is an undersupply of blood. The number of nerve fiber infarcts is significantly higher.
In the most severe stage of diabetic retinopathy, new blood vessels form in the retina. In the subsequent course, new formation of very thin-walled vessels takes place in the retina. Experts now speak of severe proliferative diabetic retinopathy.
Eye with diabetic retinopathy after ophthalmoscopy @ Dr_Microbe /AdobeStock
The risk factors include those of diabetes.
High blood sugar levels and high blood pressure allow blood clots to accumulate in the blood vessels. They also prevent the undisturbed transfer of oxygen to the retina.
Due to a disorder in fat metabolism (hyperlipidemia), patients with type 2 diabetes have an increased tendency to vision loss.
The following characteristics increase the risk of diabetic retinopathy:
A diagnosis is made during an ophthalmologic examination. Ophthalmologists can detect dangerous changes to the retina in a routine procedure.
During an ophthalmoscopy, the ophthalmologist first drops drops into the pupils so that they dilate. The doctor then illuminates the eyes with an ophthalmoscope and magnifies the back of the eye with a loupe.
Indirect ophthalmoscopy is used to capture larger areas. Here, the ophthalmologist holds the mirror at a greater distance. With lower magnification, he can examine large areas of the back of the eye.
Diabetes patients must have their ocular fundus checked regularly. Only specialists have the necessary measuring equipment.
The ophthalmologist is able to recognize and treat a tendency towards diabetic retinopathy at an early stage. Even if the patient does not yet have any symptoms.
If the patient deals with the diabetes responsibly, they can protect their retina. Diabetologists use blood glucose records to develop long-term therapeutic measures. The aim is to normalize the course of the values.
Patients should therefore keep a record of their blood glucose levels and have them analyzed regularly by a specialist. Fluctuations in blood sugar levels can be minimized through thorough preventive care. This can delay damage to the retina.
The treatment of manifest diabetic retinopathy is difficult. Careful prevention of the disease is therefore very important.
Nevertheless, there are treatment options. Ophthalmologists carry out laser treatment (argon laser coagulation) on the retina in the case of severe non-proliferative and proliferative diabetic retinopathy.
This improves the oxygen supply to the affected area. The disease cannot progress. Blindness is therefore not possible.
In all other cases, however, it is not possible to stop the disease. Especially if doctors discover the changes to the retina too late, laser treatment is no longer promising.
Therefore, if you have diabetes, you should see an ophthalmologist soon and have the back of your eye checked at least once a year.
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