Prevention of diabetic retinopathy

Dr. Ekaterina Petrova, ophthalmologist at MDC Haelan Care 2, talks about diabetic retinopathy as a serious complication of diabetes and stresses the importance of regular check-ups, prevention and control of the disease.

World Diabetes Day, celebrated on November 14, reminds us of the importance of prevention and control of the disease, which affects millions of people around the world. Diabetes leads to a number of serious changes, including diabetic retinopathy — one of the most common and dangerous vision complications in people with diabetes, leading to permanent vision impairment. It often develops asymptomatically in its early stages, which is why it is key to take preventive measures to reduce the risk of more severe consequences.

‍What is diabetic retinopathy?

Diabetic retinopathy occurs as a result of long-term damage to blood vessels in the retina caused by chronically elevated blood sugar levels (hyperglycemia). The development of diabetic retinopathy involves complex biochemical and cellular mechanisms that lead to progressive changes in retinal microcirculation, damage to blood vessels, retinal ischemia and its consequences.

Chronic hyperglycemia is a major factor in the occurrence of the impairments associated with diabetic retinopathy. High blood sugar levels activate biochemical pathways that lead to the formation of free radicals and oxidative stress. This leads to damage to endothelial cells and pericytes, which play an important role in maintaining the integrity of the retinal capillaries. Small vascular abnormalities cause microaneurysms, hemorrhages and occlusion of small blood vessels, leading to ischemia (lack of oxygen in the tissues) of the retina. In response to ischemia, the retina stimulates the formation of new blood vessels (neovascularization), which, however, are unstable and bleed easily, further damaging the retina. On the other hand, the permeability of the vessels can also lead to the accumulation of fluid in the retina (macular edema), which impairs vision. As the disease progresses, more severe retinal damage can be observed such as hemorrhages in the vitreous and retina, formation of fibrous tissue, retinal detachment, etc.

The development of diabetic retinopathy is associated with several factors, including the duration of diabetes, blood sugar levels, and the presence of high blood pressure.

According to the degree of development, diabetic retinopathy is divided into the following types:

Non-proliferative diabetic retinopathy

Non-proliferative diabetic retinopathy (NDR) is the earlier and milder stage of diabetic retinopathy. It is characterized by damage to the small blood vessels (capillaries) in the retina without observing the formation of new blood vessels (neovascularization), which is typical of the more advanced proliferative diabetic retinopathy (PDR). The main changes that occur in the retina in NDR include the formation of microaneurysms, retinal hemorrhages, exudates, ischemia, etc.

Non-proliferative diabetic retinopathy is often asymptomatic, especially in the early stages. Since changes in the retina are minimal at first, patients may not notice any visual changes. As the disease progresses, however, symptoms may include blurred vision, decreased night vision, difficulty reading, and the appearance of dark spots in the field of vision. These symptoms are often an indicator of the progress of the condition and the need for treatment.

Treatment of NDR focuses mainly on preventing the progression of the disease and maintaining good control of diabetes, since the early stages can be controlled and delayed by correcting risk factors. Due to the lack of early symptoms, regular eye examinations are critically important for diagnosing and monitoring diabetic retinopathy. The doctor may do an ophthalmoscopy or fluorescence angiography (FA) of the retina to detect and track the development of the disease.

If NDR is accompanied by diabetic macular edema (edema of the macula responsible for central vision), further treatment may be necessary. Macular edema can lead to significant blurring of vision, even in the early stages of retinopathy. Treatment may include injection of anti-VEGF drugs and laser therapy. Regular monitoring is necessary to track whether NDR passes into more severe forms such as proliferative diabetic retinopathy. It is important to take preventive measures by correcting risk factors and regular eye examination.

Proliferative retinopathy

Proliferative diabetic retinopathy (PDR) is the advanced and more serious stage of diabetic retinopathy. It is characterized by the formation of new, abnormal blood vessels (neovascularization) in the retina and other parts of the eye that arise in response to a lack of oxygen (ischemia). These new vessels are weak and easily burst, which can lead to severe bleeding and serious damage, including traction retinal detachment and neovascular glaucoma.

The main changes in PDR include neovascularization, vitreous hemorrhages, formation of fibrous tissue, traction detachment of the retina, neovascular glaucoma, etc.

In the early stages of proliferative diabetic retinopathy, the patient may not have any symptoms. However, as the disease progresses, symptoms may include sudden blurred vision or sudden loss of vision, the appearance of dark spots or floating objects in the field of vision, decreased visual acuity, and difficulty seeing in low light.

Without treatment, proliferative retinopathy can lead to permanent vision loss. Treatment includes a combination of laser therapy, anti-VEGF medication and, if necessary, surgery. The main goal is to prevent neovascularization and preserve the patient's vision. With early diagnosis and effective treatment, a significant part of the complications can be avoided, but this requires regular monitoring and strict control of diabetes.

Prevention of diabetic retinopathy

Prevention of diabetic retinopathy includes a combination of a healthy lifestyle, regular health control and timely medical examinations.

• The control of blood sugar is the main measure for the prevention of complications of diabetes. Regular monitoring of blood sugar levels and adherence to doctor-prescribed therapy significantly reduces the risk of retinal damage.
• Regular Ophthalmological Examinations. Due to the absence of early symptoms, regular eye examinations are extremely important. It is recommended that at least once a year, people with diabetes undergo a specialized examination, such as ophthalmoscopy and, if necessary, a fluorescence angiography of the retina, to detect early signs of retinopathy.
• Control of blood pressure and cholesterol. High blood pressure and increased cholesterol levels further aggravate the condition of blood vessels, including those in the retina. Monitoring and maintaining normal values of these indicators helps reduce the risk of developing complications.
• Healthy lifestyle. Compliance with a balanced diet, as well as regular physical activity, are essential factors to maintain good control of diabetes and prevent retinopathy. Also, quitting smoking can be essential, as smoking damages blood vessels and further increases the risk of complications.
• Timely treatment. With already diagnosed diabetic retinopathy, it is important to start treatment on time to prevent the progression of the disease.

Diabetic retinopathy is a serious complication of diabetes that can lead to loss of vision if not diagnosed and treated in a timely manner. Prevention and early diagnosis play a crucial role in reducing the risk of diabetic retinopathy. On the occasion of World Diabetes Day, it is important to highlight the importance of regular medical check-ups, good blood sugar control and maintaining a healthy lifestyle to ensure a better quality of life for people with diabetes. May this day be a reminder to all of us - patients, doctors and society at large that through awareness and adequate prevention we can reduce the number of people affected by diabetic retinopathy and preserve the vision of millions of people around the world.