Diabetic Retinopathy

"Eye damage from diabetes is one of the leading causes of blindness in the world".

DR. ALFREDO GARCÍA LAYANA
DIRECTOR. OPHTHALMOLOGY DEPARTMENT

The retina is the layer at the back of the eye that receives the luminous stimuli and perceives the images that will be sent to our brain. As in the other chronic complications of diabetes mellitus, the presence of elevated levels of glucose in the blood during many years, produces alterations in the blood vessels of the retina that originate damage in this important ocular tissue.

These vascular alterations make it difficult to provide oxygen to the retina, in which microaneurysms, hemorrhages, and leakage of lipids and proteins from the interior of the damaged capillaries are produced. This occurs mainly when diabetes is not properly controlled and is called diabetic retinopathy.

These changes are progressive and the lack of oxygenation of the retina stimulates the growth of more vessels that try to supply the deficit of blood supply. The appearance of these new vessels (phase called proliferating diabetic retinopathy) can produce irreversible damage to the retina.

On the other hand, damage to the capillaries in the central part of the retina, the macula, can produce a leakage of liquid into the retinal tissue (diabetic macular edema) leading to a significant decrease in the patient's vision.

Therefore, the key to the management of diabetic retinopathy is an early diagnosis, since the treatment is effective in the initial phases, and important complications can be prevented. For this reason, regular check-ups are essential.

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What are the symptoms of diabetic retinopathy?

The changes that occur in diabetic retinopathy usually do not initially affect the central portion of the retina (the macula) and, therefore, do not translate into a decrease in visual acuity, going unnoticed by the patient.

On the contrary, in cases where macular edema develops, the patient experiences a significant decrease in vision, as well as distortion of images.

Diabetic retinopathy can evolve for years without being detected by its carrier, and even be present at the time of diagnosis of diabetes. That is why a specialized regulated follow-up is the only way to detect and treat its complications early.

The most common symptoms are:

  • Asymptomatic in initial stages.
  • Decreased visual acuity.
  • Distortion of images.
  • Blindness.

Do you have any of these symptoms?

You may have a diabetic retinopathy

How is diabetic retinopathy diagnosed?

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The diagnosis of diabetic retinopathy is made by detecting the characteristic retinal alterations in a fundus examination.

In some cases it is necessary to visualize the blood vessels by means of a test called fluorescein angiography.

For the evaluation of macular edema, the use of optical coherence tomography (OCT) is fundamental, which allows the analysis of the different layers of the retina and the detection of the presence of edema in an early manner, even before signs appear in the exploration or the patient experiences visual alterations, being the ophthalmologist the professional who must analyze all these explorations.

How is diabetic retinopathy treated?

In the early stages, the best way to prevent the progression of diabetic retinopathy is to ensure adequate control of the diabetes.

When the presence of new vessel proliferation is detected in the retina, the treatment consists of the application of a laser treatment known as panphotocoagulation. In recent years new application modalities have been developed with safer and more effective laser sources.

The treatment of macular edema is performed through the use of antiangiogenic drugs and intraocular corticoids, which block the action of the main biochemical factors responsible for fluid leakage. 

Complications such as retinal detachment, glaucoma and intraocular hemorrhages usually require surgical treatment for their resolution.

Where do we treat it?

IN NAVARRA AND MADRID

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